Selecting a change and evaluating its impact on the performance of a complex adaptive health care delivery system

Boustani, Malaz; Munger, Stephanie; Gulati, Rajesh; Vogel, Mickey; Beck, Robin A.; Callahan, Christopher M.

doi:10.2147/cia.s9922

Cited by 42 publications

(64 citation statements)

References 37 publications

(89 reference statements)

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“…However, increasingly, authors argue that our view of a Newtonian "clockwork universe, " which underpins most interventions in healthcare, is to blame [11]. In our analysis of IP collaboration implementations and sustainability, we join others who conceptualize healthcare settings as complex adaptive systems (CASs) [4,6,8,9,[12][13][14]. CASs are organic and dynamic systems "where relationships between people are dynamical and not adequately captured in cause-and-effect modelling" [6, p. 342].…”

Section: Introductionmentioning

confidence: 99%

Using a Complex Systems Perspective to Achieve Sustainable Health Care Practice Change

Suter¹,

Deutschlander²,

Lait³

2011

JRIPE

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Background: There has been a surge of interventions at healthcare settings to achieve practice change, but sustaining these new practices remains a challenge. The purpose of this study was to use the Legacy Sustainability Model, a framework grounded in complexity science, to examine the implementation and sustainability of an interprofessional (IP) collaboration intervention in healthcare. The model considers six factors-communication, connections, coherence, continuous assessment, commitment, and constructs-as essential to build capacity for sustainability.

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Section: Introductionmentioning

confidence: 99%

Using a Complex Systems Perspective to Achieve Sustainable Health Care Practice Change

Suter¹,

Deutschlander²,

Lait³

2011

JRIPE

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“…Concerning the composition of papers according to the studied conditions, of the 53 study papers, 18 evaluated the quality of care provided for cardiovascular disorders (33-50) and 12 evaluated cancer conditions (51-62). Eight assessed metabolic disorders and diabetes (63)(64)(65)(66)(67)(68)(69)(70), six assessed acute infections (71)(72)(73)(74)(75)(76), three assessed orthopedic and trauma conditions (77)(78)(79), two assessed pediatric conditions (80,81), two assessed obstetric and gynecological conditions (82,83), one assessed asthma and allergic diseases (84), and one assessed geriatric conditions (85). The majority of the studies (51 in 53 articles) were carried out in high-income countries.…”

Section: Resultsmentioning

confidence: 99%

Assessment of Healthcare Providers’ Performance Considering Three Healthcare Quality Indicators: A Review Article

2016

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Context: In many healthcare systems, the quality of the healthcare delivered is monitored using a number of "indicators." In the present review, we investigate studies that address issues with the care delivered by healthcare providers. To do this, we employ indicators of the quality of those healthcare services. Evidence Acquisition:The studies for the review were identified by searching a number of electronic databases, including Cochrane Library, PubMed, Scopus, Ovid (Medline), the Social Sciences Citation Index, SID (Scientific Information Database, or Persian database), and Iran Medex (Persian database). Of 8,850 studies published between January 1971 and May 2015, 53 met the study criteria and were reviewed. In this study, the following key words were searched, both alone and in combination: health, healthcare, health care, provider*, effectiveness, quality, clinical outcome, patient satisfaction, and quality of life. We also considered healthcare quality indicators such as "clinical outcome," "patient satisfaction," and "quality of life" for our assessment of the quality of healthcare providers.Results: Of the 53 papers selected, 18 assessed the quality of care provided for cardiovascular disorders, 12 studied cancer conditions, eight dealt with metabolic disorders and diabetes, six focused on acute infection, three assessed orthopedics and trauma conditions, two studied pediatric conditions, two assessed obstetrics and gynecology conditions, one dealt with asthma and allergic disease conditions, and one assessed geriatric conditions. In our assessment of improvements in healthcare providers' performance based on healthcare quality indicators, improvements in clinical outcomes ranged from 26.6% for cancer conditions to 98.8% for pediatric and gynecological conditions. An acceptable level of patient satisfaction was achieved in the range of 30.2% for cancer conditions to 96.0% for pediatric conditions, while improvements to quality of life ranged from 12.5% for cancer conditions to 88.7% for acute infection.Conclusions: Taking account of three indicators for assessing the quality of healthcare providers (clinical outcome, patient satisfaction, and quality of life), the highest improvement levels among providers were observed for pediatric and gynecological conditions, and the lowest improvement levels were found for cancer conditions.

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“…SNFs are complex adaptive systems for which successful implementation of QI projects requires stakeholders who share goals, have dedicated meeting time and space to brainstorm strategies, and are willing to compromise (Boustani, et al, 2010). In this SHU implementation, the facility leadership and nursing staff provided active feedback into the processes and the tools resulting in grassroots support for the initiative.…”

Section: Discussionmentioning

confidence: 99%

“…This approach recommends that stakeholders share a common goal, address points of conflicts openly, and set aside time and space to meet frequently until the plan is finalized. (Boustani, et al, 2010) This Council met bi-monthly for a year at the hospital to develop a model of care --a SNF based Skilled Heart Unit (SHU).…”

Section: Developing the Skilled Heart Unit Modelmentioning

confidence: 99%

“…Individuals involved in a complex adaptive system do not interact linearly; they make up a dynamic network of competition and collaboration, coevolving within their shared environment (Boustani et al, 2010). Thus, traditional top-down directives are insufficient for promoting a sustained change and a team-based, iterative QI approach is needed (Boustani, et al, 2010). Initiatives in complex environments need tailoring of processes to fit the system's unique needs and to respect the existing culture.…”

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confidence: 99%

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Implementation of a Heart Failure Quality Initiative in a Skilled Nursing Facility: Lessons Learned

Nazir¹,

Dennis²,

Unroe³

2015

J Gerontol Nurs

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Skilled nursing facilities (SNFs) are organizations that represent complex adaptive systems, offering barriers to the implementation of quality improvement (QI) initiatives. The current article describes the authors’ efforts to use the approach of reflective adaptive process to implement a new model of care (i.e., the Skilled Heart Unit Program) for effective heart failure (HF) care in one SNF. A team of stakeholders from the local hospital system and a local SNF was convened to design and implement this new model. Evaluation of the implementation processes confirmed the value of the implementation approach, which centered on team-based approaches, staff engagement, and flexibility of processes to respect the SNF’s needs and culture. Interviews with facility staff and the administrator revealed their perceptions that the strategy resulted in better HF care, enhanced teamwork between staff and clinicians, and improved staff job satisfaction. This work provides a unique blueprint of strategic QI implementation for patients with HF in the SNF setting. [ Journal of Gerontological Nursing, 41 (5), 26–33.]

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Selecting a change and evaluating its impact on the performance of a complex adaptive health care delivery system

Cited by 42 publications

References 37 publications

Using a Complex Systems Perspective to Achieve Sustainable Health Care Practice Change

Using a Complex Systems Perspective to Achieve Sustainable Health Care Practice Change

Assessment of Healthcare Providers’ Performance Considering Three Healthcare Quality Indicators: A Review Article

Implementation of a Heart Failure Quality Initiative in a Skilled Nursing Facility: Lessons Learned

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