Kuziemsky (2016) - Decision-making in healthcare as a complex adaptive system
Introduction
Change in healthcare (HC) delivery: care in single settings and providers > care across
multiple providers and settings
→ needs to be structured and managed
Gap between how care delivery should be provided and how it is actually provided
→ challenges: support for collaborative care delivery and patient participatory medicine
Continue to struggle with unintended consequences from reform efforts
e.g. medical errors → possible solution: HIT = health information technology → led to
technology-induced errors
Fundamental question: why do strategies and intervention in healthcare so often fall short of
desired objectives and bring about unintended consequences?
primary reason: problems solving often focuses on what is visible, while failing to
acknowledge the larger system within which HC delivery exists
often systems issues that must be rectified when problem solving
many HC problems exist due to interactive and multi-dimensional nature of the
system; can rarely be blamed on one root cause or single factor
Changing the business of HC
HC delivery → uses traditional management disciplines (e.g. accounting, organizational
behavior) → how these disciplines inform decision-making in HC needs rethinking, because
HC is complex adaptive system (no isolated entities)
Reason for lack of change: both resistance within the system and an inability to effectively
understand how change needs to occur
Two levels of HC decision-making and planning:
Clinical level → treatment options and therapies
HC management level → resources and delivery of services are planned → classic
approaches have not led to meaningful change (due to complex and interrelated
nature of HC system)
HC as a complex adaptive system
= CAS
system that displays properties such as emergent behaviours, non-linear processes,
co-evolution, requisite variety, and simple rules
As a system becomes more complex, the number of components and interactions between
each component increases both within the system and between the system and its
environment
HC can be classified as a CAS → various elements such as care delivery, education, and
policy consist of a series of interacting parts that work in non-linear and evolving ways
emerging behaviours or non-linearity are what necessitates new problem solving
approaches in HC
classic problem-solving approaches are not suitable to solve complex problems →
addresses the visible issue while ignoring the underlying complexity
functional decomposition cannot be used in a CAS such as HC because of the
degree of interrelatedness
Introduction
Change in healthcare (HC) delivery: care in single settings and providers > care across
multiple providers and settings
→ needs to be structured and managed
Gap between how care delivery should be provided and how it is actually provided
→ challenges: support for collaborative care delivery and patient participatory medicine
Continue to struggle with unintended consequences from reform efforts
e.g. medical errors → possible solution: HIT = health information technology → led to
technology-induced errors
Fundamental question: why do strategies and intervention in healthcare so often fall short of
desired objectives and bring about unintended consequences?
primary reason: problems solving often focuses on what is visible, while failing to
acknowledge the larger system within which HC delivery exists
often systems issues that must be rectified when problem solving
many HC problems exist due to interactive and multi-dimensional nature of the
system; can rarely be blamed on one root cause or single factor
Changing the business of HC
HC delivery → uses traditional management disciplines (e.g. accounting, organizational
behavior) → how these disciplines inform decision-making in HC needs rethinking, because
HC is complex adaptive system (no isolated entities)
Reason for lack of change: both resistance within the system and an inability to effectively
understand how change needs to occur
Two levels of HC decision-making and planning:
Clinical level → treatment options and therapies
HC management level → resources and delivery of services are planned → classic
approaches have not led to meaningful change (due to complex and interrelated
nature of HC system)
HC as a complex adaptive system
= CAS
system that displays properties such as emergent behaviours, non-linear processes,
co-evolution, requisite variety, and simple rules
As a system becomes more complex, the number of components and interactions between
each component increases both within the system and between the system and its
environment
HC can be classified as a CAS → various elements such as care delivery, education, and
policy consist of a series of interacting parts that work in non-linear and evolving ways
emerging behaviours or non-linearity are what necessitates new problem solving
approaches in HC
classic problem-solving approaches are not suitable to solve complex problems →
addresses the visible issue while ignoring the underlying complexity
functional decomposition cannot be used in a CAS such as HC because of the
degree of interrelatedness
