Complex Adaptive Systems in Healthcare - Part III

In the first part of this article, we discussed the difference between 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 into the work environment and how every member who understands this science can benefit from working around the system.

Working in a 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 in a certain organization will lead to better outcomes. This is called self-organization.

The idea of self-organization is similar 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 three 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 healthcare facility. At one point, this seemed cost-effective. It limits patients’ hospital stay and therefore also restricts expenses to a 3-day stay. However, over time this strategy became more counterproductive than it was originally thought to be. 

In the enforcement of this 3-day stay, it was determined that the bulk of clients who were admitted to acute care facilities were elderly. Most elderly clients develop acute conditions that are successfully treated in less than three days. When they get discharged earlier than three days, they became disqualified to receive subsidized services from skilled nursing facilities. This result to them not completing their follow-up care because by that point, they had to shoulder the expense of their next visit. They chose to remain home even if their health condition warranted more medical attention. 

The outcome of these ripple-like events was that doctors gave a diagnosis that would require the patient to remain in an acute care facility for three days, where unnecessary tests and treatments were done to justify their stay. Some clients were readmitted to acute care due to poor management of the 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 where 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. The healthcare team can realign objectives and self-organize for the clients’ benefit. With this scheme in place, even the clients and their families become more active in their care because it paves the 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 other members and is usually spontaneous. It is the result of what happens if you let the behavior emerge by itself as a consequence of an action or interaction. 

In a smaller and simpler context, such as a medical unit in an acute care setting, the concept of Complex Adaptive Systems also applies. 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 of the team to treat each other with the utmost respect and dignity. A 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 negative emergent behaviors such as workplace bullying you may need to look into solutions that offer enhanced collaborative leadership and communication strategies. Use tools that utilize the context of a Complex Adaptive System and assure quality outcomes from their use.