Healthcare teams as complex adaptive systems: Focus on interpersonal interaction

Pype, Peter; Krystallidou, Demi; Deveugele, Myriam; Mertens, Fien; Rubinelli, Sara; Devisch, Ignaas

doi:10.1016/j.pec.2017.06.029

Cited by 20 publications

(22 citation statements)

References 28 publications

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“…In terms of CAS, Ciemins et al pointed out that it is supportive for the work of the multiprofessional team to comprehend patients, families, teams and organisations as CAS [32]. CAS has been suggested as an appropriate conceptual framework to understand team processes and support team development [32, 33]. Defining the palliative care situation as a CAS provides a systemic view in which the patient and his or her relatives are still central elements, but in addition, the team assumes a position within the care situation.…”

Section: Discussionmentioning

confidence: 99%

Understanding complexity – the palliative care situation as a complex adaptive system

Hodiamont

Jünger

Leidl

et al. 2019

BMC Health Serv Res

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BackgroundThe concept of complexity is used in palliative care (PC) to describe the nature of patients’ situations and the extent of resulting needs and care demands. However, the term or concept is not clearly defined and operationalised with respect to its particular application in PC. As a complex problem, a care situation in PC is characterized by reciprocal, nonlinear relations and uncertainties. Dealing with complex problems necessitates problem-solving methods tailored to specific situations. The theory of complex adaptive systems (CAS) provides a framework for locating problems and solutions.This study aims to describe criteria contributing to complexity of PC situations from the professionals’ view and to develop a conceptual framework to improve understanding of the concept of “complexity” and related elements of a PC situation by locating the complex problem “PC situation” in a CAS.MethodsQualitative interview study with 42 semi-structured expert (clinical/economical/political) interviews. Data was analysed using the framework method. The thematic framework was developed inductively. Categories were reviewed, subsumed and connected considering CAS theory.ResultsThe CAS of a PC situation consists of three subsystems: patient, social system, and team. Agents in the "system patient" are allocated to further subsystems on patient level: physical, psycho-spiritual, and socio-cultural. The "social system" and the "system team" are composed of social agents, who affect the CAS as carriers of characteristics, roles, and relationships. Environmental factors interact with the care situation from outside the system. Agents within subsystems and subsystems themselves interact on all hierarchical system levels and shape the system behaviour of a PC situation.ConclusionsThis paper provides a conceptual framework and comprehensive understanding of complexity in PC. The systemic view can help to understand and shape situations and dynamics of individual care situations; on higher hierarchical level, it can support an understanding and framework for the development of care structures and concepts. The framework provides a foundation for the development of a model to differentiate PC situations by complexity of patients and care needs. To enable an operationalisation and classification of complexity, relevant outcome measures mirroring the identified system elements should be identified and implemented in clinical practice.Electronic supplementary materialThe online version of this article (10.1186/s12913-019-3961-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Understanding complexity – the palliative care situation as a complex adaptive system

Hodiamont

Jünger

Leidl

et al. 2019

BMC Health Serv Res

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show abstract

“…In clinical situations where problems and their solutions can be addressed by drawing on procedures and guidelines, teams work in a plan-and-control way, instructions are being given and executed in a straightforward way. Under circumstances where there is uncertainty about how to best deal with the situation, thinking outside the box and trying out different approaches is the most efficient strategy [ 20 ]. In these cases, teams work as a CAS.…”

Section: Discussionmentioning

confidence: 99%

“…In these cases, teams work as a CAS. In our study, we found examples of the plan-and-control actions; however, for the purpose of the paper we only focus on accounts of collaborative practice as a CAS [ 20 , 21 ]. Some of our results are confirmed by literature, both from studies using complexity science as a framework and by studies based upon general learning theories.…”

Section: Discussionmentioning

confidence: 99%

Healthcare teams as complex adaptive systems: understanding team behaviour through team members’ perception of interpersonal interaction

Pype

Mertens

Helewaut³

et al. 2018

BMC Health Serv Res

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119

107

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BackgroundComplexity science has been introduced in healthcare as a theoretical framework to better understand complex situations. Interdisciplinary healthcare teams can be viewed as Complex Adaptive Systems (CAS) by focusing more on the team members’ interaction with each other than on the characteristics of individual team members. Viewing teams in this way can provide us with insights into the origins of team behaviour. The aim of this study is to describe the functioning of a healthcare team as it originates from the members’ interactions using the CAS principles as a framework and to explore factors influencing workplace learning as emergent behaviour.MethodsAn interview study was done with 21 palliative home-care nurses, 20 community nurses and 18 general practitioners in Flanders, Belgium. A two-step analysis consisted of a deductive approach, which uses the CAS principles as coding framework for interview transcripts, followed by an inductive approach, which identifies patterns in the codes for each CAS principle.ResultsAll CAS principles were identified in the interview transcripts of the three groups. The most prevalent principles in our study were principles with a structuring effect on team functioning: team members act autonomously guided by internalized basic rules; attractors shape the team functioning; a team has a history and is sensitive to initial conditions; and a team is an open system, interacting with its environment. The other principles, focusing on the result of the structuring principles, were present in the data, albeit to a lesser extent: team members’ interactions are non-linear; interactions between team members can produce unpredictable behaviour; and interactions between team members can generate new behaviour. Patterns, reflecting team behaviour, were recognized in the coding of each CAS principle. Patterns of team behaviour, identified in this way, were linked to interprofessional competencies of the Interprofessional Collaboration Collaborative. Factors influencing workplace learning were identified.ConclusionsThis study provides us with insights into the origin of team functioning by explaining how patterns of interactions between team members define team behaviour. Viewing healthcare teams as Complex Adaptive Systems may offer explanations of different aspects of team behaviour with implications for education, practice and research.

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“…Article authors also note that the CALTM OCQ is a promising method for assessing the functioning of any health care team. A group discussion on the questionnaire scores can serve as a starting point for identifying targets for initiatives to improve quality [17].…”

Section: Complex Adaptive Systems In Nursing Practicementioning

confidence: 99%

Review of complex adaptive systems in nursing practice

Kiviliene¹,

Blaževičienė²

2019

J., complex., health sci.

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This article describes the most typical characteristics of complex adaptive systems (CAS) theory and how it works in healthcare organizations and nursing practice. Complexity science belongs to newest systems thinking, which explore complex systems by focusing on the system components, relationships and interconnections rather than on the individual components themselves. The nurse must therefore always keep in mind the larger picture when caring for the individual patient and expect to be disturbed by unexpected possibilities. The incorporation of complexity science concepts into the practice of nursing leadership encourages new ways of thinking about organizations and is a natural model for the ideals and expected results of skilled nursing. CAS theory will take a permanent place in the healthcare organizations activities, improve nursing processes and create a better work environment for nursing and job satisfaction.

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Healthcare teams as complex adaptive systems: Focus on interpersonal interaction

Cited by 20 publications

References 28 publications

Understanding complexity – the palliative care situation as a complex adaptive system

Understanding complexity – the palliative care situation as a complex adaptive system

Healthcare teams as complex adaptive systems: understanding team behaviour through team members’ perception of interpersonal interaction

Review of complex adaptive systems in nursing practice

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