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Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science.

Publication ,  Journal Article
Leykum, LK; Lanham, HJ; Pugh, JA; Parchman, M; Anderson, RA; Crabtree, BF; Nutting, PA; Miller, WL; Stange, KC; McDaniel, RR
Published in: Implementation science : IS
November 2014

The application of complexity science to understanding healthcare system improvement highlights the need to consider interdependencies within the system. One important aspect of the interdependencies in healthcare delivery systems is how individuals relate to each other. However, results from our observational and interventional studies focusing on relationships to understand and improve outcomes in a variety of healthcare settings have been inconsistent. We sought to better understand and explain these inconsistencies by analyzing our findings across studies and building new theory.We analyzed eight observational and interventional studies in which our author team was involved as the basis of our analysis, using a set theoretical qualitative comparative analytic approach. Over 16 investigative meetings spanning 11 months, we iteratively analyzed our studies, identifying patterns of characteristics that could explain our set of results. Our initial focus on differences in setting did not explain our mixed results. We then turned to differences in patient care activities and tasks being studied and the attributes of the disease being treated. Finally, we examined the interdependence between task and disease.We identified system-level uncertainty as a defining characteristic of complex systems through which we interpreted our results. We identified several characteristics of healthcare tasks and diseases that impact the ways uncertainty is manifest across diverse care delivery activities. These include disease-related uncertainty (pace of evolution of disease and patient control over outcomes) and task-related uncertainty (standardized versus customized, routine versus non-routine, and interdependencies required for task completion).Uncertainty is an important aspect of clinical systems that must be considered in designing approaches to improve healthcare system function. The uncertainty inherent in tasks and diseases, and how they come together in specific clinical settings, will influence the type of improvement strategies that are most likely to be successful. Process-based efforts appear best-suited for low-uncertainty contexts, while relationship-based approaches may be most effective for high-uncertainty situations.

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Published In

Implementation science : IS

DOI

EISSN

1748-5908

ISSN

1748-5908

Publication Date

November 2014

Volume

9

Start / End Page

165

Related Subject Headings

  • Uncertainty
  • Quality Improvement
  • Professional Practice
  • Patient Participation
  • Observational Studies as Topic
  • Humans
  • Health Policy & Services
  • Delivery of Health Care
  • Acute Disease
  • 52 Psychology
 

Citation

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Leykum, L. K., Lanham, H. J., Pugh, J. A., Parchman, M., Anderson, R. A., Crabtree, B. F., … McDaniel, R. R. (2014). Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science. Implementation Science : IS, 9, 165. https://doi.org/10.1186/s13012-014-0165-1
Leykum, Luci K., Holly J. Lanham, Jacqueline A. Pugh, Michael Parchman, Ruth A. Anderson, Benjamin F. Crabtree, Paul A. Nutting, William L. Miller, Kurt C. Stange, and Reuben R. McDaniel. “Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science.Implementation Science : IS 9 (November 2014): 165. https://doi.org/10.1186/s13012-014-0165-1.
Leykum LK, Lanham HJ, Pugh JA, Parchman M, Anderson RA, Crabtree BF, et al. Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science. Implementation science : IS. 2014 Nov;9:165.
Leykum, Luci K., et al. “Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science.Implementation Science : IS, vol. 9, Nov. 2014, p. 165. Epmc, doi:10.1186/s13012-014-0165-1.
Leykum LK, Lanham HJ, Pugh JA, Parchman M, Anderson RA, Crabtree BF, Nutting PA, Miller WL, Stange KC, McDaniel RR. Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science. Implementation science : IS. 2014 Nov;9:165.
Journal cover image

Published In

Implementation science : IS

DOI

EISSN

1748-5908

ISSN

1748-5908

Publication Date

November 2014

Volume

9

Start / End Page

165

Related Subject Headings

  • Uncertainty
  • Quality Improvement
  • Professional Practice
  • Patient Participation
  • Observational Studies as Topic
  • Humans
  • Health Policy & Services
  • Delivery of Health Care
  • Acute Disease
  • 52 Psychology