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.

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.

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.

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.

Patient Journey Record Systems (PaJR)

2011 ◽  
pp. 75-92 ◽  
Author(s):  
Carmel M. Martin ◽  
Rakesh Biswas ◽  
Ankur Joshi ◽  
Joachim P. Sturmberg
Keyword(s):  
Health Care ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Explicit Knowledge ◽  
Care Delivery ◽  
Allied Health Professionals ◽  
Patient Journey ◽  
Complex Adaptive ◽  
Care Systems ◽  
The Individual

This chapter argues the need for a paradigm shift to focus health care from a top down fragmented process driven activity to a user-driven journey of the individual whose health is at stake. Currently many person/patients express needs that are often overlooked or not understood in the health system, and the frontline care workers express frustration in relation to care systems that prevent them from optimizing their care delivery. We argue that complex adaptive systems and social constructionist theories provide a link for knowledge translation that ultimately will lead to improved health care and better personal health outcomes/experiences. We propose the Patient Journey Record System (PaJR) as a conceptual framework to transform health care so that it supports and improves the experience of patients and improves the quality of care through adaptable and interconnected provider information and care systems. Information technology, social networking and digital democracy is proposed as a major solution to the need to put the patient and their journey at the centre of health and health care with real time shaping of care to this end. Placing PaJR at the centre of care would enable patients, caregivers, physicians, nurses, allied health professionals and students to contribute to improving care. PaJR should become a ‘discovery tool’ of new knowledge arising from different types of experiences ranging from the implicit knowledge in narratives through to the explicit knowledge that is formalized in the published peer reviewed literature and translated into clinical knowledge.

Relatonics as a Key Concept for Networked Organizations

2011 ◽  
pp. 1367-1374 ◽  
Author(s):  
Tomas Backström ◽  
Marianne Döös
Keyword(s):  
Workplace Learning ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Working Life ◽  
Virtual Organizations ◽  
Organizational Level ◽  
Complex Adaptive ◽  
Definition Of ◽  
Everyday Learning ◽  
Practical Implications

Learning in organizations, and the competence the organization thereby obtains for performing its core tasks, has come into ever sharper focus when attempts have been made to explain the degree of competitiveness of companies. Much learning takes place when people interact, converse, or co-act. In their research, the current authors have found themselves in need of a new concept, relatonic, that can be applied to the study of interaction and relations at organizational level. To focus interactions and relations is important for all organizations, and extra important for networked and virtual organizations, where persons not as often meet naturally just by working close to each other. The authors have defined and used the concept on the basis of their respective theoretical platforms. These concern recent thinking within the theories of workplace learning (WPL) and organization pedagogics (Döös, 2004, 2007) and theories of complex adaptive systems (CAS) (Backström, 2004). The possibility of a joint definition of the concept of relatonics has been explored (Backström & Döös, 2005), thereby initiating integration of parts of the theories of WPL and CAS. Next, in the Background, follows the joint definition of relatonics and the concept relatonic is expounded from a CAS perspective. Thereafter, follows a description of practical implications of relatonics. The aim is to describe the importance of relatonics for networked and virtual organizations. The main underlying problem concerns which opportunities for everyday learning and competence development are offered in working life, both at an individual and organizational level, but also the problem of stabilizing and integrating organizations composed of relatively autonomous parts.

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