Complexity science and health care management

McDaniel, Reuben R.; Driebe, Dean J.

doi:10.1016/s1474-8231(01)02021-3

Cited by 193 publications

(229 citation statements)

References 30 publications

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“…8 Because primary care practices are complex adaptive systems interconnected with many other organizations and made up of individuals with widely varying educational backgrounds, processes and outcomes of organizational change are largely unpredictable. 11,12 In these complex systems, the interactions between participants are nonlinear in that the behavior of the whole is not simply the sum of the behaviors of all of the participants. 13 Accordingly, organizational-level change efforts often have implications and effects beyond the directly targeted system.…”

mentioning

confidence: 99%

Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

Crosson¹,

Stroebel²,

Scott

et al. 2005

The Annals of Family Medicine

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PURPOSE Electronic medical record (EMR) systems offer substantial opportunities to organize and manage clinical data in ways that can potentially improve preventive health care, the management of chronic illness, and the fi nancial health of primary care practices. The functionality of EMRs as implemented, however, can vary substantially from that envisaged by their designers and even from those who purchase the programs. The purpose of this study was to explore how unique aspects of a family medicine offi ce culture affect the initial implementation of an EMR. METHODSAs part of a larger study, we conducted a qualitative case study of a private family medicine practice that had recently purchased and implemented an EMR. We collected data using participant observation, in-depth interviews, and key informant interviews. After the initial data collection, we shared our observations with practice members and returned 1 year later to collect additional data.RESULTS Dysfunctional communication patterns, the distribution of formal and informal decision-making power, and internal confl icts limited the effective implementation and use of the EMR. The implementation and use of the EMR made tracking and monitoring of preventive health and chronic illness unwieldy and offered little or no improvement when compared with paper charts.CONCLUSIONS Implementing an EMR without an understanding of the systemic effects and communication and the decision-making processes within an offi ce practice and without methods for bringing to the surface and addressing confl icts limits the opportunities for improved care offered by EMRs. Understanding how these common issues manifest within unique practice settings can enhance the effective implementation and use of EMRs. INTRODUCTIONB oth the Institute of Medicine and the Future of Family Medicine project have recommended the use of information technologies and electronic medical record (EMR) systems as tools for improving the quality of care 1 and patient safety. 2,3 Recent research has shown that information technologies can reduce medication errors, 4 improve adherence to clinical practice guidelines, 5 and improve the delivery of preventive health services, 6 thereby potentially improving health outcomes for patients. 7 In addition, using an EMR that includes electronic prescribing as well as electronic charting offers substantial fi nancial benefi ts to primary care organizations and the health system as a whole. 8 Even so, relatively few primary care practices use EMRs. 9 Reasons for not adopting EMRs may include the temporary loss of revenue associated with EMR implementation, 8 physician perception that EMRs negatively affect workfl ow, and concerns about patient privacy. 9 Even in settings where clinicians are committed to EMRs, implementation requires skilled users and a commitment to making the EMR an integral part of the 10 Without these personal and institutional commitments to full implementation, EMRs may actually represent a net fi nancial drain on primary care pr...

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mentioning

confidence: 99%

Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

Crosson¹,

Stroebel²,

Scott

et al. 2005

The Annals of Family Medicine

View full text Add to dashboard Cite

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“…Several scholars, including McDaniel and Driebe (2001) and Zimmerman (2011) Studying complex processes requires appropriate research methods, as causality is more ambiguous, patterns are harder to discern, and variation is a prime source of knowledge rather than something to be eliminated (Begun et al, 2003;Byrne and Callaghan, 2013;McDaniel et al, 2009). Use of methods (and theories) that assume linear relationships and use of models with small numbers of variables can spawn misleading findings.…”

Section: Challenges For Healthcare Management Researchmentioning

confidence: 99%

Managing complex healthcare organizations

Begun¹,

Thygeson²

2015

Handbook of Healthcare Management

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MANAGING COMPLEX HEALTHCARE ORGANIZATIONSIt is well established that healthcare organizations are among the most complex in society. It also is well established that effective management practice in any organization or setting is context-specific; that is, what works in one context may not work in another. Healthcare management theory built around the assumption that healthcare organizations are distinctively complex, therefore, is likely to be more useful in management practice.We review several guidelines for managing complex healthcare organizations that emanate from the theoretical assumption that healthcare organizations are complex. Some guidelines derive from what is referred to as "complexity science" or "complexity theory"; most come from observers who "simply" appreciate, implicitly or explicitly, that healthcare organizations are complex. (There is much similarity between guidelines that derive from the two sources, as one might hope.) We then make recommendations for taking more seriously the complexity of healthcare management in the education and research arenas. WHAT IS COMPLEX ABOUT HEALTHCARE MANAGEMENT?There are many ways to describe the complexity of healthcare management in the United States. A starting point for identifying complexity is the presence of multiple, diverse, interdependent agents. Interdependence among multiple, diverse agents produces novel outcomes, particularly when the agents and forces affecting the system are changing over time. Multiple, diverse, interdependent agents are present in healthcare organizations, most pointedly in the form of hundreds of specialized clinical healthcare professions and the administrators who attempt to help organize them into effective care delivery teams and units. The agents often

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“…But some significant differences do exist, which is why it is important to study them. If a typical example of the information flow is: professional provider of service (general practitioner-GP) and patient as a receiver of the service, then the GP has weak linkage with the receiver of the service and payer of the service (when the service is paid from insurance) and the GP does not have a feedback about service satisfaction in this tripartite (Medicare provider, patient and insurance company) [20].…”

Section: Dynamics In Health Care Businessesmentioning

confidence: 99%

Entrepreneurial dynamics – can it be effective?

Šebestová

2012

Per. Pol. Soc. and Man. Sci.

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The dynamics of a company, where all the planned activities run through this organization, must be coordinated on every level. The tendency towards static decision making and exiting from the market, due to a critical environment or situation -is why it is important to study this entrepreneurial behaviour in a practical way. Few people actually think about the relationship between strategy, goals and decision-making inside an organization or the relationship between managers and owners, who actually attend to the routine work and duties. Recent literature and research studies focus significantly on measuring turbulence in the industry based on the start up and exit rate of emerging companies and the relationship between GDP growth and company ownership. If an organization is quite small and the owner is not a good manager or coordinator, then the possibility of risk and exit from the market will be increased. It should be mentioned that survival problems are showing up mostly in companies that have been trading for 2-3 years but studies about the influence of the strategic skills of owners in dealing with business resources in a changing or turbulent environment cannot be found. This paper contributes to this understanding by examining how Health Care businesses can achieve dynamic skills in a crisis environment.

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Complexity science and health care management

Cited by 193 publications

References 30 publications

Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

Managing complex healthcare organizations

Entrepreneurial dynamics – can it be effective?

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