Developing interdisciplinary maternity services policy in Canada. Evaluation of a consensus workshop

Abstract

This evaluation used an approach comprising scoping, pattern processing and sense making. While the projects produced considerable typical research evidence, the key policy questions could not be addressed by this alone, and a process of synthesis and consensus building with stakeholder engagement was applied. An adaptive system with local needs driving a relationship based network of interdisciplinary groupings or teams with both bottom up and central leadership. A complexity framework enhanced sense making for the system approaches and understandings that emerged.

Complex adaptive systems and their relevance for nursing: An evolutionary concept analysis

“…Adaptation , elements of the system that adapt their behaviour with other parts of the system and the environment (Anderson & Whall, ; Faggioni & Simone, ; Burgess & Purkis, ; Meagher‐Stewart et al, ; Anderson et al, ; Agyepong et al, ; Bailey et al, ); Dynamics , processes of all CASs to change throughout time (Anderson & Whall, ; Faggioni & Simone, ; Forrest, ; Meagher‐Stewart et al, ; Martin & Kasperski, ; Paina & Peters, ; Agyepong et al, ; Poxton, ); Embedded , interactions of a CAS with other systems that influence it (Anderson & Whall, ; Faggioni & Simone, ; Meagher‐Stewart et al, ; Lanham et al, ); Emergency , a series of processes governed by local rules, with small confined interactions, which under appropriate conditions, give birth to a new level that can be recognized as a specific identity (Anderson & Whall, ; Burgess & Purkis, ; Meagher‐Stewart et al, ; Martin & Kasperski, ; Boustani et al, ; Chaffee & McNeill, ; Grol et al, ); Evolution , system that evolves over time if conceptualized as a result (Anderson & Whall, ; Faggioni & Simone, ; Forrest, ; Burgess & Purkis, ; Meagher‐Stewart et al, ; Anderson et al, ; Agyepong et al, ; Martin & Kasperski, ; Boustani et al, ); Feedback positive/negative , mechanism aimed to automatic control, which allows a CAS to achieve a given objective and to self‐regulate itself in the course of its operation (Anderson & Whall, ; Faggioni & Simone, ; Martin & Kasperski, ; Anderson et al, ; Poxton, ; Lanham et al, ); Homeostasis , maintenance of a condition of dynamic equilibrium (Tsasis et al, ; Arar et al, ); Interactions , a way of acting in the environment through connections and/or relations by exchanging information. The interactions have to be numerous and intense and with a short pathway, and they are not linear and are cyclic (Anderson & Whall, ; Bailey et al, ; Paina & Peters, ; Lanham et al,…”

“…The interactions have to be numerous and intense and with a short pathway, and they are not linear and are cyclic (Anderson & Whall, ; Bailey et al, ; Paina & Peters, ; Lanham et al, ; Chaffee & McNeill, ; Grol et al, ); Interactive agents , a set of parts or components that continually act and react with other elements of the system, they learn over time through connections with other parts of the system, and they are a source of diversity (Burgess & Purkis, ; Boustani et al, ); Interconnections , mutual influence among elements and their environment (Martin & Kasperski, ; Boustani et al, ; Chaffee & McNeill, ; Martin & Sturmberg, ); Learning , capacity to learn and adapt to the events that progress (Anderson & Whall, ; Faggioni & Simone, ; Meagher‐Stewart et al, ; Anderson et al, ; Agyepong et al, ; Bailey et al, ; Martin & Kasperski, ; Poxton, ); Non Linear , characteristic that ensures that small causes could have great results and vice versa (Anderson & Whall, ; Faggioni & Simone, ; Forrest, ; Meagher‐Stewart et al, ; Anderson et al, ; Agyepong et al, ; Poxton, ; Boustani et al, ); Open/closed systems , complex systems that interact with their own environment whereas closed systems are only complex systems without interaction with the environment (Forrest, ; Holland, ; Tan et al, ); Paradox , process to remain stable, it is necessary that the CASs are able to respond, when necessary, to the profound changes of the systems itself, such as the apparently absurd reactions that have certain systems in response to external perturbations (Faggioni & Simone, ; Meagher‐Stewart et al, ; Grol et al, ); Self‐organization , process by which elements of the system cooperate locally and over time in stable models. It does not exist hierarchy or formal control mechanisms, and this process can be influenced but not controlled (Anderson et al, ; Agyepong et al, ; Bailey et al, ; Martin & Kasperski, ; Paina & Peters, ; Boustani et al, ; Grol et al, ); Unpredictability , apparently absurd reactions of some systems in response to external perturbations (Faggioni & Simone, ; ...…”

