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.

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 medicine, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 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.

A Complexity Theory Framework of Issue Movement

2018 ◽  
Vol 59 (6) ◽  
pp. 1110-1150 ◽  
Author(s):  
Cedric E. Dawkins ◽  
James R. Barker
Keyword(s):  
Complexity Theory ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Sub Saharan Africa ◽  
Aids Pandemic ◽  
Industry Response ◽  
Complex Adaptive ◽  
Sub Saharan ◽  
Theory Framework

This research draws on complexity theory to provide an alternative conceptualization of issue management. We use six dynamics of complexity drawn from complex adaptive systems—equipoise, turbulence, sensitive conditions, bifurcation, attractor emergence, and symmetry breaking—to develop a metaphorical framework that describes what occurs during various periods of issue activity and what propels issues from one period of activity to another. We illustrate the framework with a case study of the pharmaceutical industry response to the HIV/AIDS pandemic in Sub-Saharan Africa. The article concludes with a discussion of the additional affordances this framework provides to extend and compliment issue life cycle models.

Competitive Success of Italian Industrial Districts: A Network-based Approach

2017 ◽  
Vol 30 (1) ◽  
pp. 78-104 ◽  
Author(s):  
Nunzia Carbonara
Keyword(s):  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Environmental Changes ◽  
Structural Features ◽  
Industrial Districts ◽  
Complex Adaptive ◽  
Competitive Success ◽  
Multiple Case ◽  
And Control

The article conducts an explorative research on the competitive success of industrial districts (IDs) based on their capacity to adapt and evolve in response to the environmental changes. The aim is to identify the ID structural features supporting adaptation by using the complexity theory. Thus, IDs are considered as complex adaptive systems (CASs) and the ID features that foster adaptation are identified based on the main CAS properties, namely inter-connectivity, heterogeneity and control. To formulate the theory linking the values of the ID structural features with the ID competitive success, a multiple case study is carried out. Finally, three theoretical propositions are derived. JEL: P13, P17, P48, R10

La politica dei Cluster in Europa: tendenze e criticitŕ emergenti

ARGOMENTI ◽  
2009 ◽  
pp. 99-122
Author(s):  
Alessandro Minello
Keyword(s):  
European Commission ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Triple Helix ◽  
Cluster Policy ◽  
Policy Makers ◽  
Critical Elements ◽  
Complex Adaptive

- Cluster policy today represent one of the main elements of the European agenda, both for policy makers and for practitioners. In the last decade an extensive-type cluster policy has produced a proliferation of clusters all over the Europe, but the generated quality of clusters created has not always been quite satisfactory. Following the input by the European commission, currently is underway a qualitative review of the goals and processes of European cluster policy. This paper aims at presenting such changes in the European cluster policy, beside the main lessons that can be learned. The analysis emphasizes some critical elements of the current process of "clustering" and highlights the role of the institutions, besides the market, in the planning of new clusters and the strengthening of those existing. The final message is that Europe needs a better cluster policy, rather than more clusters, according to the growing complexity and dynamism of clusters.Parole chiave: cluster, politica dei cluster, approccio triple-helix, sistemi adattivi complessi.Keywords: cluster, cluster policy, triple helix approach, complex adaptive systems.

Strategy in the era of “swans”: the role of strategic leadership under uncertainty and unpredictability

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Henry Adobor ◽  
William Phanuel Kofi Darbi ◽  
Obi Berko O. Damoah
Keyword(s):  
Mental Models ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Strategic Leadership ◽  
Content Type ◽  
Complexity Leadership ◽  
Complex Adaptive ◽  
Strategic Leaders ◽  
Impact Events

PurposeThe purpose of this conceptual paper is to explore the role of strategic leadership under conditions of uncertainty and unpredictability. The authors argue that highly improbable, but high-impact events require the upper echelons of management, traditionally the custodians of strategy formulation to offer a new kind of strategic leadership focused on new mindsets, organizational capabilities, more in tune with high uncertainty and unpredictability.Design/methodology/approachDrawing on strategic leadership, and complexity leadership theory, the authors review the literature and present a conceptual framework for exploring the nature of strategic leadership under uncertainty. The authors conceptualize organizations as complex adaptive systems and discuss the imperatives for developing new mental models for emergent leadership.FindingsStrategic leaders have a key role to play in preparing their organizations for episodic disruptions. These include developing their adaptive capabilities and building resilient organizations to ensure their organizations cannot only bounce back after a disruption but have the capacity for transformation to new fitness levels when necessary. Strategic leaders must engage with complexity leadership by seeing their organizations as complex adaptive systems, reconfigure their leadership approaches and organizations to build strategic adaptive capability.Research limitations/implicationsThis is a conceptual paper and the authors cannot make any claims of causality.Practical implicationsOrganizational leaders need to reconfigure their mental models and leadership approaches to reflect the new normal of uncertainty and unpredictability. Developing the strategic adaptive capability of organizations should prepare them for dealing with high impact events. To assure business continuity in the face of disruptions requires building flexible, adaptable business models.Originality/valueThe paper focuses on how managers can offer strategic leadership for a new normal that challenges some of our most cherished leadership and strategic management paradigms. The authors explore the new mental models and leadership models in an era of great uncertainty.

Food Webs as Complex Adaptive Systems

2011 ◽  
Author(s):  
Kevin S. McCann
Keyword(s):  
Food Webs ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Lake Trout ◽  
Human Impacts ◽  
Interaction Strength ◽  
Ecosystem Dynamics ◽  
Ecosystem Size ◽  
Complex Adaptive

This chapter examines some of the potential empirical signatures of instability in complex adaptive food webs. It first considers the role of adaptive behavior on food web topology, ecosystem size, and interaction strength before discussing the implications of this behavior for ecosystem dynamics and stability. It then analyzes the results of empirical investigations of Canadian Shield lake trout food webs and how human influences and ecosystems coupled in space may drive biomass pyramids, potentially leading to species loss. It also explores the tendency of subsidies, through human impacts, to homogenize natural ecosytems and concludes by assessing some of the changing conditions that are being driven by humans and how these may change ecosystems.

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.

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