Complex Adaptive Systems in Healthcare: A Leader’s Perspective – Part 3

By Greg Hunter, RT (R) (T)

      Beth Boynton, RN, MS

In the first part of this article, we discussed the difference of traditional systems and Complex Adaptive Systems as applied to the healthcare setting. In the second part, we have highlighted the qualities of exemplary leaders who embrace the Science of Complexity.

In this third of the series, we will discuss how Complex Adaptive Systems are integrated in the work environment and how every member who understands this science can benefit from working around the system.

Living and working the Complex Adaptive System

Utilizing Complexity Science as a framework for working in the healthcare world redirects our thinking about each role in the organization. While managers in the traditional system are portrayed as being in charge and in control, complexity science asserts that allowing enough flexibility, adaptability and creativity of members to flourish in a certain organization will lead to better outcomes. This is called self-organization.

The idea of self-organization is likened to flocking of birds, or gathering of schools of fish. Humans have that tendency, too, only in a much more intelligent and intricate way. Over the years, we have learned that certain patterns and policies we use in providing care are inefficient and costly. One example is how Centers for Medicare & Medicaid transformed their 3-day stay rule into packaged or bundled paid services.

The 3-day stay rule which was enforced in the mid 1960’s states that acute care facilities accommodate patients for as long as 3 days in the hospital. At that point, it is the healthcare team’s task to stabilize the patient well enough to refer the patient from acute care to a health care facility. At one point, this seemed cost-effective. It limits patients’ hospital stay and therefore also restricts expenses to a 3-day stay. As time it turned out, this strategy became more counterproductive than it was originally thought to be.

In the enforcement of this 3-day stay, it was found out that the bulk of clients who were admitted in acute care facilities were elderly. Most elderly clients develop acute conditions that are well treated in less than three days. When they get discharged earlier than three days, they become disqualified to receive subsidized services from skilled nursing facilities. The result is that they forego their follow-up care because by that point, they have to shoulder the expense of their next visit. They choose to just remain home even if their health condition warrants more medical attention.

The result of these ripple-like events is that doctors give a diagnosis that will make them remain in an acute care facility for three days, where unnecessary tests and treatments are done just to justify their stay. Some clients are readmitted to acute care due to poor management of condition at home.

When complexity science came into the picture, flexibility, adaptability and creativity enabled emergent behaviors. To facilitate emergent behaviors, Centers for Medicare & Medicaid decided to enforce bundled or packaged services wherein a specific amount is allocated for a certain diagnosis. With a global payment system scheme, health care teams are left to decide which approach and tests work on a certain client, they can realign objectives and self-organize for clients’ benefit. With this scheme, even the clients and their families become more active in their care because it paved way for better collaboration.

Emergent behaviors in a simpler context

Emergent behaviors do not necessarily come out of huge organizations. In a smaller setting within an organization, emergent behaviors do exist. Emergent behaviors are those that result from interaction with members. It is spontaneous. It is what happens if you let the behavior emerge by itself as a consequence of an action or interaction.

In a smaller and simpler context, say in a medical unit in an acute care setting, the concept of Complex Adaptive Systems applies, too. With health care team members: physicians, nurses, therapists, nurse assistants, technicians interacting with each other in an adaptive, flexible and creative setting, more healthy outcomes are generated.

Since emergent behaviors are allowed to set in, they can either take a positive or negative turn. It is therefore necessary to train every member to treat each one with utmost respect and dignity. Show of concern for fellow workers and not just the client will go a long way in the realization of organizational goals when taken collectively.

Emergent behaviors in a smaller setting cannot be dictated, but they can definitely be guided. If your organization needs to deal with workplace bullying, or needs enhanced collaborative leadership and communication strategies, automation and documentation support, ManageUP can help. ManageUP operates using the context of Complex Adaptive System and assures quality outcomes from their services.