THE ASPECTS OF SHARED LEADERSHIP IN HEALTH CARE

2018 ◽  
Vol 3 ◽  
pp. 406-414 ◽  
Author(s):  
Aelita Skarbaliene ◽  
Egidijus Skarbalius
Keyword(s):  
Health Care ◽  
Complex Adaptive Systems ◽  
Shared Leadership ◽  
Adaptive Systems ◽  
Case Study Research ◽  
Leadership Education ◽  
Theoretical Point ◽  
Healthcare Organizations ◽  
Study Results

Leadership is overwhelming the thinking of contemporary society. A well-functioning organization is first identified with its leader very often. Therefore, it is very important to question the attitude of leadership constantly, not to devalue it, but to understand it better and realize it. Moreover, the expression of leadership in different organizations is very distinct, and its specificity in areas such as health care is still insufficiently explored. Healthcare organizations hold strict hierarchy, therefore leadership is considered as equal to the administrative position. Modern conceptualizations such as transactional, shared, authentic and other leadership theories point to the educational power of a leadership; however, implementation remains challenging. The article presents the analytical-theoretical point of view and interpretive approach for case study about leadership. Firstly, the article introduces research evidence analysis of leadership educational impact for integrated health care system. Secondly, the traditional discourse of leadership is challenged with analysis of complex adaptive systems theory. The case study research was conducted with the purpose to identify the images of leadership among nursing staff and to recognize the needs for leadership education in the healthcare system. Case study results reveal the great need for leadership education in general and for shared leadership in particular.

Information as Change Agent or Barrier in Health Care Reform?

2013 ◽  
pp. 1-17
Author(s):  
Alan C. Gillies ◽  
John Howard
Keyword(s):  
Health Care ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Process Models ◽  
Value Systems ◽  
Care Services ◽  
Primary Care Services ◽  
Complex Adaptive ◽  
Care Systems

Health care systems across the world are in a state of flux. If the experience of the early 1990s can be used as a model, the recent global economic downturn will lead to very significant pressures to reduce spending and achieve better value. Systems have provided a range of approaches to modeling and evaluating these more complex organizations, from simple process models to complex adaptive systems. This paper considers the pros and cons of such approaches and proposes a new modeling approach that combines the best elements of other techniques. This paper also describes a case study, where the approach has been deployed by the authors. The case study comes from health care services in Ontario, Canada, who are shifting from the traditionally hospital-based system to one that recognizes a greater role for community and primary care services.

scholarly journals Using Complexity Assessment to Inform the Development and Deployment of a Digital Dashboard for Schizophrenia Care: Case Study (Preprint)

2019 ◽  
Author(s):  
Andreas Gremyr ◽  
Boel Andersson Gäre ◽  
Trisha Greenhalgh ◽  
Ulf Malm ◽  
Johan Thor ◽  
...  
Keyword(s):  
Health Care ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Point Of Care ◽  
Scale Up ◽  
Mental Illnesses ◽  
Complex Adaptive ◽  
Complexity Assessment ◽  
Practical Implications

BACKGROUND Health care is becoming more complex. For an increasing number of individuals, interacting with health care means addressing more than just one illness or disorder, engaging in more than one treatment, and interacting with more than one care provider. Individuals with severe mental illnesses such as schizophrenia are disproportionately affected by this complexity. Characteristic symptoms can make it harder to establish and maintain relationships. Treatment failure is common even where there is access to effective treatments, increasing suicide risk. Knowledge of complex adaptive systems has been increasingly recognized as useful in understanding and developing health care. A complex adaptive system is a collection of interconnected agents with the freedom to act based on their own internalized rules, affecting each other. In a complex health care system, relevant feedback is crucial in enabling continuous learning and improvement on all levels. New technology has potential, but the failure rate of technology projects in health care is high, arguably due to complexity. The Nonadoption, Abandonment, and challenges to Scale-up, Spread, and Sustainability (NASSS) framework and complexity assessment tool (NASSS-CAT) have been developed specifically to help identify and manage complexity in technology-related development projects in health care. OBJECTIVE This study aimed to use a pilot version of the NASSS-CAT instrument to inform the development and deployment of a point-of-care dashboard supporting schizophrenia care in west Sweden. Specifically, we report on the complexity profile of the project, stakeholders’ experiences with using NASSS-CAT, and practical implications. METHODS We used complexity assessment to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We also performed a thematic analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on its usefulness. RESULTS Application of the NASSS framework revealed different types of complexity across multiple domains, including the condition, technology, value proposition, organizational tasks and pathways, and wider system. Stakeholders perceived the NASSS-CAT tool as useful in gaining perspective and new insights, covering areas that might otherwise have been neglected. Practical implications derived from feedback sessions with managers and developers are described. CONCLUSIONS This case study shows how stakeholders can identify and plan to address complexities during the introduction of a technological solution. Our findings suggest that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general.

