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According to McDaniel and Jordan (2009) and Johnson and Anderson (2020) all health care organizations are Complex Adaptive Systems. Consider the health care organization where you currently work or have worked in the past and describe how five of the attributes of CASs, consistent with General System Theory, are at play: Agent, Interconnections, Self-Organization, Emergence, Co-evolution.
My hospital just purchased 2 smaller hospitals that had been struggling. Concord Hospital, Lakes Region General Hospital, and Franklin Hospital are all of the agents in the situation. Due to these acquisitions, I am now watching the organization become a complex adaptive system first hand. The most obvious attribute is self-organizing. While Franklin and Lakes were their own independent entities until the merger they are now being folded into the bigger system. The two smaller hospitals are also maintaining their own identity during this process, but do not have much control over a lot of the decisions that are being made. The smaller hospitals also bring a very different culture to the system that is sometimes at odds with the larger facility and the planned integration. This has created some friction that is still being worked out. This has lead to some issues with emergence. Many of the staff members at both the larger hospital and the two smaller ones are not comfortable with the changes happening. The dynamics are complex and many are worried they will either be out of a job or it will be very different than what they are used to. What upper administration is proposing is a co-evolution model. This will allow all three hospitals to grow and change in their own ways while supporting each other. Concord has become the tertiary care center of the system with Lakes and Franklin feeding into it. The goal for both Lakes and Franklin is to help them become sustainable as they have both run large deficits for years.
Until the acquisition, they were at risk of just closing which would have left a large geographic area with no hospital. This would have then put further pressure on Concord as they would have become the closest option. It is this interconnected system that lead to the proposal at first and the strong ties made the merger a natural option. Concord had often taken care of patients that were deemed too sick to remain at the smaller facilities and the merger will hopefully strengthen this connection and allow for a stronger system to be put into place.
Johnson, J. A., Anderson, D. E., & Rossow, C. C. (2020). Health systems thinking: A primer. Burlington, MA: Jones & Bartlett Learning.
Northouse, P. G. (2021). Introduction to leadership: Concepts and practice (5th ed.). Thousand Oaks, CA: SAGE Publications.
Weberg, D. R., & Davidson, S. (2021). Leadership for evidence-based innovation in nursing and health professions. Burlington, MA: Jones & Bartlett Learning.
2. General system theory, introduced in the late 19th and early 20th centuries, looked at the universe holistically rather than its parts, pretty much like nursing. Human systems are all interrelated, and they communicate with each other (Johnson, Anderson, & Rossow, 2020). The complex adaptive system (CAS) was introduced in the 1980s, and it was more relatable to health organizations. All of the healthcare organizations can be described as CAS as we are constantly adjusting to the change in the environment and responding to the feedback from within and outside (Johnson, Anderson, & Rossow, 2020). As nurses, we are acting like the CAS as we are constantly adjusting to the changes being made in the healthcare system. One of the recent examples would be the changes related to the pandemic. Some of the attributes that are similar to both systems are Agents, Interconnections, Self-Organization, Emergence, and Co-Evolution.
Some of the agents involved in my health care organization are all the staff members involved in providing care. Arising problems are fixed from the bottom up (Johnson, Anderson, & Rossow, 2020). At the beginning of the pandemic there was a lot of ambiguity among the caregivers and management about keeping them safe with proper equipment. The Infectious disease department, nurses, management, and everyone had to work cohesively to tackle the problem.
During the pandemic interconnections were very important among the hospital staff. The guidelines in regards to patient care and staff safety were ever-changing. The organization had to develop a way to clean the N95 masks and communicate with the nurses to make sure that we were safe and how to continue giving effective patient care.
Emergence is the result of interconnection and a new way to achieve improved goals. One example of this at my healthcare organization was to tackle the problem of patient falls. A few years ago on our floor we had numerous falls occurring on a regular basis. Our hospital followed the LEAN process to fix a process that is broken or to improve it to be more efficient. We came up with the idea to first identify patients who were at a fall risk, mention it during our staff huddle, put a sticker outside the patient’s room to take note of it, and always remember to have bed alarms enabled. After all the proposed changes were implemented, by the entire team contributing to this emergent situation, we successfully helped in the reduction of falls and consequently saved money for the hospital itself.
The other attribute is Self-Organization; it is a bottom-up approach rather than a top-down one. Units self-organize and develop relationships in order to find solutions to problems, and find the most efficient and productive way to give patient care (Johnson, Anderson, & Rossow, 2020). During the beginning of the pandemic COVID-19 and non-COVID-19 patients alike were assigned to the same nurse at times. This led to nurses and patients getting infected with COVID. Having a four-patient assignment with COVID and non-COVID patients was a lot, and this problem was brought to the attention of management. To overcome this problem we made different assignmnets for COVID and non-COVID patients. Nurses would get a week of COVID patient assignments, and that nurse was only assigned to three COVID patients max every shift to reduce their workload. These were tough changes that needed to be made because only the nursing staff understands the workload of the COVID patient.
Co-Evolution is the change that takes place within and outside of the health organization. During the pandemic all the hospitals and health care services had to adjust processes due to COVID-19, and it changed the way the entire medical industry operated. As part of that evolution at my hospital we had to completely temporarily get rid of the surgical floor and transform it into a COVID-19 floor. Nurses from that floor were allocated to COVID floors or other floors that needed help. The way we operated had to be fluid with ever-changing guidelines put forward by the CDC regularly, and medical staff periodically getting sick and taking leave. There was a shortage of crucial vaccines, N95 masks, surgical masks, PPE, and thermometers. So with the emergence of the pandemic medical industry had to evolve.
Johnson, J. A., Anderson, D. E., & Rossow, C. C. (2020). Health Sytems Thinking. Burlington: Jones and Barlett Learning.
Kiviliene, J., & Blazeviciene, A. (2019). Review of complex adpative system in nursing practice. Journal of complexity in health sciences, 46-50.
According to McDaniel and Jordan (2009) and Johnson and Anderson (2020) all health care organizations are Complex Adaptive Systems.
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