Considering complexity in healthcare systems

Abstract

A recent trend in the literature has been to characterize healthcare activities in terms of complex systems theory. Complexity has often been loosely and variously defined, with meanings ranging from "not simple" to "complicated" to "intractable." In this paper, we consider various aspects of complexity and how they relate to modern healthcare practice, with the aim of developing research approaches for studying complex healthcare environments. We propose a theoretical lens for understanding and studying complexity in healthcare systems based on degrees of interrelatedness of system components. We also describe, with relevant caveats, how complex healthcare systems are generally decomposable, rendering them more tractable for further study. The ideas of interrelatedness among the components of a system as a measure of complexity and functional decomposition as a mechanism for studying meaningful subcomponents of a complex system can be used as a framework for understanding complex healthcare systems. Using examples drawn from current literature and our own research, we explain the feasibility of this approach for understanding, studying, and managing complex healthcare systems.

Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness

“…48 According to these models, the complexity of any given system or task is influenced by the number of components comprising the system or task (i.e., component complexity), and the number and qualities of relationships among the components (i.e., coordinative complexity). 46,48 Within the context of health care, these concepts have been used to evaluate complex clinical decisions and healthcare system work flow.…”

“…46,48 Within the context of health care, these concepts have been used to evaluate complex clinical decisions and healthcare system work flow. [47][48][49][50] By conceptualizing patients with multiple chronic conditions as complex systems, one can begin to explore and potentially quantify the contributions of component complexity (i.e., number and characteristics of an individual's conditions) and coordinative complexity (i.e., comorbidity interrelatedness) to quality of care (Fig. 1).…”

Title: Playing Telephone: Understanding the state of medication decision making in growing healthcare teams in the time of electronic health records (Preprint)

“…Kannampalli, Schauer, Cohen and Patel note "complex systems can appear very different, depending on aspects, granularity, and circumstances that the researcher chooses to focus on." 15 By focusing on the relationship between physician and pharmacists in this study, we saw that each healthcare profession has access to critical information that the other profession does not (e.g., pharmacists do not have access to a medication's reason for use physicians do not have access to adherence information). Outdated communication systems also restrict and reinforce the pharmacists' limited role in medication decision making.…”

Renewal of an entry to practice baccalaureate nursing curriculum: Adapting to complexity

“…[24,25] Despite this opposition the concepts and metaphors drawn from this theory clearly continue to help people to make sense of the healthcare environment in which they work and inspire them to think creatively about approaches to managing the complex problems they encounter. [18] This can be seen in a range of areas where 'complexity thinking' continues to inspire change and innovation in curricula across a variety of health disciplines such as, for example, medicine, [26] healthcare management, [27] dentistry, [28] sports science, [29] interprofessional practice [30] and nursing. [31] Complexity Theory has been proposed as "a natural framework for nursing educators and nurse leaders to use in .…”