scholarly journals Using Complexity Assessment to Inform the Development and Deployment of a Digital Dashboard for Schizophrenia Care: Case Study

10.2196/15521 ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. e15521
Author(s):  
Andreas Gremyr ◽  
Boel Andersson Gäre ◽  
Trisha Greenhalgh ◽  
Ulf Malm ◽  
Johan Thor ◽  
...  
Keyword(s):  
Health Care ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Point Of Care ◽  
Scale Up ◽  
Mental Illnesses ◽  
Complex Adaptive ◽  
Complexity Assessment ◽  
Practical Implications

Background Health care is becoming more complex. For an increasing number of individuals, interacting with health care means addressing more than just one illness or disorder, engaging in more than one treatment, and interacting with more than one care provider. Individuals with severe mental illnesses such as schizophrenia are disproportionately affected by this complexity. Characteristic symptoms can make it harder to establish and maintain relationships. Treatment failure is common even where there is access to effective treatments, increasing suicide risk. Knowledge of complex adaptive systems has been increasingly recognized as useful in understanding and developing health care. A complex adaptive system is a collection of interconnected agents with the freedom to act based on their own internalized rules, affecting each other. In a complex health care system, relevant feedback is crucial in enabling continuous learning and improvement on all levels. New technology has potential, but the failure rate of technology projects in health care is high, arguably due to complexity. The Nonadoption, Abandonment, and challenges to Scale-up, Spread, and Sustainability (NASSS) framework and complexity assessment tool (NASSS-CAT) have been developed specifically to help identify and manage complexity in technology-related development projects in health care. Objective This study aimed to use a pilot version of the NASSS-CAT instrument to inform the development and deployment of a point-of-care dashboard supporting schizophrenia care in west Sweden. Specifically, we report on the complexity profile of the project, stakeholders’ experiences with using NASSS-CAT, and practical implications. Methods We used complexity assessment to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We also performed a thematic analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on its usefulness. Results Application of the NASSS framework revealed different types of complexity across multiple domains, including the condition, technology, value proposition, organizational tasks and pathways, and wider system. Stakeholders perceived the NASSS-CAT tool as useful in gaining perspective and new insights, covering areas that might otherwise have been neglected. Practical implications derived from feedback sessions with managers and developers are described. Conclusions This case study shows how stakeholders can identify and plan to address complexities during the introduction of a technological solution. Our findings suggest that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general.

Information as Change Agent or Barrier in Health Care Reform?

2011 ◽  
Vol 6 (1) ◽  
pp. 19-35 ◽  
Author(s):  
Alan C. Gillies ◽  
John Howard
Keyword(s):  
Health Care ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Health Care Services ◽  
Health Care Systems ◽  
Process Models ◽  
Value Systems ◽  
Economic Downturn ◽  
Care Services

Health care systems across the world are in a state of flux. If the experience of the early 1990s can be used as a model, the recent global economic downturn will lead to very significant pressures to reduce spending and achieve better value. Systems have provided a range of approaches to modeling and evaluating these more complex organizations, from simple process models to complex adaptive systems. This paper considers the pros and cons of such approaches and proposes a new modeling approach that combines the best elements of other techniques. This paper also describes a case study, where the approach has been deployed by the authors. The case study comes from health care services in Ontario, Canada, who are shifting from the traditionally hospital-based system to one that recognizes a greater role for community and primary care services.

