The case study approach of the evaluation, supported by interviews and unstructured observation, allowed these themes to emerge, but there remains a challenge for creating more targeted research designs and methods capable of capturing, measuring, and interpreting these interactive and emergent processes. Klein JH, Young T. Health care: a case of hypercomplexity? 2003;25(4):325â35. In a healthy individual, the inter-beat variation, as measured by the RâR interval, fluctuates in a stable manner that is hypothesized to be due to the influence of biological âstrange attractorsâ (Table 2).4 In plain English, this means that the heart receives information from other organs, including the sympathetic nervous system and various endocrine glands while also being affected by changes in breathing and posture; an ability to respond to these (and therefore show variability) is clearly a requirement for normal homeostasis. Qualit Res Organ Manage. Finally, we revisit our case study to discuss how we put pragmatic complexity research into action as the evaluation framework for a simulation modeling project. 2001;323:746â9. Phase changes: Where a small change in the system inputs results in a qualitative change in the systemâs state. Holland JH. The MHS was responsible for government-funded inpatient and community mental health services across the age spectrum, with different but overlapping catchment areas for early in life (under 25 years), adult, and aged (over 65 years) services. In: 13.90 edn; 2010. In complexity theory, these contexts could include different nested systems, and different time points [44]. Sanderson I. If social complexity theory does represent a purely descriptive epistemology, which makes no claims to the translation of findings across contexts, then its ability to contribute to implementation science may be minimal. Another of the risks identified by complexity theorists is the pre-emptive labelling of a system as complex [40]; a pragmatic approach does not require such a priori assumptions. Large, multi-faceted organizations such as the NHS frequently behave as complex systems and as such may benefit from alternative management strategies, informed by complexity theory. J Operat Res Soc. The loss of biological variability, with an attendant increase in entropy, is characteristic of several disease states, including MODS and even normal ageing.6 Therefore, although MODS represents an example of a complex system, it may also be viewed as a higher entropy state than health and therefore as a step on the decomplexification pathway that may lead ultimately to death (Table 2). Byrne D, Callaghan G, Winter T. Complexity theory and the social sciences: the state of the art. This creates a rift in complexity theoryâs understanding of agency. 2005;28(6):312â5. There are many similarities between the arguments of social complexity researchers and pragmatists. Emergence as a construct: history and issues. 151â2). 2011;60(1):3â19. Key concepts in complex systems theory presented in pictures. Plsek PE, Greenhalgh T. The challenge of complexity in health care. As an example, one might consider how the best way to reduce anaesthetic drug errors within a theatre complex might be achieved. Scientific knowledge is treated not as a qualitatively different form of knowledge, but simply as a more formalized version of everyday human inquiry [48]. Political action, error and failure: the epistemological limits of complexity. Long, K.M., McDermott, F. & Meadows, G.N. Pycroft a, Bartollas C. Bristol: policy press; 2014. p. 181â98. In healthcare, these systems level outcomes represent public health interests such as the efficiency and effectiveness of healthcare delivery, the populationâs quality of life, and rates of disease morbidity and mortality. The 3-year research project aimed to develop simulation models to provide strategic decision support for a senior leadership group (SLG) in a large public mental health service (MHS) in Australia. A pragmatic frame encouraged us to embrace different types of inquiry and data collection methods, using questionnaire, interview, observation, and document analysis approaches.
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