Abstract
This article was migrated. The article was marked as recommended. Healthcare improvement initiatives have not led to expected changes in patient population outcomes over the last decade. This can, in part, be explained by overly reductionist approaches in medical practice and education. This article describes some insights and experiences using a Complex Adaptive Systems approach in the conceptualisation of an in-service training program and reflections on elements that may lead to enhanced practice behaviours and system improvements.
Highlights
Through the decades, progress in health care quality and performance has been known to be slow
Woodruff suggests that we cannot solve complex problems using a reductionist paradigm because complexity exists within all layers of the healthcare system and affects the efforts of clinicians and policy makers to improve and reconcile individuals’ healthcare experience, population outcomes and healthcare costs (Woodruff, 2019)
Batalden and Davidoff (2007) propose a model that describes the complex relationship between high quality professional development and quality improvement programming characterized by involvement of patients, families, payers, planners, researchers and educators towards improved patient outcomes
Summary
Progress in health care quality and performance has been known to be slow. The model outlines four system elements required for self-organising systems or resilient medical organisations tasked with complex problem solving These include "intrinsic characteristics" that contribute to the mission (expertise, knowledge), an "attractor" (shared values, professionalism), "adaptive capacity" (judgment, responsiveness to the surrounding environment), and "the absence of excessive central control" (professional autonomy, space to respond autonomously to local phenomena). A facilitated discussion followed using a hypothetical case about a teenager with ID, autism and challenging behaviours presenting to hospital and staff were encouraged to discuss ways to elicit the patient’s communication, care needs and reasonable adjustments required for a better experience within their context Participants shared their own personal experiences of working with children with ID/DD identifying what was working well and the challenges they faced.
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