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BACKGROUND/RATIONALE:
The Institute of Medicine’s report, Crossing the Quality Chasm: A New System for the 21st Century, highlighted the organizational and clinical applications of complexity science and recommended it as a useful theoretical framework with important, practical implications for improving quality and redesigning the health care system. This academic expert collaboration focused on the opportunity to qualitatively change health care delivery by defining how knowledge management systems should be operationalized for complex adaptive systems. We chose Rueben McDaniel, PhD, Professor of Management Science and Information Systems at the University of Texas at Austin as our collaborator. He has built a unique set of skills and knowledge over his 37 year career which he has applied to understanding the behavior of health care organizations, most recently using the dual theoretical lenses of complexity theory/ complex adaptive systems and knowledge management.
OBJECTIVE(S):
The overall purpose is to establish internal expertise at VERDICT for pursuing research using the theoretical lenses of complexity science and knowledge management.
METHODS:
1. Customized course on complexity science to the VERDICT investigators. 2. Mentoring of junior investigators: Drs. Best, Parchman, Mortensen, Leykum. 3. Co-production of manuscripts. 4. Facilitate connections with additional experts with complementary skills (added since application).
FINDINGS/RESULTS:
Results: The customized course was completed and the curriculum and bibliography for that course is available for distribution throughout the VA: The course covered the elements of complex adaptive systems and how these affect health care research; special characteristics of organizations that emerge because of their nature as complex adaptive systems, particularly the role of sense-making; and, the basic nature of knowledge management systems, including attention to learning in organizations. VERDICT investigators have acquired new understandings of organizational phenomenon that will affect their research programs. The bibliography for the course targets conceptual issues related to complexity science in organizational research. Several models of this kind of research were presented as well as the use of the methodologies of nonlinear dynamic analysis and ethnography. These ideas have influenced several completed and in-progress grant applications. Approximately fifteen investigators participated in the course. Mentoring of junior investigators: Dr. McDaniel met with individual investigators every month to review progress and to give feedback during 1- to 2-hour conferences. Each month, draft proposals were reviewed and feedback was also provided by email. Included among the proposals reviewed were grant applications prepared by Drs. Arar, Best, Parchman, Adams, Mortensen, Leykum, Restrepo and Hysong. There were numerous phone consultations. E-mail was used significantly for in-depth reviews of proposals and manuscripts. In-depth mentoring was provided for Drs. Pugh, Parchman, Leykum, Best, Mortensen, and Hysong. Manuscripts: Three are under review: Pugh, Research designs for studies promoting heathcare organization change; should action research have a place at the table? Pugh, The Case for Integrating Knowledge Management with Service Delivery in Clinical Microsystems: Treating Complex Patients., and Leykum, The application of complexity science to organizational interventions is associated with improved outcomes for patients with Type II diabetes. Three grant proposals have been submitted. Connections with researchers at the Robert Woods Johnson School of Medicine (Professor Benjamin Crabtree, PhD, PI) and the Case Western Reserve School of Medicine (Professor Kurt Stange, MD, PI) were enhanced through the academic expert’s association with their research projects. Connections regarding research design issues were established with Professor Ruth Anderson, RN, PHD, Duke University.
IMPACT:
The three manuscripts currently under review contribute the literature explicating the role of complex adaptive system theory in health care organizational change. The grant proposals submitted will continue to expand this line of research. We believe that the application of this new lens will lead to further improvements in health care quality and employee satisfaction in the VA.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Communication and Decision Making
Keywords:
Management, Organizational issues
MeSH Terms:
none
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