TY - JOUR
T1 - Uncertainty, emergence and adaptation
T2 - A complex adaptive systems approach to quality improvement
AU - Wilson, William
AU - McLachlan, Scott
AU - Dube, Kudakwashe
AU - Potter, Kathleen
AU - Jayamaha, Nihal
N1 - Publisher Copyright:
© 2023 American Society for Quality.
PY - 2023
Y1 - 2023
N2 - The healthcare quality improvement (QI) literature is replete with examples stating that continued failure to regard healthcare as a complex adaptive system (CAS) reduces the effectiveness of quality improvement initiatives. Recommendations and strategies for managing change within CAS exist, but the specific mechanisms that bring about successful change within CAS and the implications for quality practitioners are under-explored. This article presents a generalizable model for QI within CAS and provides a specifically CAS explanation for incremental change. We develop a conceptual model from foundational CAS principles that is then operationalized as an agent-based simulation model. Our model captures critical complex system behavior in a generic manner easily applied to different improvement contexts. We tested the simulation model using a recognizably complex healthcare improvement case: reducing antipsychotic prescribing levels in aged residential care. Nonlinear phase transitions were observed in the agent network, conditioned on the network’s ability to learn solution options and simultaneously maintain cooperation. We believe that a CAS explanation of change can assist practitioners navigating complex QI activities.
AB - The healthcare quality improvement (QI) literature is replete with examples stating that continued failure to regard healthcare as a complex adaptive system (CAS) reduces the effectiveness of quality improvement initiatives. Recommendations and strategies for managing change within CAS exist, but the specific mechanisms that bring about successful change within CAS and the implications for quality practitioners are under-explored. This article presents a generalizable model for QI within CAS and provides a specifically CAS explanation for incremental change. We develop a conceptual model from foundational CAS principles that is then operationalized as an agent-based simulation model. Our model captures critical complex system behavior in a generic manner easily applied to different improvement contexts. We tested the simulation model using a recognizably complex healthcare improvement case: reducing antipsychotic prescribing levels in aged residential care. Nonlinear phase transitions were observed in the agent network, conditioned on the network’s ability to learn solution options and simultaneously maintain cooperation. We believe that a CAS explanation of change can assist practitioners navigating complex QI activities.
KW - agent-based model
KW - complex adaptive systems
KW - healthcare improvement
KW - improvement networks
KW - problem-solving strategies
UR - http://www.scopus.com/inward/record.url?scp=85161952313&partnerID=8YFLogxK
U2 - 10.1080/10686967.2023.2211287
DO - 10.1080/10686967.2023.2211287
M3 - Article
AN - SCOPUS:85161952313
SN - 1068-6967
VL - 30
SP - 168
EP - 186
JO - Quality Management Journal
JF - Quality Management Journal
IS - 3
ER -