Understanding health system reform – a complex adaptive systems perspective

Sturmberg, Joachim P.; O'Halloran, Di; Martin, Carmel M.

doi:10.1111/j.1365-2753.2011.01792.x

Cited by 139 publications

(135 citation statements)

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“…However, after implementation of quality improvements, a longer period of evaluation may be needed to reveal changes in service delivery as experienced by patients and informal caregivers [9]. It is a worldwide challenge to initiate, develop and evaluate integrated care on a large scale with multiple health care providers involved in a changing health care economy, also called 'complex adaptive systems' or 'complex interventions' [22][23][24]. These systems are complex because of the dynamics within the different health care providers and the large number of components that interact when developing integrated care delivery [13,22,23,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…It is a worldwide challenge to initiate, develop and evaluate integrated care on a large scale with multiple health care providers involved in a changing health care economy, also called 'complex adaptive systems' or 'complex interventions' [22][23][24]. These systems are complex because of the dynamics within the different health care providers and the large number of components that interact when developing integrated care delivery [13,22,23,25,26]. Another explanation may be that the national project had too optimistic expectations about the capacity of the organisations to execute a successful change themselves.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Changes in geriatric rehabilitation: a national programme to improve quality of care. The Synergy and Innovation in Geriatric Rehabilitation study

Holstege¹,

Caljouw²,

Zekveld³

et al. 2015

Int J Integr Care

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Objective: To describe changes in the health service delivery process experienced by professionals, patients and informal caregivers during implementation of a national programme to improve quality of care of geriatric rehabilitation by improving integration of health service delivery processes. This article is published in a peer reviewed section of the International Journal of Integrated Care 1 Study setting: Sixteen skilled nursing facilities. Research and TheoryStudy design: Prospective study, comparing three consecutive cohorts.Data collection: Professionals (elderly care physicians, physiotherapists and nursing staff) rated four domains of health service delivery at admission and at discharge of 1075 patients. In addition, these patients [median age 79 (Interquartile range 71-85) years, 63% females] and their informal caregivers rated their experiences on these domains 4 weeks after discharge.Principal findings: During the three consecutive cohorts, professionals reported improvement on the domain team cooperation, including assessment for intensive treatment and information transfer among professionals. Fewer improvements were reported within the domains alignment with patients' needs, care coordination and care quality. Between the cohorts, according to patients (n = 521) and informal caregivers (n = 319) there were no changes in the four domains of health service delivery.Conclusion: This national programme resulted in small improvements in team cooperation as reported by the professionals. No effects were found on patients' and informal caregivers' perceptions of health service delivery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Changes in geriatric rehabilitation: a national programme to improve quality of care. The Synergy and Innovation in Geriatric Rehabilitation study

Holstege¹,

Caljouw²,

Zekveld³

et al. 2015

Int J Integr Care

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show abstract

“…Its usefulness has been demonstrated for a patient-oriented planning case in an expert organization in the health care domain, exemplary for diverse and complex system transformations (Sturmberg et al, 2012(Sturmberg et al, , 2013. It is grounded on stakeholder articulation and analyses of stakeholder interactions featuring structured knowledge processing and decision-making.…”

Section: Vol 18 No 4 2014 Journal Of Knowledge Management Page 653mentioning

confidence: 99%

“…Health systems could have people-centred attractors or others, such as financial attractors. A shift in the system's attractor is fundamental to progress health reform thinking (Sturmberg et al, 2012).…”

Section: A Stakeholder-centered Approach Integrating Vna and S-bpmmentioning

confidence: 99%

Non-disruptive knowledge and business processing in knowledge life cycles – aligning value network analysis to process management

Stary

2014

Journal of Knowledge Management

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Purpose – This paper aims to achieve fully intertwined knowledge and business processing in change processes. It proposes streamlining situated articulation work, value network analyses (VNA) and subject-oriented business process modelling (S-BPM) and execution to provide non-disruptive single and double learning processes driven by concerned stakeholders. When implementing knowledge life cycles, such as Firestone and McElroy’s knowledge life cycle, the agility of organizations is significantly constrained, in particular, when surviving knowledge claims should be implemented in the business processing environment in a seamless way. Design/methodology/approach – The contribution is based on a conceptual analysis of knowledge life cycle implementations, learning loop developments and an exploratory case study in health care to demonstrate the effectiveness of the proposed approach. The solution towards non-disruptive knowledge and business processing allows stakeholders to actively participate in single- and double-loop learning processes. Findings – The introduced approach supports problem and knowledge claim formulation, knowledge claim evaluation and non-disruptive knowledge integration into a business process environment. Based on stakeholder articulation, the steps to follow are: holomapping, exchange analysis, impact analysis, value creation analysis, subject-oriented modelling, business process validation and execution. Seamless support of stakeholders is enabled through the direct mapping of stakeholder and activity descriptions from value network representations to behaviour specifications (process models) on the individual and organizational layer. Research limitations/implications – Current knowledge life cycle developments and implementations can now be analyzed in a structured way. Elements of the proposed approach could be integrated in disruptive implementations to overcome current limitations of knowledge life cycles. However, further case studies need to be performed to identify hindrances or barriers of combining VNA and S-BPM, both on the technological and methodological layer. What works for expert service industries might need to be adapted for production industries, and tools or tool chains might need to be configured accordingly. Finally, the socio-economic impact of the approach needs to be explored. Practical implications – The presented case study from health care reveals the potential of such a methodological combination, as cycle times can be reduced, in particular, due to the execution of role-specific process models in the respective business processing environment. It can be considered as a fundamental shift for existing change management procedures, as they require rework of the entire functional process models when addressing business processing. Now, stakeholder- or role-specific behaviour can be handled isolated and in parallel, without affecting the entire organization in case of modifications. Originality/value – The proposed methodological integration has not been done before. It enables stakeholders to perform single- and double-loop change processes in a seamless way.

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“…For instance, contrary to what traditional policy makers sustain, having more rules and stronger normativity may cause health systems to actually perform worst than before. It has even been stated that "As more regulations are created to control the behavior of a complex system, the more the system may deviate from a desired outcome" [36] based on cases such as the redesign of the Australian healthcare structure [38]. The study of Sturmberger et al [38], actually discourages the use of normative strategies such as the so-called disease protocols (i.e.…”

Section: Hierarchical Complexity and Health Systems Managementmentioning

confidence: 99%

Health Systems as Complex Systems

Martínez-García¹,

Hernández‐Lemus²

2013

AJOR

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Health systems are paradigmatic examples of human organizations that blend a multitude of different professional and disciplinary features within a critically performance environment. Communication failure and defective processes in health systems have a tremendous impact in society, both in the financial and human aspects. Traditionally, health systems have been regarded as linear hierarchic structures. However, recent developments in the sciences of complexity point out to health systems as complex entities governed by non-linear interaction laws, self-organization and emergent phenomena. In this work we review some aspects of complexity behind health systems and how they can be applied to improve the performance of healthcare organizations.

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Understanding health system reform – a complex adaptive systems perspective

Cited by 139 publications

References 31 publications

Changes in geriatric rehabilitation: a national programme to improve quality of care. The Synergy and Innovation in Geriatric Rehabilitation study

Changes in geriatric rehabilitation: a national programme to improve quality of care. The Synergy and Innovation in Geriatric Rehabilitation study

Non-disruptive knowledge and business processing in knowledge life cycles – aligning value network analysis to process management

Health Systems as Complex Systems

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