Surprise, Surprise, Surprise! A Complexity Science View of the Unexpected

McDaniel, Reuben R.; Jordan, Michelle E.; Fleeman, Brigitte F.

doi:10.1097/00004010-200307000-00008

Cited by 125 publications

(92 citation statements)

References 25 publications

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“…McDaniel, Jordon and Fleeman (2003) have used complexity principles in building a dynamical viewpoint to account for management practices within healthcare systems. Incorporating terms such as trajectories, bifurcations and self-organization, these authors have proffered a unique management perspective built on expressions found in the complexity literature.…”

Section: Complexity Principles and The Dynamics Of Social Systemsmentioning

confidence: 99%

Occupation and Social Complexity

Eakman¹

2007

Journal of Occupational Science

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Section: Complexity Principles and The Dynamics Of Social Systemsmentioning

confidence: 99%

Occupation and Social Complexity

Eakman¹

2007

Journal of Occupational Science

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“…8 Because primary care practices are complex adaptive systems interconnected with many other organizations and made up of individuals with widely varying educational backgrounds, processes and outcomes of organizational change are largely unpredictable. 11,12 In these complex systems, the interactions between participants are nonlinear in that the behavior of the whole is not simply the sum of the behaviors of all of the participants. 13 Accordingly, organizational-level change efforts often have implications and effects beyond the directly targeted system.…”

mentioning

confidence: 99%

Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

Crosson¹,

Stroebel²,

Scott

et al. 2005

The Annals of Family Medicine

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PURPOSE Electronic medical record (EMR) systems offer substantial opportunities to organize and manage clinical data in ways that can potentially improve preventive health care, the management of chronic illness, and the fi nancial health of primary care practices. The functionality of EMRs as implemented, however, can vary substantially from that envisaged by their designers and even from those who purchase the programs. The purpose of this study was to explore how unique aspects of a family medicine offi ce culture affect the initial implementation of an EMR. METHODSAs part of a larger study, we conducted a qualitative case study of a private family medicine practice that had recently purchased and implemented an EMR. We collected data using participant observation, in-depth interviews, and key informant interviews. After the initial data collection, we shared our observations with practice members and returned 1 year later to collect additional data.RESULTS Dysfunctional communication patterns, the distribution of formal and informal decision-making power, and internal confl icts limited the effective implementation and use of the EMR. The implementation and use of the EMR made tracking and monitoring of preventive health and chronic illness unwieldy and offered little or no improvement when compared with paper charts.CONCLUSIONS Implementing an EMR without an understanding of the systemic effects and communication and the decision-making processes within an offi ce practice and without methods for bringing to the surface and addressing confl icts limits the opportunities for improved care offered by EMRs. Understanding how these common issues manifest within unique practice settings can enhance the effective implementation and use of EMRs. INTRODUCTIONB oth the Institute of Medicine and the Future of Family Medicine project have recommended the use of information technologies and electronic medical record (EMR) systems as tools for improving the quality of care 1 and patient safety. 2,3 Recent research has shown that information technologies can reduce medication errors, 4 improve adherence to clinical practice guidelines, 5 and improve the delivery of preventive health services, 6 thereby potentially improving health outcomes for patients. 7 In addition, using an EMR that includes electronic prescribing as well as electronic charting offers substantial fi nancial benefi ts to primary care organizations and the health system as a whole. 8 Even so, relatively few primary care practices use EMRs. 9 Reasons for not adopting EMRs may include the temporary loss of revenue associated with EMR implementation, 8 physician perception that EMRs negatively affect workfl ow, and concerns about patient privacy. 9 Even in settings where clinicians are committed to EMRs, implementation requires skilled users and a commitment to making the EMR an integral part of the 10 Without these personal and institutional commitments to full implementation, EMRs may actually represent a net fi nancial drain on primary care pr...

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“…This is a qualitative explorative study based on the framework of Complex Adaptive Systems [CAS] [18][19][20][21]. A system can be called complex if it contains non-linear relationships between many parts that interact in unstable and unpredictable ways.…”

Section: Methodsmentioning

confidence: 99%

Shaping the midwifery profession in Nepal – Uncovering actors' connections using a Complex Adaptive Systems framework

Bogren

Berg

Edgren

et al. 2016

Sexual & Reproductive Healthcare

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Objectives: To explore how actors connect in a system aiming at promoting the establishment of a midwifery profession in Nepal.Methods: A qualitative explorative study based on the framework of Complex Adaptive Systems. Semi-structured interviews were conducted with 17 key people representing eight different organisations [actors] promoting the development of the midwifery profession. Results:The actors' connections can be described with a complex set of facilitators for and barriers to promoting the establishment of a midwifery profession. The identified facilitators for this establishment in Nepal are (1) a common goal and (2) a desire to collaborate, whilst the barriers are (1) different political interests and priorities, (2) competing interests of the nursing profession and societal views, (3) divergent academic opinions on a midwifery profession, and (4) insufficient communication. The results also showed that Nepalese society cannot distinguish between nursing and midwifery and that the public support for a midwifery profession was hence minimal. Conclusion:The move of midwifery from an occupation to a profession in Nepal is an on-going, challenging process. The study indicates the importance of understanding the motivations of, and barriers perceived by, actors that can promote or obstruct the establishment of the midwifery profession. It also points to the importance of informing the wider public about the role and responsibility of an autonomous midwifery profession. Highlights The progress of midwifery from an occupation to a profession is a challenging process. Actors promoting the profession connect through a set of facilitators and barriers. Common goals and collaboration are critical for building a midwifery profession. Political priorities challenge the professional establishment. Conflicting opinions regarding midwives' required academic level delay the implementation process.

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Surprise, Surprise, Surprise! A Complexity Science View of the Unexpected

Cited by 125 publications

References 25 publications

Occupation and Social Complexity

Occupation and Social Complexity

Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

Shaping the midwifery profession in Nepal – Uncovering actors' connections using a Complex Adaptive Systems framework

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