Precision Medicine and Complexity

Aron, David C.

doi:10.1007/978-3-030-24593-1_13

Cited by 2 publications

(2 citation statements)

References 89 publications

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“…Systems dynamics may be difficult to think through and require specific training to apply. Complex systems can exhibit counterintuitive properties, but qualitative understanding is often sufficient to guide practice (276)(277)(278)(279). Quantitative models of specific problems could allow clinicians to examine the effects of potential interventions on system dynamics to guide treatment and predict outcomes.…”

Section: Discussionmentioning

confidence: 99%

A cultural-ecosocial systems view for psychiatry

Gómez-Carrillo

Kirmayer

2023

Front. Psychiatry

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While contemporary psychiatry seeks the mechanisms of mental disorders in neurobiology, mental health problems clearly depend on developmental processes of learning and adaptation through ongoing interactions with the social environment. Symptoms or disorders emerge in specific social contexts and involve predicaments that cannot be fully characterized in terms of brain function but require a larger social-ecological view. Causal processes that result in mental health problems can begin anywhere within the extended system of body-person-environment. In particular, individuals’ narrative self-construal, culturally mediated interpretations of symptoms and coping strategies as well as the responses of others in the social world contribute to the mechanisms of mental disorders, illness experience, and recovery. In this paper, we outline the conceptual basis and practical implications of a hierarchical ecosocial systems view for an integrative approach to psychiatric theory and practice. The cultural-ecosocial systems view we propose understands mind, brain and person as situated in the social world and as constituted by cultural and self-reflexive processes. This view can be incorporated into a pragmatic approach to clinical assessment and case formulation that characterizes mechanisms of pathology and identifies targets for intervention.

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Section: Discussionmentioning

confidence: 99%

A cultural-ecosocial systems view for psychiatry

Gómez-Carrillo

Kirmayer

2023

Front. Psychiatry

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“…Most current referral processes can be characterised by over-reliance on low reliability process designs—reminders, tracking lists, push-forward processes, limited IT use, lack of automated feedback loops and personal workarounds—resulting in poor referral completion rates and timeliness. Redesigned processes that ensure loops are closed by default, including the human factors approach of failure prevention, identification and mitigation,19 28 and the high reliability focus on resilience,29–31 are nearly non-existent but potentially could have significant value. SE analysis and process design methods are useful for both highlighting the nature of problems in current processes and identifying potential improvements to achieve more reliable and timely diagnostic referral processes.…”

Section: Discussionmentioning

confidence: 99%

Systems engineering analysis of diagnostic referral closed-loop processes

et al. 2021

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BackgroundClosing loops to complete diagnostic referrals remains a significant patient safety problem in most health systems, with 65%–73% failure rates and significant delays common despite years of improvement efforts, suggesting new approaches may be useful. Systems engineering (SE) methods increasingly are advocated in healthcare for their value in studying and redesigning complex processes.ObjectiveConduct a formative SE analysis of process logic, variation, reliability and failures for completing diagnostic referrals originating in two primary care practices serving different demographics, using dermatology as an illustrating use case.MethodsAn interdisciplinary team of clinicians, systems engineers, quality improvement specialists, and patient representatives collaborated to understand processes of initiating and completing diagnostic referrals. Cross-functional process maps were developed through iterative group interviews with an urban community-based health centre and a teaching practice within a large academic medical centre. Results were used to conduct an engineering process analysis, assess variation within and between practices, and identify common failure modes and potential solutions.ResultsProcesses to complete diagnostic referrals involve many sub-standard design constructs, with significant workflow variation between and within practices, statistical instability and special cause variation in completion rates and timeliness, and only 21% of all process activities estimated as value-add. Failure modes were similar between the two practices, with most process activities relying on low-reliability concepts (eg, reminders, workarounds, education and verification/inspection). Several opportunities were identified to incorporate higher reliability process constructs (eg, simplification, consolidation, standardisation, forcing functions, automation and opt-outs).ConclusionFrom a systems science perspective, diagnostic referral processes perform poorly in part because their fundamental designs are fraught with low-reliability characteristics and mental models, including formalised workaround and rework activities, suggesting a need for different approaches versus incremental improvement of existing processes. SE perspectives and methods offer new ways of thinking about patient safety problems, failures and potential solutions.

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Precision Medicine and Complexity

Cited by 2 publications

References 89 publications

A cultural-ecosocial systems view for psychiatry

A cultural-ecosocial systems view for psychiatry

Systems engineering analysis of diagnostic referral closed-loop processes

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