Using Systems Thinking and Complexity Theory to understand and improve Emergency Medicine: Lessons from COVID‐19 in a safety net health system

Abstract

RationaleCOVID‐19 has fundamentally changed the practice of Emergency Medicine (EM). Care delivery on the front lines has historically depended upon ostensibly reliable input‐output models for staffing, supplies, policies, and therapies. Challenged by the complexity of healthcare during the pandemic, the fallibility of these reductionist models was quickly revealed. Providers and systems quickly had to reconceptualize their dependence on the wider, complex system in which healthcare operates and find adaptive solutions to rapid changes.Aims/MethodThis papers seeks to review and describe how Systems Thinking and Complexity Theory (ST/CT)—concepts, principles, and tools that can be used to understand and impact our constantly evolving health system—can be applied to better understand and enact change in complex settings such as during COVID‐19. Some of these ST/CT are described through the real world example of the Alameda Health System Vaccine Taskforce.ResultsST/CT concepts such as Unintended Consequences, Interrelationships, Emergent Behavior, Feedback Loops, and Path Dependence can help EM providers and planners understand the context in which their system operates. Key principles such as Collaboration, Iterative Learning, and Transformational Leadership can help these actors respond to current and future challenges. The integration of these concepts and principles into the Learning Health System offers a model for tying these key concepts and principles together into an adaptive, cross‐sectoral organizational approach.ConclusionBy integrating ST/CT into the practice of EM, we can not only improve our ability to care for patients but also our capacity to understand and strengthen our wider systems of care.

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.…”

“…The papers by Rusoja 22 and Teele 23 and colleagues discuss the translation of systems and complexity thinking to improve care in the emergency department and intensive care unit respectively.…”

“…Rusoja and colleague 22 share their experiences of COVID-19 in the emergency department. Their reflections are a call for action to apply systems and complexity thinking to the redesign of the emergency department in preparation for the next inevitable healthcare emergency.…”

“…32 Interventions based on linear input-output models do not reflect the actual complexities of the systems in which acute care operates and arec-ca-prioric-cdoomed to fail. 33 Rusoja and colleague's 22 case study of a learning health system provide a model to achieve learning systems 34 with the greatest possible potential to sustainably improve healthcare. Their approaches provide a practical example that synchronises well with the work of the Complexity Working Group of the North American Primary Health Care Research Group on Superutilization.…”