Analyzing Katana referral hospital as a complex adaptive system: agents, interactions and adaptation to a changing environment

Abstract

This study deals with the adaptation of Katana referral hospital in Eastern Democratic Republic of Congo in a changing environment that is affected for more than a decade by intermittent armed conflicts. His objective is to generate theoretical proposals for addressing differently the analysis of hospitals governance in the aims to assess their performance and how to improve that performance. The methodology applied approach uses a case study using mixed methods ( qualitative and quantitative) for data collection. It uses (1) hospital data to measure the output of hospitals, (2) literature review to identify among others, events and interventions recorded in the history of hospital during the study period and (3) information from individual interviews to validate the interpretation of the results of the previous two sources of data and understand the responsiveness of management team referral hospital during times of change. The study brings four theoretical propositions: (1) Interaction between key agents is a positive force driving adaptation if the actors share a same vision, (2) The strength of the interaction between agents is largely based on the nature of institutional arrangements, which in turn are shaped by the actors themselves, (3) The owner and the management team play a decisive role in the implementation of effective institutional arrangements and establishment of positive interactions between agents, (4) The analysis of recipient population’s perception of health services provided allow to better tailor and adapt the health services offer to the population’s needs and expectations. Research shows that it isn’t enough just to provide support (financial and technical), to manage a hospital for operate and adapt to a changing environment but must still animate, considering that it is a complex adaptive system and that this animation is nothing other than the induction of a positive interaction between agents.

Substandard and Falsified Antibiotics and Medicines against Noncommunicable Diseases in Western Cameroon and Northeastern Democratic Republic of Congo

“…In the DR Congo, the health zone is a set of health centers linked to a hospital. 28 In each of the selected health zones, the samples were collected first from the main hospital of that zone. When this was a government-operated general referral hospital, medicines were sampled also from the nearest church health center, private pharmacy, and informal vendor of medicines.…”

Key nodes affecting patient satisfaction in a cross-regional referral service process: an empirical analysis study in Sichuan

“…Therefore, medical service organizations of different levels should establish collaborative standards in terms of system, environment and service so as to enhance the experience of patients. Similarly, research by Karemere H [ 18 ] also demonstrated that referral performance depends on the institutional arrangements of the intermediary agency and their ability to adapt to demands. Additionally, Kurtzman [ 19 ] focused on the impact of the regional environment on the practice of healthcare practitioners and found that the referral environment is a factor influencing the service provided by nurses; therefore, local referral services should be conducted in an organized manner.…”

Irrational use of antibiotics in Iran from the Perspective of Complex Adaptive Systems: redefining the challenge

“…Although health care systems have been acknowledged as CAS by many scientists [23,26,27,29,36,39,41], it seems that it has rarely been translated into practice. Considering a paradigm shift toward description of health care systems as complex systems in recent years and insu ciency of the traditional approaches, it is therefore worthwhile to explore the premises of complexity science to approach health care problems.…”

“…Recently complexity science approach to health, settings and organizations has emerged as a promising approach which can provide a more thorough understanding of complex health issues [24][25][26][27][28][29]. Similarly, applying the Complex Adaptive Systems (CAS) theory, a derivative of complexity science to understand, explore, scale up, evaluate and research in health systems has become popular with researchers in recent years [22,[30][31][32][33].…”