“…In this sense, the term CAS is often used to identify other complex concepts. In the retrieved 64 nursing documents, a series of surrogate concept terms were highlighted as health organizations (Burgess & Purkis, ; Meagher‐Stewart et al, ; Martin & Kasperski, ; Tan et al, ), health systems (Anderson & Whall, ; Cooper & Geyer, ; Anderson et al, ; Agyepong et al, ; Bailey et al, ; Martin & Kasperski, ; Paina & Peters, ; Boustani et al, ; Chaffee & McNeill, ; Grol et al, ), healthcare activities (Paina & Peters, ; Boustani et al, ; Chaffee & McNeill, ; Grol et al, ), integrated systems (Agyepong et al, ; Tsasis et al, ; Arar et al, ), leaderships (Meagher‐Stewart et al, ; Bailey et al, ; Martin & Kasperski, ), network (Anderson & Whall, ; Cooper & Geyer, ; Agyepong et al, ; Bailey et al, ; Martin & Kasperski, ; Boustani et al, ; Chaffee & McNeill, ; Grol et al, ), operating theatres (Lanham et al, ), and rehabilitation centres (Anderson et al, ; Bailey et al, ; Chaffee & McNeill, ).…”

“…Adaptation, elements of the system that adapt their behaviour with other parts of the system and the environment (Anderson & Whall, 2011;Faggioni & Simone, 2009;Burgess & Purkis, 2010;Meagher-Stewart et al, 2010;Anderson et al, 2005;Agyepong et al, 2012;Bailey et al, 2012); Dynamics, processes of all CASs to change throughout time (Anderson & Whall, 2011;Faggioni & Simone, 2009;Forrest, 1990;Meagher-Stewart et al, 2010;Martin & Kasperski, 2010;Paina & Peters, 2012;Agyepong et al, 2012;Poxton, 2006); Embedded, interactions of a CAS with other systems that influence it (Anderson & Whall, 2011;Faggioni & Simone, 2009 ; Feedback positive/negative, mechanism aimed to automatic control, which allows a CAS to achieve a given objective and to selfregulate itself in the course of its operation (Anderson & Whall, 2011;Faggioni & Simone, 2009;Martin & Kasperski, 2010;Anderson et al, 2005;Poxton, 2006;Lanham et al, 2009); Homeostasis, maintenance of a condition of dynamic equilibrium (Tsasis et al, 2013;Arar et al, 2011); Interactions, a way of acting in the environment through connections and/or relations by exchanging information. The interactions have to be numerous and intense and with a short pathway, and they are not linear and are cyclic (Anderson & Whall, 2011;Bailey et al, 2012;Paina & Peters, 2012;Lanham et al, 2009;Chaffee & McNeill, 2007;Grol et al, 2007); Interactive agents, a set of parts or components that continually act and react with other elements of the system, they learn over time through connections with other parts of the system, and t...…”

Primary maternity care reform: Whose influence is driving the change?

“…Implementation of the primary maternity care model will bring Australian maternity services in line with developments in New Zealand, Canada and the UK (Downe et al, 2010;Martin and Kasperski, 2010;Skinner and Foureur, 2010). The reform will see healthy pregnant women, formerly included into obstetric load, being re-categorised to non-obstetric based services (Lane, 2006).…”