A Socio-Technical Interpretation of IT Convergence Services

2009 ◽  
pp. 308-328
Author(s):  
Myeong Ho Lee
Keyword(s):  
Complex Adaptive Systems ◽  
Value Chain ◽  
Adaptive Systems ◽  
Actor Network Theory ◽  
Mobile Banking ◽  
Actor Network ◽  
Case Study Analysis ◽  
Complex Adaptive ◽  
Actor Networks

The trend toward convergence, initiated by advances in ICT, entails the creation of new value chain networks, made up by partnerships between actors in unrelated industries. Such a process of convergence, however, can create a new dimension of network complexity, precipitating dynamic behavior among actors. In this paper we seek to understand how different actors in value chain networks have co-evolved in practice with the development of convergence services. Interpretative case studies on two different converged services in Korea (mobile banking, and One phone services) are undertaken to examine how different actor network adapted in different ways to shape the overall complexity of the converged service. The case study analysis is innovative in being conducted within a combined framework of Complex Adaptive Systems and Actor Network Theory. This synthesis offers a way to characterize the drivers of co-evolutionary behavior, capturing the translation processes undergone by actor networks.

Behavioral patterns in born-again global firms

2014 ◽  
Vol 22 (4) ◽  
pp. 418-441 ◽  
Author(s):  
Patrick Schueffel ◽  
Rico Baldegger ◽  
Wolfgang Amann
Keyword(s):  
International Entrepreneurship ◽  
New Ventures ◽  
Case Study Research ◽  
Content Type ◽  
Study Research ◽  
Starting Point ◽  
Study Results ◽  
Established Firms ◽  
Born Again

Purpose – The purpose of this paper is to identify factors that influence so-called born-again global firms’ internationalization behavior. Specifically, this article explores the following questions: why do mature, domestically focused firms suddenly turn into born-again global firms, how do they do so and what elements are needed for born-again global firms to be sustainable. Design/methodology/approach – Using an established international entrepreneurship model as a starting point, we extract relevant factors for a conceptual framework on born-again global firms’ internationalization activities. Case study research among a cross-sectional sample of born-again global firms is being applied for that purpose. Findings – Driven by the insufficient size of their domestic market, born-again global firms typically embark on internationalization after a generational change at the chief executive officer level. Throughout their internationalization journey, they flexibly adapt toward new needs of their foreign environments. Due to their idiosyncratic characteristics, born-again global firms deserve consideration as a separate group of research objects in the field of international entrepreneurship. Research limitations/implications – The investigated sample of case study firms was drawn across a variety of industries. As such, industry-specific conditions could not be observed and the findings from case study research run the risks of being generalized too broadly. In addition, the accuracy of the case study results may suffer from a certain degree of hindsight bias as the internationalization event took place in the past. Practical implications – Openness to learning from other markets and the flexibility to modify products according to client needs strengthen born-again global firms’ competitiveness. To endure, born-again global firms have to be innovative in adapting to changes, which makes it easier for them to launch their products in new markets. Originality/value – To date, international entrepreneurship has focused on the activities of small and newly established firms, largely neglecting the behavior of somewhat larger and established firms in traditional sectors. This study shows that established companies can exhibit the same innovative, proactive and risk-seeking behavior across borders as new ventures do. Despite their strongly rooted structures, strategies and cultures, born-again globals can flexibly adapt to new environments.

scholarly journals Understanding health professional role integration in complex adaptive systems A multiple-case study of Physician Assistants in Ontario, Canada

2019 ◽  
Author(s):  
Kristen Burrows ◽  
Julia Abelson ◽  
Patricia Miller ◽  
Mitch Levine ◽  
Meredith Vanstone
Keyword(s):  
Complexity Theory ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Healthcare Providers ◽  
Physician Assistants ◽  
Role Integration ◽  
Complex Adaptive ◽  
Multiple Case

