Complex systems in medicine, 1st ed , david c aron, 2020 3951

253 0 0
  • Loading ...
1/253 trang
Tải xuống

Thông tin tài liệu

Ngày đăng: 08/05/2020, 06:56

Complex Systems in Medicine A Hedgehog’s Tale of Complexity in Clinical Practice, Research, Education, and Management David C Aron 123 Complex Systems in Medicine David C. Aron Complex Systems in Medicine A Hedgehog’s Tale of Complexity in Clinical Practice, Research, Education, and Management David C. Aron School of Medicine and Weatherhead School of Management Case Western Reserve University and Cleveland Veterans Affairs Medical Center Cleveland, OH USA ISBN 978-3-030-24592-4    ISBN 978-3-030-24593-1 (eBook) © Springer Nature Switzerland AG 2020 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword You are either a highly educated person, curious, or a fool for picking up a book with such an obtuse title You might be so bored you are reading the labels of food products in your kitchen But your instincts are sound; you are in for a treat David demystifies one of the most complex systems in our society  – our health care Actually, it is a set of embedded complex systems, like Russian Matryoshka dolls Open the first doll, and inside of the health-care system, you discover an organizational complex system Open that and you discover a physician-patient relationship Open that and you discover the complex system of the human body Open that and you discover the complex system of mitochondrial DNA The treat is that David explains each and every level of complex systems! He engages you with endearing personal and patient stories Then, he explains the intricate details of the processes and components as the insightful scholar and professor that he is You end each chapter with a profound set of insights about what goes into the process of being healthy and trying to make you healthier If all you wanted to get out of this is an answer as to how to make our health-care system more accessible and lower cost, let me save you time Lose weight, stop smoking, eat the correct foods, and exercise If, on the other hand, you wish to understand why successive administrations and Congresses of the United States fail to keep up with the medical innovations in recrafting our health-care system, you will see why so many cannot grasp how to change a truly multilevel, complex system When I was designing interplanetary vehicles in my first career, I thought such rockets and ships were complex systems Little did I know or contemplate many puzzles I would learn about health and getting health care as I aged Nor did I comprehend how the systems within which I operated as a clinical psychologist in the Veterans Health Administration hospitals as I began my second career In the early chapters, David will explain how a complicated system is to a complex system like checkers is to chess (or Go) When I began analyzing human behavioral change, I realized that my training in physics and materials science was important Although counterintuitive, little in life and human behavior is linear Few of the intentional or desired change processes are continuous For those of us who are volumechallenged, we know that being on a diet does not mean you lose half a pound a day v vi Foreword Some days you lose two pounds Some days you lose nothing Some days you gain a pound or two If there is a longer-term trend toward losing weight, it has most likely occurred in “fits and starts.” It seems random It is not; it is merely chaotic When moments of consciousness or awareness of a new state occur, the realization feels sudden and often a surprise That is a moment of emergence In the early days of complex systems scholarship, it was called catastrophe theory Scientists pondered how and why one moment water was a liquid, and then all of a sudden, it became ice and a solid We wondered how we could predict weather In Boston, the old adage is if you don’t like the weather, wait a minute and it will change The quest was to understand the seemingly chaotic nature of weather Materials and climate science became a focus of these nonlinear dynamics Others puzzled how to understand economic booms or busts, like the tulip craze in the seventeenth century Holland, or why supposedly savvy investors would pay exorbitantly high stock prices for a new, high-technology start-up company that has not earned any profits for several years Many were introduced to these puzzles and the development of catastrophe theory, chaos theory, complex adaptive systems theory, and now more simply complex systems or complexity through popular fiction and their movies from writers such as Michael Crichton This is a world in which linear assumptions about motivating physicians and nurses through new metrics, specific goals, and dashboards seem out of place and, in fact, don’t work as forces of change It was somewhere in the fourth decade of studying desired behavioral change that my neuroimaging and hormonal studies explained why a person’s dream or personal vision is more powerful in sustaining change efforts than specific goals The entire process of learning and sustained behavioral change is better understood with the complexity concepts David uses in this book than our current mythology in management circles Like Indiana Jones, David Aron has slogged through the jungles of obesity, diabetes, endocrinology, and quality improvement in hospitals He shows us why disruptive innovations, like urgent care centers in CVS or Walgreens, are transforming health care and why telemedicine might truly democratize access to our health-care system But these innovations did not occur with logical, strategic planning You ever wonder why treatment adherence (i.e., doing the things that your physician or nurse tells you will improve your recovery or health) is about 50% in most countries of the world for type II diabetics It appears the same for orthopedic surgery (i.e., broken ankle or knee