Complex Adaptive Systems in Healthcare

Kathryn Moultrie

Clinical Microsystem

According to Freshman, 2010, et al p. 19-20, complex high delivery healthcare delivery systems are the intricate framework of “relationships” (groups), within an organization that provides health care in our complex society and environment. These relationships should represent the multiple interactions with roles of each member. The line between those within the system, and those outside systems should remain clear; every system has ways of including and excluding elements. The coalitions (partnerships) formed are a necessity, the boundaries must remain open as to not isolate any member. Communication between members is the rules that keep the group stable, as well as information exchange with positive feedback, which in turn makes the outcomes of the groups as a whole effective. A clinical microsystem is the combination of a small group of people who work together in a definite setting on a regular base or need to provide care and the individuals who receive that care, are recognized as a member of the group to (Freshman, 2010, et al p. 19-20, 21-23 and Complex Adaptive Systems in Healthcare, Video (n. d.).

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The system (at work), that I would like to  better understand are the aspects of the “system”, of our Patient Aligned Care Team (PACT) which consist of 5-6 individuals including a Travel Nurse coordinator (TVC). Systems in general, according to Freshman 2010, et al p. 20-23, are made up of groups of individuals (“well-oiled machines”); however in healthcare some systems (like ours) are often excluding, isolating, lack of knowledge and obscure to their users who are the Veteran/patients, physician nurses, and staff, essential elements of a microsystem. Our organizations constructed clinical microsystems, involves the Veteran/Patient, Aligned Care Team (PACT), the PCP, Nurse, and Travel Nurse Coordinator (TVC). This system designed for providing clinical care (while the Veteran is traveling) that is based on theories of patients’ knowledge  organizational development, leadership and quality improvement in the paradigm of continuum of care (Freshman 2010, et al p. 20-23 and Mack 2017 Nu 414 Interprofessional Teams Discussion Board posts p. 1).

Part 2 Sociogram

A sociogram is a graphic representation which serves to reveal and analyses the relationships within the group and the environment of health and education services, however I found it difficult to draw a sociogram, for mapping the emotional/ functional dynamics of this group/unit, instead I have instead discussed the aspect of the system to understand better. The “system”, of our Patient Aligned Care Team (PACT), (related to care of the Veterans while traveling), which includes patient/family, PCP, TVC (RN), nurse (PACT), social worker (PACT), or others. The primary objective, as a group is the ability of these individual to communicate and collaborate effectively and to ensure that no elements are excluded so that the line between those within the system and outside of the system is clear to all. The open boundaries include closed boundaries’ isolate. Information exchange increases knowledge,  and would have a positive outcome of the group as a whole (Freshman 2010, et al p. 20-23 and Mack 2017 Nu 414 Interprofessional Teams Discussion Board posts p. 1).

Part 3: The Complexity of the Work of the Registered Nurse in Practice.

The complexity of the work of the Registered Nurse (RN), in practice, is the freedom to make clinical judgement choices and actions relevant to their clinical practice. This often also involves, other work activities related to the daily functioning of the nurses individual unit as well as other parts of the unit or hospital or even interdisciplinary team. The registered nurse must be skillful in a given moment to evaluate the situation; this is referred to “trade-off decisions”. Making a “trade-off” decisions, involves the critical evaluation of a given situation, the interpretation of patient’s information, and to then to make critical decisions about the needed actions (Ebright, P., 2010 and Cook, R., & Woods, D. 1994).

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An example of a situation in which I had to make a  “trade-off ” decision in my professional practice was as following; stay with a dying patient (with a  do not resuscitate (DNR) order) and her(very upset), husband, demanding that I explain why his wife received pain medication without his permission, take report on new admission (slightly unstable myocardial infarction (MI) low heart rate and low blood pressure) from the ED, make sure the assigned room was prepared with all the necessary equipment for the (slightly unstable myocardial infarction (MI), patient  being admitted, and providing support to an experience ICU registered nurse (RN) new to, continuous venous-venous hemodialysis (CVVHD), her second day with patients, and the machine is alarming (Moultrie 2017).

I chose the latter (continuous venous-venous hemodialysis (CVVHD), her second day with patient, and the machine is alarming). This decision did not impact the care of other patients, because through collaborating with the nurse manger attended the husband of my dying patient, our units’ resource nurse, her role and responsibility is the support, intervene in any “trade-off” situations, took the report and delayed admission of the new stable MI patient. The “trade-off” decision did not impact the interprofessional team as a whole due to the dynamics of our group/team and the effective collaboration and communication of the team as a whole (Moultrie 2017).

In conclusion, consideration of the complexity (difficulty) of providing and giving nursing care is essential for managing changes that demand “trade-off, and at the same time, decisions that will effectively promote healthier work environments and the safety of the nurses assigned patients.. In most health care facility settings, whether the locations are acute care inpatient, emergency room or outpatient (Ebright, P., 2010 and Cook, R., & Woods, D. 1994).