Many of you have experience in complex adaptive systems whether you realize it or not. Thinking about your current or future practice area, identify an issue or concern. In your initial response, please describe the concern. Does the concern primarily occur at the micro, meso, or macro level? How would you address this issue? What impact might your solution have on the other levels of the system? In what ways could interprofessional collaboration be used to resolve the issue?
Systems Structure and Function
Today’s healthcare environment is complex and rapidly evolving. With this shift, new ways of understanding organizations as flexible and fluid systems must be considered. Complexity science and systems theory provide helpful guidance regarding the workings of healthcare systems. The term healthcare system has a variety of meanings, including the entire healthcare industry, with its structure, processes, and personnel; or it may refer to a single organization or system within the organization (Marshall, 2016). Healthcare systems are structures or organizations that directly or indirectly influence health care through the delivery of services or the provision of care (Mensik, 2014) Healthcare systems may include hospitals, health insurance companies, community-based care organizations, academic institutions, health insurance companies, pharmaceutical companies, technology companies, and legislative settings. Systems are comprised of components such as organizations, departments, and units. Systems can further be classified by levels: mesosystems, macrosystems, and microsystems. Regardless of specialty area, master’s-prepared advanced practice nurses work in systems. Understanding the systems and learning skills and attitudes that can help navigate the system will have a great impact on practice outcomes.
Historically, mechanistic theory guided thinking about organizations. Mechanistic theory is based on the assumption that organizations run like machines. Organizations were thought to be static, structured, orderly, and linear. Likewise, organizational changes were predictable, planned, and controlled. This mechanistic approach prevail has long prevailed in traditional hierarchical hospitals and institutions, in which value is placed on inflexible structures rather than complex adaptive structures (Marshall, 2016). However, a paradigm shift is underway. Technological advances, expansion of knowledge, and increasing complexity in healthcare has led to the understanding that organizations are flexible and adaptive systems rather than static entities.
Systems theory views healthcare organizations as dynamic, complex sets of intertwined elements, continuously interacting with the environment in which they operate. A system takes inputs from the environment in the form of various energy sources such as money, raw materials, information, and patients. A system then transforms the inputs via throughput processes and exports the products into the open environment in the form of outputs. Systems thinking examines how parts of an organization interact with one another, allowing leaders to recognize new ways of solving problems by grasping entire processes and systems (Marshall, 2016). Systems thinking is critical for today’s healthcare leaders. Systems thinkers understand that systems are about relationships, matrices of connections, community, and culture (Marshall, 2016).
Complexity Science and Complex Adaptive Systems
The structure of contemporary organizations can be explained through complexity science. Complexity science evolved from several scientific disciplines, including systems theory, mathematics, theoretical biology, and physics (Marshall, 2016). Complexity science recognizes the unpredictability and chaos inherent in complex, adaptive systems. Important concepts in complexity science include self-organization, multi-dimensionality, system history, emergence, and interconnected relationships. Complexity science helps explain the relationship between macro-level structures, such as organizations, and behavior at the micro- or individual level (Chandler et al., 2015).
Complex adaptive systems are flexible and fluid in nature. Organizations are adaptive systems that are integral parts of their environments. They are not static, but rather, are in constantly shifting states which can create uncertainty and unpredictability. Complex adaptive systems are learning organizations that embrace uncertainty and can adapt to emerging change. Master’s prepared advanced practice nurses must become comfortable with ambiguity and uncertainty and learn to accept, manage, and benefit from uncertainty which encourages creativity, innovation, and risk taking that leads to emergence of new order and process within the organization (NLN, 2012). Common characteristics of complex adaptive systems include: parts of systems interact; new behaviors, patterns, and ideas emerge from relationships; results are nonlinear and unpredictable; and self-organization occurs with connective leadership and simple rules (Crowell, 2015). From a complex adaptive system perspective organizations are living systems. Healthcare and healthcare related organizations must be open and receptive to the unpredictable, dynamic, and fluid nature of their environments if they are to survive.
Micro-, Meso-, and Macrosystems
Organization systems can be divided into different levels: micro-, meso-, and macrosystems. The system levels can be viewed as individual, unit, department, organization, or more globally as department, organization, and community. Each system level requires new adaptive responses from leaders to create an optimal practice environment conducive to quality outcomes.
A complex adaptive system focuses on the interconnections and relations of the system elements instead of individual elements (Pype et al., 2018). It involves a system that adapts to a changing environment. The application of complex adaptive system properties to nursing care is consistent with the notion of holism. As a diverse healthcare profession with changing practices, nursing contributes to the concerns from employees and issues regarding adaptation (Pype et al., 2018). At times, such concerns can aid departments in reviewing the reforms to ascertain that they were the appropriate decisions or steps.
A concern in our current and future practice is patient safety and quality. Patient safety and quality are a concern due to the aging healthcare workforce. As the healthcare workforce retires, the number of providers left to ensure patient safety and quality decreases (Son?ur et al., 2017). Efforts to enhance patient safety and quality extend from healthcare institution’s executives to doctors, nurses, and medical equipment specialists. It also involves compliance with government accreditations and mandates, facilities, and the process associated with performance bonuses for employees. Besides the aging healthcare workforce and decreased healthcare workforce, lack of collaboration, misdiagnosis and delayed diagnosis contributes to the patient safety and quality concern (Son?ur et al., 2017).
Patient safety and quality concerns primarily occur at the meso-level since it affects groups of individuals, institutions, and communities. One would address the patient safety and quality issue by advocating for evidence-based practice and encouraging interprofessional collaboration (Son?ur et al., 2017). Healthcare professionals can provide care that improves quality and safety through evidence-based practice, thus preventing related issues. Further, evidence-based practice promotes a collaborative approach to care where healthcare workers base their care on scientific evidence, reducing the variation of care (Son?ur et al., 2017). These solutions to patient safety and quality also positively impact other system levels. Interprofessional collaboration could resolve the concern since it improves coordination and communication between providers, influencing the exchange of information needed to promote patient safety and quality.
Pype, P., Mertens, F., Helewaut, F., & Krystallidou, D. (2018). Healthcare teams as complex adaptive systems: Understanding team behaviour through team members’ perception of interpersonal interaction. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3392-3
Son?ur, C., Özer, Ö., Gün, Ç., & Top, M. (2017). Patient safety culture, evidence-based practice and performance in nursing. Systemic Practice and Action Research, 31(4), 359-374. https://doi.org/10.1007/s11213-017-9430-y