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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Published on: February 16, 2011

Reframing the challenges to integrated care: a complex-adaptive systems perspective.

Peter Tsasis¹, Jenna M Evans, Susan Owen

¹School of Health Policy and Management, Faculty of Health, York University, 4700 Keele Street, Toronto, Ontario, Canada M3J1P3.

International Journal of Integrated Care

|April 18, 2013

Summary

Healthcare integration efforts often fail due to a lack of complex-adaptive systems (CAS) perspective. Adopting a CAS approach can foster self-organization and improve health system change.

Keywords:

complex adaptive system health systems integration integrated care inter-organizational inter-professional partnership

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Last Updated: May 12, 2026

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Published on: February 16, 2011

Area of Science:

Health Services Research
Systems Science
Organizational Behavior

Background:

Integrated care initiatives have seen limited success despite decades of research.
Existing conceptualizations of integrated care may not adequately address system complexity.
A complex-adaptive systems (CAS) perspective offers a novel lens for understanding integrated care.

Purpose of the Study:

To explore the utility of a complex-adaptive systems (CAS) perspective in understanding health systems integration.
To analyze healthcare professionals' experiences with integration efforts in Ontario, Canada.
To identify barriers and facilitators to integrated care from a CAS viewpoint.

Main Methods:

Qualitative study using focus groups with diverse healthcare professionals in the Greater Toronto Area.
Convenience and snowball sampling methods were employed.
Data were analyzed using a CAS framework to assess its theoretical fit with participant responses.

Main Results:

Integration is hindered by system complexity, weak professional/organizational ties, lack of funding incentives, and command-and-control management.
CAS characteristics observed include interdependent actors, co-evolutionary systems, emergent behaviors, and self-organization.
Participant data align with CAS principles, suggesting its relevance to integrated care.

Conclusions:

Failure to adopt a CAS perspective may explain the lack of progress in healthcare integration.
Future integration initiatives should be grounded in CAS principles, focusing on self-organization.
Effective integration requires policies promoting awareness, relationships, information sharing, and recognizing change as an evolving process.