The meaning of integrated care: a systems approach

Abstract

Introduction: Organizations can be regarded as systems. The traditional model of systems views them as machines. This seems to be insufficient when it comes to understanding and organizing complex tasks. To better understand integrated care we should approach organizations as constantly changing living organisms, where many agents are interconnected in so-called Complex Adaptive Systems (CAS). Theory and discussion:The term "complex" emphasizes that the necessary competence to perform a task is not owned by any one part, but comes as a result of co-operation within the system. "Adaptive" means that system change occurs through successive adaptations. A CAS consists of several subsystems called agents, which act in dependence of one another. Examples would be the ant-hill, the human immune defence, the financial market and the surgical operating theatre team. Studying a CAS, the focus is on the interaction and communication between agents. Although these thoughts are not new, the CAS-approach has not yet been widely applied to the management of integrated care. This helps the management to understand why the traditional top down way of managing, following the machine model thinking, may meet with problems in interdependent organizations with complex tasks. Conclusion:When we perceive health and social services as CASs we should gain more insight into the processes that go on within and between organizations and how top management, for example within a hospital, in fact executes its steering function.

Integrated care for chronic conditions: The contribution of the ICCC Framework

“…To date, the evidence partially supports these expectations but is not conclusive in all respects [37][38][39][40]27,41,42]. The difficulty of assessing complex interventions in complex systems has to be considered when assessing evidence on the effects of integration [43,44].…”

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

“…A CAS consists of several subsystems, called actors, which act in relation to one another. CAS is described as an integrated model that connects the actors of a system instead of exploring the characteristics of each actor [22,23]. The actors in the system interact in a self-organised manner.…”

Taxonomy for complexity theory in the context of maternity care

“…Interconnection (Sturmberg et al, 2014;Trenholm and Ferlie, 2013;Jayasinghe, 2011;Kannampallil et al, 2011;Albanese et al, 2009;Sturmberg and Martin, 2009;Edgren, 2008;Martin and Sturmberg, 2008;Patel et al, 2008;Boustani et al, 2007;Chaffee and McNeill, 2007;Lessard, 2007;Gatrell, 2005;Holden, 2005;Minas, 2005;Plsek, 2003;Sweeney and Kernick, 2002;Sweeney and Mannion, 2002;Miller et al, 2001;Anderson and McDaniel, 2000;Bujak, 1999) Complex systems have a dynamic range of agents (e.g. people) that cannot be understood as the simple sum of the individual characteristics.…”

“…As international networks of childbearing women and midwives developed over the next 20 years, and as experience of waterbirth was shared, interest in the practice spread through linked networks to other countries across the world. Feedback loops (Edgren, 2008;Rickles et al, 2007;Gatrell, 2005;Holden, 2005) Interconnectivity facilitates feedback loops in which the positive and/or negative effects of a particular action or change are fed back to the people in the network. This feedback affects the way these people behave in the future, also in the connection with one another.…”