Crossing the Quality Chasm A New Health System for the 21st Century (2001) / Chapter Skim
Currently Skimming:
Appendix B: Redesigning Health Care with Insights from the Science of Complex Adaptive Systems
Appendix B: Redesigning Health Care with Insights from the Science of Complex Adaptive Systems
Pages 309-322
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 309... ...
SYSTEMS THINKING A "system" can be defined by the coming together of parts, interconnections, and purpose (see, for example, definitions proposed by von Bertalanffy [19681 and Capra [19961~. While systems can be broken down into parts which are interesting in and of themselves, the real power lies in the way the parts come together and are interconnected to fulfill some purpose.
|
From page 310... ...
TABLE B-1 Mechanical Versus Naturally Adaptive Systems Type of System Mechanical Naturally Adaptable Simple Thermostat and fan Patient giving history information to a physician Complex Office building heating, ventilation and air conditioning U.S. health care The distinction between mechanical and naturally adaptive systems is obvious when given some thought.
|
From page 311... ...
An example in health care is a surgical team doing routine gall bladder surgery. Through experience and the accumulation of knowledge, there is a high degree of certainty about the surgical procedures that lead to successful outcomes.
|
From page 312... ...
Further, well-meaning, rational, intelligent people might not always agree as to the approach or outcome, meaning that there are only modest levels of agreement. For the most part the issues associated with designing the 21st-century health care system are in the zone of complexity where it would be more appropriate to use the paradigm of a complex adaptive system.
|
From page 313... ...
Forecasting is inherently an inexact, yet bounded, art. For example, in weather forecasting, the fundamental laws governing pressure and temperature in gases are nonlinear.
|
From page 314... ...
CAS science and the Stacey diagram suggest additional metaphors to assist our thinking. Box-B-1 highlights some key ideas that emerge from the application of CAS science to the challenges of designing the 21st-century health care system.
|
From page 315... ...
(Just as in biological evolution, seemingly harmful genetic variations do not die out completely in a generation; a not-so-fit characteristic might prove highly fit when combined with some other characteristic that evolves in a later generation.) These notions of evolutionary design are intuitively behind rapid-cycle plan-do-study-act (PDSA)
|
From page 316... ...
The concept of complex system design using simple rules has also been demonstrated in organizations. The credit card company VISA built a trillion dollar business with very little central control.
|
From page 317... ...
CONCLUSION Complexity science provides a new paradigm to guide system design. Some key questions raised by a CAS-inspired approach to redesigning health care for the 21st century include: .
|
From page 318... ...
and Singer J.L. The Mind, the Brain, and Complex Adaptive Systems.
|
From page 319... ...
Pikkujamsa S.M., Makikallio T.H., Sourander L.F., et al. Cardiac interbeat interval dynamics from chil&ood to senescence: Comparison of conventional and new measures based on fractals and chaos theory.
|
From page 320... ...
A complex adaptive systems model of organizational change. Nonlinear Dynamics, Psychology, and Life Science.
|
From page 321... ...
Integrated shop floor control using autonomous agents. IIE Transactions.
|
From page 322... ...
Zimmerman B.J. Complexity science: A route through hard times and uncertainty.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.