Healthcare Reform: The Need for a Complex Adaptive Systems Approach

Sturmberg, Joachim P.; O'Halloran, Di; Martin, Carmel M.

doi:10.1007/978-1-4614-4998-0_47

Cited by 25 publications

(26 citation statements)

References 40 publications

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“…The challenge for health systems is how to develop a model of integrated care that is centred on the needs of the person, rather than the needs of the health system itself [6,18,19]). Medical generalism, or ‘expertise in whole person medicine’, has been proposed as a professional practice-based solution to the problem [2].…”

Section: Introductionmentioning

confidence: 99%

Generalist solutions to complex problems: generating practice-based evidence - the example of managing multi-morbidity

et al. 2013

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BackgroundA growing proportion of people are living with long term conditions. The majority have more than one. Dealing with multi-morbidity is a complex problem for health systems: for those designing and implementing healthcare as well as for those providing the evidence informing practice. Yet the concept of multi-morbidity (the presence of >2 diseases) is a product of the design of health care systems which define health care need on the basis of disease status. So does the solution lie in an alternative model of healthcare?DiscussionStrengthening generalist practice has been proposed as part of the solution to tackling multi-morbidity. Generalism is a professional philosophy of practice, deeply known to many practitioners, and described as expertise in whole person medicine. But generalism lacks the evidence base needed by policy makers and planners to support service redesign. The challenge is to fill this practice-research gap in order to critically explore if and when generalist care offers a robust alternative to management of this complex problem.We need practice-based evidence to fill this gap. By recognising generalist practice as a ‘complex intervention’ (intervening in a complex system), we outline an approach to evaluate impact using action-research principles. We highlight the implications for those who both commission and undertake research in order to tackle this problem.SummaryAnswers to the complex problem of multi-morbidity won’t come from doing more of the same. We need to change systems of care, and so the systems for generating evidence to support that care. This paper contributes to that work through outlining a process for generating practice-based evidence of generalist solutions to the complex problem of person-centred care for people with multi-morbidity.

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Section: Introductionmentioning

confidence: 99%

Generalist solutions to complex problems: generating practice-based evidence - the example of managing multi-morbidity

et al. 2013

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“…The papers in this edition provide insights of the workings of these rules, and how they contribute to creating a more patient‐centred health system [26–30].…”

Section: Discussionmentioning

confidence: 99%

“…• explore the patient's experience and explanation of his illness [20][21][22][23]; and • manage the patient's illness as a whole according to the patient's preferences [22][23][24][25]. 2 The papers in this edition provide insights of the workings of these rules, and how they contribute to creating a more patient-centred health system [26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Multimorbidity and chronic disease: an emergent perspective

Sturmberg

2014

Evaluation Clinical Practice

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The concept of emergence offers a new way of thinking about multimorbidity and chronic disease. Multimorbidity and chronic disease are the end result of ongoing perturbations and interconnected activities of simpler substructures that collectively constitute the complex adaptive superstructure known as us, the person or patient. Medical interventions cause perturbations of many different sub-systems within the patient, hence they are not limited to the person's bodily function, but also affect his general health perception and his interactions with his external environments. Changes in these domains inevitably have consequences on body function, and close the feedback loop of illness/disease, recovery and regained health.

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“…Its usefulness has been demonstrated for a patient-oriented planning case in an expert organization in the health care domain, exemplary for diverse and complex system transformations (Sturmberg et al, 2012(Sturmberg et al, , 2013. It is grounded on stakeholder articulation and analyses of stakeholder interactions featuring structured knowledge processing and decision-making.…”

Section: Vol 18 No 4 2014 Journal Of Knowledge Management Page 653mentioning

confidence: 99%

Non-disruptive knowledge and business processing in knowledge life cycles – aligning value network analysis to process management

Stary

2014

Journal of Knowledge Management

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Purpose – This paper aims to achieve fully intertwined knowledge and business processing in change processes. It proposes streamlining situated articulation work, value network analyses (VNA) and subject-oriented business process modelling (S-BPM) and execution to provide non-disruptive single and double learning processes driven by concerned stakeholders. When implementing knowledge life cycles, such as Firestone and McElroy’s knowledge life cycle, the agility of organizations is significantly constrained, in particular, when surviving knowledge claims should be implemented in the business processing environment in a seamless way. Design/methodology/approach – The contribution is based on a conceptual analysis of knowledge life cycle implementations, learning loop developments and an exploratory case study in health care to demonstrate the effectiveness of the proposed approach. The solution towards non-disruptive knowledge and business processing allows stakeholders to actively participate in single- and double-loop learning processes. Findings – The introduced approach supports problem and knowledge claim formulation, knowledge claim evaluation and non-disruptive knowledge integration into a business process environment. Based on stakeholder articulation, the steps to follow are: holomapping, exchange analysis, impact analysis, value creation analysis, subject-oriented modelling, business process validation and execution. Seamless support of stakeholders is enabled through the direct mapping of stakeholder and activity descriptions from value network representations to behaviour specifications (process models) on the individual and organizational layer. Research limitations/implications – Current knowledge life cycle developments and implementations can now be analyzed in a structured way. Elements of the proposed approach could be integrated in disruptive implementations to overcome current limitations of knowledge life cycles. However, further case studies need to be performed to identify hindrances or barriers of combining VNA and S-BPM, both on the technological and methodological layer. What works for expert service industries might need to be adapted for production industries, and tools or tool chains might need to be configured accordingly. Finally, the socio-economic impact of the approach needs to be explored. Practical implications – The presented case study from health care reveals the potential of such a methodological combination, as cycle times can be reduced, in particular, due to the execution of role-specific process models in the respective business processing environment. It can be considered as a fundamental shift for existing change management procedures, as they require rework of the entire functional process models when addressing business processing. Now, stakeholder- or role-specific behaviour can be handled isolated and in parallel, without affecting the entire organization in case of modifications. Originality/value – The proposed methodological integration has not been done before. It enables stakeholders to perform single- and double-loop change processes in a seamless way.

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Healthcare Reform: The Need for a Complex Adaptive Systems Approach

Cited by 25 publications

References 40 publications

Generalist solutions to complex problems: generating practice-based evidence - the example of managing multi-morbidity

Generalist solutions to complex problems: generating practice-based evidence - the example of managing multi-morbidity

Multimorbidity and chronic disease: an emergent perspective

Non-disruptive knowledge and business processing in knowledge life cycles – aligning value network analysis to process management

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