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Complex Adaptive Systems as a Model for Evaluating Organisational Change Caused by the Introduction of Health Information Systems
 

Complex Adaptive Systems as a Model for Evaluating Organisational Change Caused by the Introduction of Health Information Systems

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Paper presented at Health Informatics Society of Australia Conference 2009, Canberra Convention Centre

Paper presented at Health Informatics Society of Australia Conference 2009, Canberra Convention Centre

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  • This is a representative sample of the proportions of different staff. No night staff yet, but coming.
  • Field notes from management meetings, research reporting meetings, “keeping an eye on the industry” (e.g. I know that some s/w is closely aligned to documentation competence training) . Communication with other people on the research team on parallel projects.
  • Asking the question what are the effects of change. Management, care and staff effects (there could be more)
  • Political/regulatory: move from RCS (doc based funding) to ACFI (assessment based funding). <br /> Demographic: Ageing workforce, age of nurses in RAC
  • We&#x2019;ll look at the inputs in this system after looking at complexity in more detail first.
  • Content versus process - perhaps &#x201C;are efficiency and effectiveness the same thing&#x201D;?
  • process v content and efficiency (quality) v effectiveness (quality) link. Is efficiency the same as effectiveness. From the perspective of a worker on an assembly line it is. From a nurses perspective it isn&#x2019;t
  • So now we start to reconcile how to understand this from a complexity viewpoint.
  • Efficiency v effectiveness: quantity versus quality - showering a resident efficiently (i.e. in the allotted time) is not necessarily effective (interpersonal dimension)
  • Understanding Resources and understanding Surprisal.
  • This emergent role is in part created by the new assessment based funding model, but also seems to work well with the electronic system due to improved oversight. Having someone &#x201C;in charge of&#x201D; docs (ownership) can positively influence completeness and accuracy. But they still need to perform some floor tasks, while delegating others.
  • A population of PCWs with good training and awareness of the capabilities of the system can drive critical mass of adoption. <br /> <br /> One interesting alternative approach (especially on paper based system) - night staff as documentation auditors. However this is a discretionary role (night nurse&#x2019;s choice)

Complex Adaptive Systems as a Model for Evaluating Organisational Change Caused by the Introduction of Health Information Systems Complex Adaptive Systems as a Model for Evaluating Organisational Change Caused by the Introduction of Health Information Systems Presentation Transcript

