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.

Low mental health treatment participation and Confucianist familial norms among East Asian immigrants: A critical review

“…Complexity theory figures around the model of an open, dynamic, adaptive system to be addressed holistically (Morrison, 2005), wherein individuals shape their environment to the effect of creating global level change from local-level interactions (Paley, 2010). Within health, applications of the theory have been found in palliative care (Munday et al, 2003), supply and demand of health care (Brailsworth et al, 2011), health education (Bleakley, 2010;Doll & Trueit, 2010), among other areas (see Litaker et al, 2006). Its distinction from the first approach relies on its conception of an interplay of events that is characterized by ambiguity or multiple ways of understanding over a single representation (Mennin, 2010a).…”

Clinic-Level Process of Care for Depression in Primary Care Settings

“…Tension exists between the potential benefits of allowing local autonomy in adapting care models and guidelines, versus the benefits of disseminating standardized, evidenced-based models (Litaker et al 2006). Although standardization has advantages of greater confidence in fidelity to the evidence basis and efficiency in dissemination, there is the disadvantage that the standardized model may go unused because it does not specifically address problems as perceived by local stakeholders.…”

Role of Data in Improving Care within a Health System: A Case Study of the Australian Health System

“…The CAS framework was particularly useful in that it identified certain key features of complex adaptive systems. For example, CAS could not be decomposed hierarchically which meant that it did not respond to the incentive structures of a traditional mechanistic or deterministic system [42] [86].…”