Abstract Background To meet the complex needs of healthcare delivery, the Ministry of Health and Long Term Care (MOHLTC) introduced Physician Assistants (PAs) into the Ontario health care system in 2006 to help increase access to care, decrease wait times, and improve continuity of care. Integration of new health professional roles is often stymied by role resistance and funding barriers. The characterization of healthcare organizations as complex adaptive systems (CAS) may offer insight into the relationships and interactions that optimize and restrict successful PA integration. The aim of this study is to explore the integration of PAs across multiple case settings and to understand the role of PAs within complex adaptive systems.Methods An exploratory, multiple-case study was used to examine PA role integration in four settings: family medicine, emergency, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 family medicine clinics in Ontario, Canada. Analysis was conducted in three phases: inductive thematic analysis within each of the four cases; a cross-case thematic analysis; and a broader exploration of cross-case patterns pertaining to specific complexity theory principles of interest.Results Support for PA contributions across various health care settings, the importance of role awareness, supervisory relationship attributes, and role vulnerability (in relation to sustainability and funding) are interconnected and dynamic in hospital and community settings. Findings represent the experiences of PAs and other healthcare providers, and demonstrate how the PA’s willingness to work and ability to build relationships within existing health systems allows for the establishment of interprofessional, collaborative, and person-centered care. As a self-organizing agent in complex adaptive systems (i.e. health organizations), PA role exploration revealed patterns of team behavior, non-linear interconnections, open relationships, dynamic systems, and the legacy of role implementation as defined by complexity theory.Conclusions By exploring the role of PAs across multiple sites, the complexity theory lens concurrently fosters an awareness of emerging patterns, relationships and non-linear interactions within the defined context of the Ontario healthcare system. By establishing collaborative, interprofessional care models in community and hospital settings, PAs are making a significant contribution to Ontario healthcare settings.

scholarly journals Understanding health professional role integration in complex adaptive systems A multiple-case study of Physician Assistants in Ontario, Canada

2020 ◽  
Author(s):  
Kristen Burrows ◽  
Julia Abelson ◽  
Patricia Miller ◽  
Mitch Levine ◽  
Meredith Vanstone
Keyword(s):  
Complexity Theory ◽  
Thematic Analysis ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Healthcare Providers ◽  
Physician Assistants ◽  
Role Integration ◽  
Complex Adaptive ◽  
Multiple Case

Abstract Background To meet the complex needs of healthcare delivery, the Ministry of Health and Long Term Care (MOHLTC) introduced Physician Assistants (PAs) into the Ontario health care system in 2006 to help increase access to care, decrease wait times, and improve continuity of care. Integration of new health professional roles is often stymied by role resistance and funding barriers. The characterization of healthcare organizations as complex adaptive systems (CAS) may offer insight into the relationships and interactions that optimize and restrict successful PA integration. The aim of this study is to explore the integration of PAs across multiple settings and to understand the PA role within complex adaptive systems. Methods An exploratory, multiple-case study was used to examine PA role integration in four settings: family medicine, emergency, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 family medicine clinics in Ontario, Canada. Analysis was conducted in three phases: inductive thematic analysis within each of the four cases; a cross-case thematic analysis; and a broader exploration of cross-case patterns pertaining to specific complexity theory principles of interest. Results Support for PA contributions across various health care settings, the importance of role awareness, supervisory relationship attributes, and role vulnerability (in relation to sustainability and funding) are interconnected and dynamic in hospital and community settings. Findings represent the experiences of PAs and other healthcare providers, and demonstrate how the PA’s willingness to work and ability to build relationships within existing health systems allows for the establishment of interprofessional, collaborative, and person-centered care. As a self-organizing agent in complex adaptive systems (i.e. health organizations), PA role exploration revealed patterns of team behavior, non-linear interconnections, open relationships, dynamic systems, and the legacy of role implementation as defined by complexity theory. Conclusions By exploring the role of PAs across multiple sites, the complexity theory lens concurrently fosters an awareness of emerging patterns, relationships and non-linear interactions within the defined context of the Ontario healthcare system. By establishing collaborative, interprofessional care models in community and hospital settings, PAs are making a significant contribution to Ontario healthcare settings.

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