Understanding clinical complexity in organ and organizational systems: Challenges local and global

Abstract

IntroductionComplexity in healthcare systems has been arbitrarily defined as tasks or systems ranging from complicated to intractable, with a general view of these not being ‘simple’. Complexity in healthcare systems in first‐world countries has been well elucidated, however, data from third‐world countries is still scant.Materials and MethodsWe present four cases each from three different organ systems—chronic kidney disease, alcohol use disorder, and heart failure—in the backdrop of our healthcare organization. We present our analysis of the complexities faced clinically and, in our local healthcare system which led to these events.ResultsAnalysis of these cases showed that patients with chronic kidney disease had vertebral–spinal pathologies due to poor infection control measures during haemodialysis. All these patients were young with a long history of secondary hypertension. In patients with alcohol use disorder, a common theme of how government regulations and peer pressure promote alcohol use is analysed. In the four patients with unexplained heart failure, vascular health is viewed as a fractal dimension and the various factors affecting vascular health are elaborated.ConclusionComplexities exist clinically in making a diagnosis, and organizationally, in the variables and nodes dictating patient outcomes. Clinical complexities cannot be simplified but have to be navigated in an optimized way to improve clinical outcomes.

From theory to practice: The pragmatic value of applying systems thinking and complexity sciences in healthcare

“…The articles [19][20][21][22][23] in this edition of the Complexity Forum provide further insights that will shape the ongoing development of systems thinking informed healthcare. Sturmberg and Marcum discuss the philosophical basis and consequences of systemic thinking on research and conclude that the observable outcomes of health, health care delivery and health systems are governed by causes and effectsevery cause leads to effects that themselves become causes for other effects.…”

“…Samitinjay and colleagues 21 show a practical example how causes and effects thinking impacts clinical care. They deconstructed the nature of the hidden layers between the case presentation/symptom(s) (input) and the clinical diagnosis/patient trajectory (output).…”