Complex adaptive systems (CAS): an overview of key elements,
characteristics and application to management theory

Ellis, Beverley Suzanne; Herbert, Stuart

doi:10.14236/jhi.v19i1.791

Cited by 55 publications

(73 citation statements)

References 10 publications

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“…68,[75][76][77] The rapid improvements by most practices are evidence that the intervention had great salience to providers and staff, that they place high value on delivering quality care, and were ready to take advantage of the opportunity to change, by using the facilitator as a catalyst. Although classic practice-based quality improvement depends on formal group meetings to perform plan-do-study-act cycles, we found that the facilitator' s flexibility to many practices' preference for brief informal "huddles" and one-on-one interactions was key for maintaining buy-in and motivation; clinicians and staff learned to take responsibility both individually and as a group in plan-dostudy-act-led improvement.…”

Section: Figurementioning

confidence: 99%

Practice-Tailored Facilitation to Improve Pediatric Preventive Care Delivery: A Randomized Trial

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Children receive only half of recommended health care; disadvantaged children have higher risk of unmet needs. Practice coaching combined with quality improvement using rapid-cycle feedback has potential to help practices meet quality standards and improve pediatric health care delivery. WHAT THIS STUDY ADDS:The Practice-tailored Facilitation Intervention led to large and sustained improvements in preventive service delivery, including substantial numbers of disadvantaged children, and in multiple simultaneous health care domains. Practice-tailored facilitation holds promise as a method to advance pediatric preventive care delivery. abstract OBJECTIVE: Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services. METHODS:In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. RESULTS:Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: ,0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P , .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P , .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need.CONCLUSIONS: Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care.

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Section: Figurementioning

confidence: 99%

Practice-Tailored Facilitation to Improve Pediatric Preventive Care Delivery: A Randomized Trial

et al. 2014

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“…One limitation regarding use of complexity theory is variability in the application of core CAS principles which may lead to conceptual confusion (29). This limitation did indeed lead to challenges in the operationalization of complexity theory within this research study, as multiple resources reference slightly different principles or features (27,(29)(30)(31)(32)(33)(34). However, the methodological approach of iterative coding and thematic analysis within and between cases, in addition to application of complexity theory, allowed for the identification and refinement of the CAS features most relevant to participant experiences.…”

Section: Strengths and Limitationsmentioning

confidence: 96%

Understanding health professional role integration in complex adaptive systems A multiple-case study of Physician Assistants in Ontario, Canada

Burrows

Abelson

Miller

et al. 2020

Preprint

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Background To meet the complex needs of healthcare delivery, the Ministry of Health and Long Term Care (MOHLTC) introduced Physician Assistants (PAs) into the Ontario health care system in 2006 to help increase access to care, decrease wait times, and improve continuity of care. Integration of new health professional roles is often stymied by role resistance and funding barriers. The characterization of healthcare organizations as complex adaptive systems (CAS) may offer insight into the relationships and interactions that optimize and restrict successful PA integration. The aim of this study is to explore the integration of PAs across multiple settings and to understand the PA role within complex adaptive systems. Methods An exploratory, multiple-case study was used to examine PA role integration in four settings: family medicine, emergency, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 family medicine clinics in Ontario, Canada. Analysis was conducted in three phases: inductive thematic analysis within each of the four cases; a cross-case thematic analysis; and a broader exploration of cross-case patterns pertaining to specific complexity theory principles of interest. Results Support for PA contributions across various health care settings, the importance of role awareness, supervisory relationship attributes, and role vulnerability (in relation to sustainability and funding) are interconnected and dynamic in hospital and community settings. Findings represent the experiences of PAs and other healthcare providers, and demonstrate how the PA’s willingness to work and ability to build relationships within existing health systems allows for the establishment of interprofessional, collaborative, and person-centered care. As a self-organizing agent in complex adaptive systems (i.e. health organizations), PA role exploration revealed patterns of team behavior, non-linear interconnections, open relationships, dynamic systems, and the legacy of role implementation as defined by complexity theory. Conclusions By exploring the role of PAs across multiple sites, the complexity theory lens concurrently fosters an awareness of emerging patterns, relationships and non-linear interactions within the defined context of the Ontario healthcare system. By establishing collaborative, interprofessional care models in community and hospital settings, PAs are making a significant contribution to Ontario healthcare settings.

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“…③Complex mode means the objective developing law formed under the combined effect of both internal and external driving factors. In general, regional talent aggregation system should continually take strategy to construct other-organization system that is subject to specific external environment [11]. And with the system growing gradually, self-organization's internal driving system should be used, and the coordinated evolution role of the driving factors from other-organization and self-organization shall be exerted, so as to promote the sustainable development of regional innovative driving mechanism.…”

Section: 1mentioning

confidence: 99%

The Research on Innovation-Driven Paths of High-tech Zone Under the New Normal in China

Fei¹,

Bu²

2017

Proceedings of the 2016 International Conference on Modern Management, Education Technology, and Social Science (MMETSS 2016)

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Abstract. Talent aggregation of high level is good for high-tech zone of one country's economic pattern to achieve new dynamics of innovation-driven development, and then to push forward regional industrial restructure and economic transformation and upgrading. From that, how to recognize the driving force of talent aggregation and construct its assessment system scientifically plays an important role in high-tech zone for achieving innovation advantage successively. This kind of correlation effect is very prominent in high-tech zone development in China's costal area. Among that, talent aggregation, as the catalyst of economic-coordinated development, has drawn extensive attention from theoretical cycle and industrial field. Therefore, this study, according to the systematic constructing thought proposed by Complex Systematic, explores the index assessment frame of talent aggregation system of China's high-tech zone by content analysis; assesses the weight of different indexes by analytic hierarchy process; and finally, summarizes theoretical deduction and empirical analyzing results to put forward the paths and strategies for the innovation-driven development of high-tech zone based on talent aggregation system evaluation and optimization.

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Complex adaptive systems (CAS): an overview of key elements, characteristics and application to management theory

Cited by 55 publications

References 10 publications

Practice-Tailored Facilitation to Improve Pediatric Preventive Care Delivery: A Randomized Trial

Practice-Tailored Facilitation to Improve Pediatric Preventive Care Delivery: A Randomized Trial

Understanding health professional role integration in complex adaptive systems A multiple-case study of Physician Assistants in Ontario, Canada

The Research on Innovation-Driven Paths of High-tech Zone Under the New Normal in China

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