In reading for WCCS later this month, I wonder if Braithwaite et al. (open access) may have found Hodges' model useful in addressing both the learning objectives and questions they raise in their chapter; and as a response to the recommendations?
Braithwaite J, Ellis LA, Churruca K, et al. Complexity Science as a Frame for Understanding the Management and Delivery of High Quality and Safer Care. 2020 Dec 15. In: Donaldson L, Ricciardi W, Sheridan S, et al., editors. Textbook of Patient Safety and Clinical Risk Management [Internet]. Cham (CH): Springer; 2021. Chapter 27. Available from: https://www.ncbi.nlm.nih.gov/books/NBK585611/ doi: 10.1007/978-3-030-59403-9_27' Learning Objectives and Questions Covered in the Chapter
- How does a linear view of improvement contrast with a complexity science approach?
- The complexity frame makes it harder to manage and deliver high quality and safer care — does it therefore need to be rejected in favour of simpler improvement models?
- What examples can be brought to bear to show how studies in the complexity frame can lead to good outcomes and positive change?'
'In addition, in homing in on any part of a CAS, we can discern elements of both selfsimilarity and local nuances. Self-similarity can manifest fractally, at different scales (e.g., features of the culture of the organisation at the team level approximate to that of the culture of the department, and then division, and then the whole organisation) or laterally (e.g., one department looks comparable structurally to another). It might seem paradoxical, but healthcare levels or departments, despite being self-similar in some respects, also each operate as unique entities. There are always localised contextual, cultural and structural distinctions. Such local nuances occur as the result of the particular configurations of agents (e.g., nurses, doctors, quality managers, patients) following their internalised rules and shared mental models (e.g., put the patients first, project a good reputation to the outside world, prioritise safety) in that unique setting.' pp.378-379.
'Bringing clinicians from different departments together with the patient as the focus, provided a deeper understanding of other’s roles and barriers, helped create a shared mental model, and fostered a whole-of-system approach to the care for patients with this condition.' p.382.
[CAS - Complex Adaptive System]
'Recommendations
1. Sensitise those with responsibility for leading, managing, improving or researching care settings to a systems view.
2. Train sufficient staff in the tools of complexity: FRAM, network analyses, system dynamics modelling, process mapping, and the like.
3. Approach quality and safety and risk management activities with a knowledge of complexity science, sense-making, and non-linearity rather than as a set of linear problems amenable to simplistic causal change logic.
4. Consider how our studies, borrowing from complexity theory, have resisted simplifying the challenges, but have nevertheless made progress in understanding care systems and their improvement.' p.389.
[FRAM - Functional Resonance Analysis Method]
I will include this in my presentation, duly cited:
'Complexity science as a frame: or, frame for complexity science?'