Managing complex healthcare organizations

Begun, James W.; Thygeson, Marcus

doi:10.4337/9781783470167.00005

Cited by 13 publications

(17 citation statements)

References 13 publications

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“…It also tends to be viewed as an emergent phenomenon that is observable as a result of the interaction among dynamic agents in a CAS [ 27 ]. Begun states that “in a complex organizational setting, leadership tasks (for example, finding direction, building commitment, and overcoming challenges) are accomplished by emergent, relational dialogue among diverse individuals” [ 28 , 29 ]. This definition aligns with notions of distributed leadership, where leadership is not role-based but action-based, and where leadership is a social process amongst a group rather than the action of an individual [ 30 ].…”

Section: Key Insights On the Application Of Complexity Science To Heamentioning

confidence: 99%

“…Managing CAS requires an enhanced attentiveness to the nature and interactions of system actors to determine how uncertainty can be harnessed into positive adaptation and innovative practices. It is recommended that managers promote exploration as a response to uncertainty, while also encouraging “dissent and diversity” [ 28 , 33 ]. These ideas are consistent with Uhl-Bien’s concept of adaptive space, described above [ 11 ], and are aligned with the concept of “positive deviance”, a change management technique that endeavours to support the identification of “sustainable solutions hidden within plain sight” by promoting the emergence of group learning and adaption [ 27 ].…”

Section: Key Insights On the Application Of Complexity Science To Heamentioning

confidence: 99%

“…For example, in order to improve quality and team performance in a CAS, Bar-Yam suggests empowering group competitions that let teams work locally and non-prescriptively to stimulate innovation using an evolutionary dynamic: team competition (e.g., posting infection rates by ward) [ 12 ]. Begun and Thygeson note that in order to encourage diversity and exploration amongst teams, managers must ensure that a system has effective communication processes to allow all voices to be heard, but must “curate the work of the group” to ensure that quality standards are adhered to [ 28 ]. Complexity thinking suggests acknowledging rather than seeking to resolve the tension between these demands.…”

Section: Key Insights On the Application Of Complexity Science To Heamentioning

confidence: 99%

“…Complexity thinking suggests acknowledging rather than seeking to resolve the tension between these demands. One tactic to working within this tension may be the “act-then-look” approach [ 8 ], which suggests that because CAS are inherently unpredictable and in flux, learning which informs innovation may be best achieved by acting first and then seeking feedback [ 28 ]. This approach is similar to the plan-do-study-act approach [ 34 ]; what a complexity perspective adds is creating conditions around how novel ideas emerge.…”

Section: Key Insights On the Application Of Complexity Science To Heamentioning

confidence: 99%

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Embracing uncertainty, managing complexity: applying complexity thinking principles to transformation efforts in healthcare systems

Khan

Vandermorris

Shepherd

et al. 2018

BMC Health Serv Res

Self Cite

112

104

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BackgroundComplexity thinking is increasingly being embraced in healthcare, which is often described as a complex adaptive system (CAS). Applying CAS to healthcare as an explanatory model for understanding the nature of the system, and to stimulate changes and transformations within the system, is valuable.Main textA seminar series on systems and complexity thinking hosted at the University of Toronto in 2016 offered a number of insights on applications of CAS perspectives to healthcare that we explore here. We synthesized topics from this series into a set of six insights on how complexity thinking fosters a deeper understanding of accepted ideas in healthcare, applications of CAS to actors within the system, and paradoxes in applications of complexity thinking that may require further debate: 1) a complexity lens helps us better understand the nebulous term “context”; 2) concepts of CAS may be applied differently when actors are cognizant of the system in which they operate; 3) actor responses to uncertainty within a CAS is a mechanism for emergent and intentional adaptation; 4) acknowledging complexity supports patient-centred intersectional approaches to patient care; 5) complexity perspectives can support ways that leaders manage change (and transformation) in healthcare; and 6) complexity demands different ways of implementing ideas and assessing the system. To enhance our exploration of key insights, we augmented the knowledge gleaned from the series with key articles on complexity in the literature.ConclusionsUltimately, complexity thinking acknowledges the “messiness” that we seek to control in healthcare and encourages us to embrace it. This means seeing challenges as opportunities for adaptation, stimulating innovative solutions to ensure positive adaptation, leveraging the social system to enable ideas to emerge and spread across the system, and even more important, acknowledging that these adaptive actions are part of system behaviour just as much as periods of stability are. By embracing uncertainty and adapting innovatively, complexity thinking enables system actors to engage meaningfully and comfortably in healthcare system transformation.

