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Healthcare improvement as planned system change or complex responsive processes? a longitudinal case study in general
Barbara J Booth1, Nicholas Zwar, Mark F Harris
1Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia. bj.booth@unsw.edu.au
BMC Family Practice
|April 27, 2013
Summary
Healthcare improvement in general practice is complex and emergent, not a planned process. Understanding change through a complexity lens reveals how practices adapt to deliver better chronic illness care.
Area of Science:
- Healthcare Improvement Science
- Complexity Science in Healthcare
- General Practice Management
Background:
- Evidence-based practice implementation in healthcare faces challenges.
- Primary care struggles with chronic disease burden in aging populations.
- Translating research into practice remains elusive despite intense study.
Purpose of the Study:
- Explore healthcare improvement dilemmas in general practice.
- Challenge current thinking on healthcare improvement.
- Apply complexity lens to understand organizational change.
Main Methods:
- Embedded case study of organizational change over a decade.
- Data collection via interviews, document review, and observation.
- Comparison with standard implementation prescriptions and complexity science theories.
Main Results:
- Practice continuously improved chronic illness care over ten years.
- Improvements included process redesign, community linkages, self-management support, and nurse integration.
- Change was emergent, non-linear, and self-organized, not based on explicit plans.
Conclusions:
- Implementation science as planned change doesn't match general practice reality.
- Complexity concepts, like complex responsive processes, better explain healthcare change.
- These insights inform how stakeholders improve healthcare delivery.
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