Complexity in practice: understanding primary care as a complex
adaptive system

Ellis, Beverley Suzanne

doi:10.14236/jhi.v18i2.763

Cited by 29 publications

(37 citation statements)

References 28 publications

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“…The above results align with themes identified earlier in this body of work, 1,2 and suggest that the variety of opinions, responses and behaviours shown by participants in the study added to their development; such as recognition of the need to develop practical informatics skills. Table 2 summarises multidisciplinary responses to a survey question that sought to determine quality improvement.…”

Section: Theme 5: Emphasis On a Positive Approachsupporting

confidence: 87%

“…This body of work 1,2 contributes to public service management theory by providing a new sociotechnical model for understanding the role of primary care informatics in helping to improve quality within locality organisations in England. Applying a complex adaptive system (CAS) conceptual framework helps to explain responses and behaviours resulting from change instigated by the introduction of policy.…”

Section: Introductionmentioning

confidence: 99%

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Complex adaptive systems: a tool for interpreting responses and behaviours

Ellis

2011

Journal of Innovation in Health Informatics

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Section: Theme 5: Emphasis On a Positive Approachsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Complex adaptive systems: a tool for interpreting responses and behaviours

Ellis

2011

Journal of Innovation in Health Informatics

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“…They form useful models of the types of social interactions between professionals looking to implement change (Cilliers, 1998;Anderson, 1999;Ellis, 2010).…”

Section: Complex Adaptive Systemsmentioning

confidence: 99%

Clinical governance, education and learning to manage health information

Ellis

Howard

2011

Clinical Governance: An International Journal

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Purpose This paper suggests that the concept of clinical governance goes beyond a bureaucratic accountability structure and can be viewed as a negotiated balance between imperfectly aligned and sometimes conflicting goals within a complex adaptive system. On this view, the information system cannot be separated conceptually from the system of governance it supports or the people whose work it facilitates or hinders. The paper concludes and makes recommendations in two key governance areas: education and learning to manage health information.In practice, the lessons learned provide opportunities to inform future approaches to health informatics educational programmes. MethodologyThe study, located within the English National Health Service (NHS) between 1999 and 2005, is case study based using a multi method approach to data collection within two Primary Care Organisations (PCOs). The research strategy is conducted within a social constructionist ontological perspective. FindingsThe findings reflect the following broad-based themes: mutual adjustment of a plurality of stakeholder perceptions, preferences and priorities; the development of information and communication systems, empowered by informatics; an emphasis on education and training to build capacity and capability. LimitationsLimitations of case study methodology include a tendency to provide selected accounts. These are potentially biased and risk trivialising findings. Rooted in specific context, their generalisability to other contexts is limited by the extent to which contexts are similar. Reasonable attempts were made to minimise any bias. The diversity of data collection methods used in the study was an attempt to counterbalance the limitations highlighted in one method by strength from alternative techniques. Practical ImplicationsIn practice, the lessons learned provide opportunities to inform future approaches to educational programmes.

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“…For a science like ours where there is socio-technical complexity systematic reviews are complex. 10 We publish a protocol to provide insight into how to go about conducting a systematic review in informatics. 11 We hope this will become a model for future use.…”

Section: International Lessons In Informaticsmentioning

confidence: 99%