Facilitating Organization Change: Lessons from Complexity Science (J-B O-D (Organizational Developme

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The authors explain how, rather than focusing on the macro ""strategioc"" level of the organization system, complexity theory suggests that the most powerful change processes occur at the micro level where relationship, interaction and simple rules shape emerging patterns. Permissions Request permission to reuse content from this site.

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Table of contents Reviews 1. Leader As Change Agent 3. Decision Making Under Conditions of Uncertainty 4.

Fractal As Metaphor 7. Same and Different 8. Table of contents Reviews 1.

Scoping review of complexity theory in health services research

Leader As Change Agent 3. Decision Making Under Conditions of Uncertainty 4. Fractal As Metaphor 7. Same and Different 8. Self-Organization and the Change Agent: Such an approach has fallen short when studying health systems [ 87 ]. Instead, complexity theory offers a toolkit i.

Complexity brings to the forefront the unpredictable nature of a complex system. Specifically, according to complexity, systems are still comprised of agents, but those agents interact with each other. The interactions of the agents are decentralized. From these interactions, changes occur within the system that may bring about additional change.

One cannot trace the original cause of the change. So, while other theories offer tools for studying systems, many are based on the assumptions that systems behave like a complicated system, are predictable, and can be understood by studying components of a system. The reason we stop short of suggesting complexity is more appropriate than other theories for studying health services research is because health systems are comprised of both complex and complicated systems.

In some instances, depending on how the researcher conceptualizes the phenomena of study, theories that assume a complicated system are appropriate. However, instances where complex systems are involved, such as understanding how change may influence organizational culture, complexity theory offers an appropriate perspective. Complexity theory is similar to other theories useful in health services research—especially theories aimed at exploring relationships in systems.

Two such theories are systems theory and social network theory. Authors identify systems theory as being closely related to complexity theory [ 88 — 90 ]. Similar to complexity, systems theory also seeks to understand how relationships between agents of a system influence change. However, according to Phelan [ 89 ], systems theory is focused on identifying and optimizing relationship characteristics whereas complexity is focused on understanding what influences interactions so that conditions may be created to support further interactions.

In essence, complexity is more exploratory whereas systems theory is more confirmatory [ 89 ]. Social network theory offers a perspective of how relationships between individuals can influence the spread of something e. Using social network theory, researchers can map detailed relationships between entities for the purposes of describing and predicting how network structure may influence an outcome. In essence, the focus in social network theory is the connection of agents within a system.

While complexity theory also offers a perspective on connections between agents, the focus of complexity takes a less reductionist view on interactions than social network theory. Clearly systems theory, social network theory, and many other theories are appropriate for health services research. A choice of theory depends on multiple perspectives. As such, we stop short of suggesting complexity theory is more appropriate than other theories align ourselves with Davis and Sumara [ 90 ] to suggest complexity does not rise over other theories but instead rises among them.

Variation across studies on how complexity is incorporated is expected.

It is a product of intellectual grappling, experimentation, and exploration on how a complexity perspective can be incorporated to answer health services research questions. In a sense, the findings of this scoping review represent evidence that the foundational work that so many authors urge is occurring. Although we are unable to determine what is appropriate use of complexity theory in health services research, the appropriateness of variation in the early stages of complexity applied to health services research is an expected finding of this scoping review.

There are several limitations in our review. First, related to our search strategy, we acknowledge that not all authors will agree our search terms are integral with elements of complexity theory. Second, this scoping review was conducted as part of a doctoral dissertation. As such, it was conducted primarily independently with a second reviewer when needed and, therefore, did not benefit from a team approach to scoping methodology see for example [ 26 , 94 ].

A solitary approach has been used in scoping reviews by other doctoral candidates e. Third, we included only studies published in English. The effect of inclusion and exclusion in systematic reviews by language is inconclusive [ 96 ], yet there is a possibility of excluding important studies from our scoping review—most likely related to the country of research origin.

Researchers are incorporating complexity theory in health services research.

Scoping review of complexity theory in health services research

Researchers using complexity theory in health services research are primarily using the theory for various aspects of qualitative case studies e. Authors have employed many attributes of complexity and descriptions often incorporate aspects of complexity theory related to how diverse relationships and communication between individuals in a system can influence change. The overarching theme from this scoping review is variation.

Although variation may be thought of as a drawback, variation may also be a product of applying a novel and malleable theory in a new context. We do not yet know how best to incorporate complexity to study phenomena in health services research and the debate is far reaching. Perhaps there is no one method to apply this theory and its malleability permits broad application? That said, authors are attempting to study important phenomena using complexity theory and are grappling with how to use this theory. Although complexity theory shows promise in health services research and health services delivery, conceptual confusion and inconsistent application hinders the operationalization of this potentially important perspective.

Complexity appears particularly applicable for studying relationships and interactions between health professionals and management. However, generalizability from studies that use complexity theory, at present, is difficult due to heterogeneity and variation in reporting.

