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.

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.

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

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.

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.

Price discovery by the market's mind: an investor's perspective on numerical archetypes

2013 ◽  
Vol 5 (2) ◽  
pp. 140-153
Author(s):  
Patrick Schotanus
Keyword(s):  
Complexity Theory ◽  
Complex Adaptive Systems ◽  
Intelligent Agents ◽  
Adaptive Systems ◽  
Price Discovery ◽  
Adaptive System ◽  
Complex Adaptive System ◽  
Modern Society ◽  
Necessary Condition ◽  
Complex Adaptive

The aim of this paper is to contribute to Jung's later work, with a particular focus on the numerical archetypes viewed from an investor's perspective. It attempts to achieve this via a three-pronged approach. First, placing complex psychology in the framework of complexity theory allows a robust acknowledgement and treatment of ‘elusive’ macroscopic properties, i.e. archetypal dynamics, involved in the ordering of a mind as a complex adaptive system. Second, modern insights in number sense (the direct intuition of what numbers mean) provide neuroscientific support for numerical archetypes and clarify their primacy. Third, this paper points to the empirical relevance of numerical archetypes in price discovery, the self-organizing principle of the capital markets (which allocate resources in modern society). The resulting proposition is that the (collective) mind's unconscious and conscious forces can be considered as ‘intelligent’ agents. The competition between these two domains provides the necessary condition to endogenously generate innovative outcomes, the essential capability of complex adaptive systems. According to this view producing such adaptive novelty is achieved in the form of intuitive insights and imagination, which result in a vast array of symbols, e.g. prices in the case of the market's mind.

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