  • Complex Adaptive Systems as a Model for Evaluating Organisational Change Caused by the Introduction of Health Information Systems Kieren Diment1, Ping Yu1, Karin Garrety2, 1. Health Informatics Research Lab, Faculty of Informatics, University of Wollongong, NSW 2. School of Management, University of Wollongong, NSW PhD Scholarship funded by ARC Linkage Grant held by Dr Ping Yu: Introducing computer-based nursing documentation into residential aged care: A multi-method evaluation of success
  • Study Focus: Introduction of electronic nursing documentation into residential aged care facilities
  • Residential Aged Care (RAC) • Physically and emotionally demanding work • Most carers have limited computer experience • Humanitarian/vocational occupation • not a way to get rich!
  • Study Sites • One management group (so far ...) • High Care • Low Care • Mixed Care
  • • 58 Interviews • Managers / Deputies (N=10) • Registered Nurses (N=9) • Enrolled Nurses (N=6) • Personal Care Workers (N=25) • Others (N=8) • Recreation Officers (N=5) • Physiotherapy Assistants (N=2) • Carer “promoted” to administration (1)
  • Additional Data • Management meetings • Working group meetings • Research reporting meetings • RAC Software Industry • Collaborative research
  • Evaluating Organisational Change In the Nursing Home Management effects Interaction effects Care effects Staff effects
  • Management effects Interaction effects Care effects Staff effects
  • Understanding management effects are relatively straightforward Management’s relationship with nursing documentation: • Need to retrieve information • Need complete information • Concern with resource use and availability
  • Other effects less so ... Management effects Interaction effects Care effects Staff effects
  • Management effects Complex Adaptive Systems Interaction effects • “Systems with multiple elements adapting or reacting to the pattern these elements Care effects 1 Staff effects create.” 1. Arthur, W. B. (1999). Complexity and the economy. Science, 284(5411), 107.
  • Understanding complexity Management effects Intersects represent multiple interacting elements Interaction effects Care effects Staff effects
  • Part of an Open System External forces*: Political Economic Demographic Regulatory *In no particular order
  • Part of an Open System ... External forces: Political Economic Demographic Regulatory Image © National Geographic Society Constant inputs from somewhat unpredictable external forces
  • Part of an Open System ... External forces: Autonomous system reacting to its environment Political Economic Demographic Regulatory Image © National Geographic Society Constant inputs from somewhat unpredictable external forces
  • Complex systems are not in equilibrium • Require a constant input of energy (aka resources) to retain their function • Change introduction will increase resource use • Energy use should plateau to an optimum post-change
  • Complex systems are not in equilibrium • Understanding the flow of energy/resources • Helps us to optimise decision making
  • Is Aged Care eDoc Implementation complex? • Is the process rational (i.e. purely governed by logic?) • i.e. Do we have a predetermined, optimum, logically derived set of objectives?1 • Content versus Process - what we do versus how we do it? 1. After Macintosh, R, & Maclean, D. (1999) Conditioned emergence: A dissipative structures approach to transformation. Strategic Management Journal, 20(4), 297–316.
  • Examples of management systems governed by content: Assembly lines (Many) Call centres
  • Content driven systems: Tasks are clearly defined Tasks are determined by fairly rigid scripts Outcomes are deterministic (Newtonian) Some aspects of RAC are mechanistic. Many are not.
  • RAC Duties • Although tasks are clearly defined, the high level of personal contact with clients and colleagues introduces complexity • Busy, demanding high productivity environment • Residents are in final years • Frail and in pain. • Will die (“pass on”) at end of care. • Introduces requirement for high levels of sensitivity to workers’ environment.
  • RAC Duties High levels of sensitivity require attention to process as well as content This introduces complexity and unpredictability.
  • Entropy? • In thermodynamics, entropy is the measure of the uniformity of distribution of energy in a system. • In information theory, entropy is a (statistical) measure of the content of a communication (and has a unit called surprisal!)
  • Entropy? • Non-equilibrium system requires input of resources (energy). • Nursing homes require input of resources through funding, staffing and resident throughput.
  • Entropy? • Initial input of resources for implementation: • IT infrastructure • Training • } Software use quasi-independent • Awareness
  • Entropy? • Resources are obtained from: • Funding • Staffing • Resident turnover • Outputs: • Resident care
  • Entropy? Resource consumption before change } Resource input to start change Is there an optimum? Resource consumption during change Optimum efficiency Optimum effectiveness? Resource consumption at end of change
  • Why Entropy? A useful metaphor/abstraction: • As resources are consumed, results dissipate into the environment. • The resources are consumed to a purpose • Not all resource allocation goes directly for intended purpose
  • Why Entropy? Can account for phenomena before during and after change.
  • Why Entropy? A metaphor for use with the systems view.
  • An Example Documentation strategy Management/Carer interaction
  • Emergence of Nursing Documentation Specalist: A change in resource use. • Performs and co-ordinates assessments. • Gathers data from electronic or paper system. • Oversees and performs care planning. • Reduces doc load on other staff.
  • Emergence of Nursing Documentation Specalist: A change in resource use. • Gathers data from electronic or paper system. • Requires other users’ cooperation • And use of the system
  • Emergence of Nursing Documentation Specalist: A change in resource use. • Requires • working close to the floor • monitoring and delegation • Alternative: • Can be split between managers and registered nurses.
  • Conclusion • The complexity approach allows us to focus on the systems view of the organisation. • Focuses on resource input required to maintain state. • Allows us to identify and evaluate multiple competing factors • May be amenable to scenario simulation.
  • Part of an Open System ... Image © National Geographic Society Constant inputs from somewhat unpredictable external forces
  • Part of an Open System ... Image © National Geographic Image © Creative Commons Rowen Atkinson http://www.flickr.com/photos/scttw Society Understand how to maintain appropriate control in an unpredictable environment
  • Contact: kd21@uow.edu.au http://www.uow.edu.au/~kd21/ace