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In summary, more research, debate, and exploration are still needed to continue to understand how complexity theory can be incorporated in health services research. The authors gratefully acknowledge the librarian assistance of Debra Gold for assisting with the search and anonymous reviewers for improving previous drafts. This differs from the term incorporated , which we use to refer to the broader use of complexity in health services research and to encompass all of our questions.

DT was the principal investigator. This study comprised part of the graduate work of DT. DT designed the study, conducted the search, extracted the data, and analyzed the data. DS acted as a second reviewer. All authors read and approved the final manuscript. National Center for Biotechnology Information , U.

Published online Mar Received Nov 5; Accepted Mar 9. This article has been cited by other articles in PMC. Abstract Background There are calls for better application of theory in health services research. Results We included 44 studies in this review: Conclusion Complexity theory is incorporated in many ways across a variety of research designs to explore a multitude of phenomena.. Complexity theory, Health services research, Theory. Background There are calls to increase the use of theory when designing and conducting health services research. In doing so, we answer the following research questions: What are the characteristics of studies that use complexity theory in health services research?

What research questions and phenomena of interest do researchers focus on when using complexity theory? How are researchers using complexity theory within health services research 1? Methods We anticipated heterogeneous studies in terms of research purposes, phenomena of interest, methods, participants, and context.

Identifying relevant studies Literature published between inception of each database and June was collected from the following databases: Table 1 Search strategy by database. Open in a separate window. Study selection A study was eligible for inclusion if: Table 2 Study characteristics, application, and attributes of complexity theory in health services research.

Settings and professions studied using complexity theory All of the seven professions listed in our inclusion criteria were represented in our review. Research purpose and phenomena of interest Authors used a variety of research purposes to study an assortment of phenomena using complexity theory. Table 3 Research purpose and phenomena of interest.

Descriptions of complexity theory Authors have incorporated a wide range of attributes from complexity theory to study phenomena related to health services research. Table 4 Parent and referrent attributes.

Facilitating Organization Change: Lessons from Complexity Science

Change emerges through self-organization, defined as the mutual adjustment of behavior arising from interactions among staff as they meet immediate care demands [ 51 ]. Complexity science suggests that organizations, such as hospitals, are complex adaptive systems. As such, a hospital is defined as a set of connected or interdependent parts or agents—including caregivers and patients— bound by a common purpose and acting on their knowledge [ 58 ].

Complexity science, as related to healthcare, is the science of moving in a nonlinear and interactive manner where unpredictable outcomes are often realized; organizations are described as ever-changing collections of individuals and conditions in the organization; and patterns of interaction among individuals and connections are made in day-to-day practices among and between individuals [ 66 ]. Discussion This is the first scoping review to explore how complexity theory has been incorporated into health science research.

Limitations There are several limitations in our review. Conclusion Researchers are incorporating complexity theory in health services research. Acknowledgements The authors gratefully acknowledge the librarian assistance of Debra Gold for assisting with the search and anonymous reviewers for improving previous drafts. Footnotes 1 The term use in this instance refers to how authors used complexity theory specifically in their study.

Competing interests The authors declare they have no competing interests. Contributor Information David S. Framing together a sustainable transfrontier knowledge translation vision. Zwarenstein M, Reeves S. Knowledge translation and interprofessional collaboration: Where the rubber of evidence-based care hits the road of teamwork.

J Contin Educ Health Prof. A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. A scoping review to improve conceptual clarity of interprofessional interventions. Theory and Knowledge Translation: The use of systems and organizational theories in the interprofessional field: Findings from a scoping review. Graham ID, Tetroe J. KT Theories Research Group: Some theoretical underpinnings of knowledge translation. Best A, Holmes B. Systems thinking, knowledge and action: Doing the dance of culture change: The need for systems change: Complexity theory applied to itself.

Emerging order in CAS theory: Changing Teaching in Complex Times. Handbook of Systems and Complexity in Health. The Complexity of Complexity Theory: Mapping the field of Complexity Theory: A computational approach to understanding changes in the field. Systems and complexity thinking in the general practice literature: Complex adaptive systems and nursing. The appropriation of complexity theory in health care.

J Health Serv Res Policy. Grant MJ, Booth A. A typology of reviews: Health Inf Libr J. Int J Soc Res Methodol. Morris PE, Dracup K. Quality improvement or research? The ethics of hospital project oversight. A Science Lifecycle Approach. Accessed 24 May Patient-centered care and communication in primary care practice: Local interaction strategies and capacity for better care in nursing homes: Leadership practice as interaction in primary care emergency team training.

Health Care Manage Rev. From words to action: Connection, regulation, and care plan innovation: Patterns of medical and nursing staff communication in nursing homes: Factors involved in the delivery of nursing care. High-performing and low-performing nursing homes: Caring nurse practice in the intrapartum setting: Helping primary care teams emerge through a quality improvement program. Referral hospitals in the Democratic Republic of Congo as complex adaptive systems: Pan Afr Med J. How improving practice relationships among clinicians and nonclinicians can improve quality in primary care.

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