Using Complexity Theory to Build Interventions that Improve Health Care Delivery in Primary Care

Abstract

Previous observational research confirms abundant variation in primary care practice. While variation is sometimes viewed as problematic, its presence may also be highly informative in uncovering ways to enhance health care delivery when it represents unique adaptations to the values and needs of people within the practice and interactions with the local community and health care system. We describe a theoretical perspective for use in developing interventions to improve care that acknowledges the uniqueness of primary care practices and encourages flexibility in the form of intervention implementation, while maintaining fidelity to its essential functions.

Enhancing Learning, Innovation, Adaptation, and Sustainability in Health Care Organizations

“…41 The first is combinatorial complexity-which involves seeking the best solution from a large permutation of possibilities because of the interconnected The ELIAS Performance Management Framework 185 nature of multiple stakeholders involved in health care provision. 7,9,10,41,48,[54][55][56][58][59][60][61][62][63][64] Because organizational learning is important for the coevolution of knowledge within health care organizations and adaptation to the external environment, it also represents a critically important feature for success within CASs. 41 Moreover, the existence of dynamic complexity is important for understanding CASs because the same action can have different effects in the short term and the long term and locally and elsewhere in the system.…”

“…66 Sustainability must be a strategic imperative in order for health care organizations to succeed. 28,55,56,[60][61][62] It is reflective of a continuous process of learning, innovation, and adaptation that enables health care organizations to adapt to and coevolve with its environment despite environmental ambiguity and uncertainty. 28,55,56,[60][61][62] It is reflective of a continuous process of learning, innovation, and adaptation that enables health care organizations to adapt to and coevolve with its environment despite environmental ambiguity and uncertainty.…”

“…106,155,173,174 This systematic process is data driven and involves defining the problem that was identified. 6,17,22,49,60,116,146,150,151,175 This is why it is best done within an action learning framework utilizing OLMs that ensure the generation and utilization of performance feedback, experimentation and experiential learning; local contextual research evidence; the utilization of social networks; top-down and bottom-up participation in the generation of decision criteria; assessment of alternatives based on these criteria; and choosing the solution. 6,92,119,149,155,174 In keeping with the tenets of CASs and the presence of multiple agents and interconnectedness, the development of solutions should not be the purview of a few but should involve stakeholders at all organizational levels affected by and who affect the performance measures.…”

“…34,60,92,96,119,131,144,146,149,153,155,156 Learning occurs as a result of using the feedback from measurement and the deliberate act of reflection on the information being communicated with the aim of developing evidencebased solutions. 34,60,92,96,119,131,144,146,149,153,155,156 Learning occurs as a result of using the feedback from measurement and the deliberate act of reflection on the information being communicated with the aim of developing evidencebased solutions.…”

“…Measurement as shown in the Figure can be as a result of the performance measurement aspect of accountability mechanisms, or assessment of the achievement of strategic objectives, or quality assurance and continuous improvement programs, or an aspect of benchmarking initiatives-hereafter altogether referred to as performance measurement or performance measurement systems. 40,49,60,146 Furthermore, Berwick 155 explicitly stated that measurement is a critical and necessary component for enhancing learning in health care organizations while helping to clarify cause-and-effect relationships and determining whether innovations should be kept, modified, or rejected. 5,30,33,132 However, its utility as the initiator of performance management is being poorly utilized, thus leaving this latter purpose largely unfulfilled.…”