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Section: Key Insights On the Application Of Complexity Science To Heamentioning

confidence: 99%

Section: Key Insights On the Application Of Complexity Science To Heamentioning

confidence: 99%

Section: Key Insights On the Application Of Complexity Science To Heamentioning

confidence: 99%

Section: Key Insights On the Application Of Complexity Science To Heamentioning

confidence: 99%

See 2 more Smart Citations

Embracing uncertainty, managing complexity: applying complexity thinking principles to transformation efforts in healthcare systems

Khan

Vandermorris

Shepherd

et al. 2018

BMC Health Serv Res

Self Cite

112

104

View full text Add to dashboard Cite

show abstract

“…Many small health care organizations lack financial and human resources for undertaking substantive (as opposed to symbolic) IT security programs [41]. For their part, large health care organizations tend to be complex systems in their structure and management [42,43], and in such systems, cultural shifts to implement security and privacy measures may take a lot of time.…”

Section: Methodsmentioning

confidence: 99%

European Hospitals’ Transition Toward Fully Electronic-Based Systems: Do Information Technology Security and Privacy Practices Follow?

Uwizeyemungu¹,

Poba‐Nzaou²,

Cantinotti³

2019

JMIR Med Inform

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Background Traditionally, health information has been mainly kept in paper-based records. This has deeply changed throughout approximately the last three decades with the widespread use of multiple health information technologies. The digitization of health care systems contributes to improving health care delivery. However, it also exposes health records to security and privacy breaches inherently related to information technology (IT). Thus, health care organizations willing to leverage IT for improved health care delivery need to put in place IT security and privacy measures consistent with their use of IT resources. Objective In this study, 2 main objectives are pursued: (1) to assess the state of the implementation of IT security and privacy practices in European hospitals and (2) to assess to what extent these hospitals enhance their IT security and privacy practices as they move from paper-based systems toward fully electronic-based systems. Methods Drawing on data from the European Commission electronic health survey, we performed a cluster analysis based on IT security and privacy practices implemented in 1723 European hospitals. We also developed an IT security index, a compounded measure of implemented IT security and privacy practices, and compared it with the hospitals’ level in their transition from a paper-based system toward a fully electronic-based system. Results A total of 3 clearly distinct patterns of health IT–related security and privacy practices were unveiled. These patterns, as well as the IT security index, indicate that most of the sampled hospitals (70.2%) failed to implement basic security and privacy measures consistent with their digitization level. Conclusions Even though, on average, the most electronically advanced hospitals display a higher IT security index than hospitals where the paper system still dominates, surprisingly, it appears that the enhancement of IT security and privacy practices as the health information digitization advances in European hospitals is neither systematic nor strong enough regarding the IT-security requirements. This study will contribute to raising awareness among hospitals’ managers as to the importance of enhancing their IT security and privacy measures so that they can keep up with the security threats inherently related to the digitization of health care organizations.

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Mapping Educational uncertainty stimuli to support health professions educators’ in developing learner uncertainty tolerance

Lazarus,

Gouda-Vossos,

Ziebell

et al. 2024

Adv in Health Sci Educ

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Uncertainty is a feature of healthcare practice. In recognition of this, multiple health profession governing bodies identify uncertainty tolerance as a healthcare graduate attribute and evaluate uncertainty tolerance within new graduate cohorts. While it is clear that uncertainty tolerance development for healthcare learners is valued, gaps remain for practically addressing this within healthcare curricula. Guiding frameworks for practical approaches supporting uncertainty tolerance development in healthcare learners remains sparse, particularly outside of medicine and in certain geographical locations. As uncertainty tolerance is increasingly recognised as being, at least in part, state-based (e.g. contextually changeable)– a broader understanding of teaching practices supporting uncertainty tolerance development in diverse health professions is warranted. This study explored educators’ teaching practices for purposefully stimulating learners’ uncertainty tolerance. Semi-structured interviews investigated how academics at a single institution, from diverse fields and health professions, stimulate uncertainty across multiple learning contexts. Framework analysis identified three themes for stimulating uncertainty: Purposeful questioning, Forecasting uncertainty, and Placing learners in unfamiliar environments, with characterisation of these themes (and related subthemes) also described. Many of the identified themes align with aspects of existing learning theories suggesting that curricular frameworks supporting learner uncertainty tolerance development may be informed by theories beyond the boundaries of health professions education research.

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Managing complex healthcare organizations

Cited by 13 publications

References 13 publications

Embracing uncertainty, managing complexity: applying complexity thinking principles to transformation efforts in healthcare systems

Embracing uncertainty, managing complexity: applying complexity thinking principles to transformation efforts in healthcare systems

European Hospitals’ Transition Toward Fully Electronic-Based Systems: Do Information Technology Security and Privacy Practices Follow?

Mapping Educational uncertainty stimuli to support health professions educators’ in developing learner uncertainty tolerance

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