How Complexity Science Can Inform a Reflective Process for Improvement in Primary Care Practices

被引:135
作者
Stroebel, Christine K. [1 ]
McDaniel, Reuben R., Jr. [2 ]
Crabtree, Benjamin F. [3 ]
Miller, William L. [4 ]
Nutting, Paul A. [5 ]
Stange, Kurt C. [6 ,7 ]
机构
[1] ORBIS Int, New York, NY USA
[2] Univ Texas Austin, McCombs Sch Business, Hlth Care Management, Austin, TX 78712 USA
[3] Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Family Med, Somerset, NJ 08873 USA
[4] Lehigh Valley Hosp & Hlth Network, Dept Family Med, Allentown, PA USA
[5] Univ Colorado, Hlth Sci Ctr, Ctr Res Strategies, Res, Denver, CO USA
[6] Case Western Reserve Univ, Dept Family Med, Cleveland, OH 44106 USA
[7] Case Western Reserve Univ, Dept Epidemiol & Biostat, Cleveland, OH 44106 USA
基金
美国医疗保健研究与质量局;
关键词
D O I
10.1016/S1553-7250(05)31057-9
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Quality improvement processes have sometimes met with limited success in small, independent primary care settings. The theoretical framework for these processes uses an implied understanding of organizations as predictable with potentially controllable components. However, most organizations are not accurately described using this framework. Complexity science provides a better fit for understanding small primary care practices. Methods: The Multimethod Assessment Process (MAP)/Reflective Adaptive Process (RAP) is informed by complexity science. This process was developed in a series of studies designed to understand and improve primary care practice. A case example illustrates the application and impact of the MAP/RAP process. Results: Guiding principles for a reflective change process include the following: an understanding of practices' vision and mission is useful in guiding change, learning and reflection helps organizations adapt to and plan change, tension and discomfort are essential and normal during change, and diverse perspectives foster adaptability and new insights for positive change. Discussion: A reflective change process that treats organizations as complex adaptive systems may help practices make sustainable improvements.
引用
收藏
页码:438 / 446
页数:9
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