replacements) Foreword vii Don’t feel constrained by some traditional logic that this book should be read chapter by chapter in sequence This is not a John Grisham thriller or James Peterson detective story Except for the first few chapters that introduce the concepts used throughout, the reader should follow his or her interest and bounce around Complexity and research in human learning suggests that it will result in more retention of what you read In other words, you might learn better from this fascinating and insightful exploration into health and health care Richard E. Boyatzis Distinguished University Professor Case Western Reserve University Cleveland, OH, USA Coauthor of the international best seller Primal Leadership and the New Helping People Change Acknowledgments This book could not have been written without the help and inspiration of many others Of these, no one has been more important than my wife of 48 years, Vicky There were many times at which I would have been happy to throw in the towel but didn’t so because of her My son, Joshua, has never been far from my mind and my parents, Paul and Beatrice, have continued to inspire me years after they died The poem There Are Stars by Hannah Senesh says it better than I could ever I have also learned much from my friends and colleagues Top of the list is Len Pogach who as a crusader for the destruction of “quality” measures that result in harm care  – the one ring  – has been an inspiration I have been privileged to be Samwise to his Frodo I have always learned more from my students than they have from me This includes the hundreds of medical students and other physician trainees at Case Western Reserve University and the Cleveland Veterans Affairs Medical Center with whom I have had interactions as a lecturer, small group leader, and ward or clinic attending Special appreciation is deserved by the fellows in the VA Quality Scholars Program and students in the Doctorate in Management Program at the Weatherhead School of Management I have also been privileged to mentor many fine individuals at various stages of their careers, and mentoring is a two-way street Five months as a visiting fellow at Clare Hall (College) and the Department of History and Philosophy of Science, the University of Cambridge provided me time to write and extraordinarily stimulating academics Every lunchtime at Clare Hall was an adventure in learning There was an unwritten rule that one should not sit at an unoccupied table, so I ended up participating in conversations with other fellows and graduate students on diverse topics in both the sciences and humanities The academic environment of Clare Hall (which advertises itself as a place to think) and Cambridge in general is beyond compare I want to acknowledge several people who have read this book at various stages in its development These include Stephen John, my faculty sponsor at the University of Cambridge; Mark Tonelli, Rafael Scholl, and Arne Thorvik who were co-­ participants in the Philosophy and Medicine Reading Group; Dawn Linn, a VA Quality Scholars fellow; Samira Askarova, a student at Weatherhead; Richard Boyatzis and Richard Buchanan, faculty at Weatherhead; and Rene Hearns, research ix x Acknowledgments administrator for my unit here I have made many revisions and corrections based on their suggestions, but the responsibility for any and all remaining errors are mine alone I have used the university’s plagiarism detection software (how pathetic that there is such a thing, but a sign of the times I guess) and did my best to ensure that I have cited everything appropriately If there are any mistakes, I will correct them in a future edition (how optimistic of me, but dum spiro spero) About the Author David C. Aron, M.D., M.S.  is director of Clinical Program Research and Education at the Cleveland VA Medical Center He is a clinical endocrinologist, health services researcher, and leader of the VA Quality Scholars Fellowship Program, a training program in quality improvement He is professor of Medicine and Epidemiology and Biostatistics at the School of Medicine, Case Western Reserve University He is also adjunct professor of Organizational Behavior at the Weatherhead School of Management where he teaches a class on Managing Complex Systems He is a graduate of Columbia College (1971) and College of Physicians and Surgeons (1975) In 2018, he was a visiting scholar in the Department of History and Philosophy of Science and visiting fellow at Clare Hall (College), University of Cambridge, where the writing of this book began A former laboratory bench researcher, his current research interests are eclectic and have included health services and implementation research related to quality measurement and improvement, especially diabetes-related, and, most recently, applications of principles of complex systems However, as has often been the case in the past, exactly what he will be working on, even in the not too distant future, cannot be predicted with any certainty xi 240 Appendix: Syllabus for EDMP 673: Complex Systems c­ oncepts and principles of complex systems and how they relate to real world problems including your own management practice and research The purpose of this course is to try to come to some conclusions, however tentative, about what this all means and what the implications are for management practice and management research Specifically, I hope that you find ways in which the information and methods you learn here can apply in your own work whether it be research or practice or both My own views about complexity and complex systems continue to evolve and I hope to learn from this course just as I hope that you Objectives  By the conclusion of this class, participants should be able to: • Describe how complexity theory/sciences differ from other ways of understanding and interpreting problems? • Describe the basic concepts and principles of complex systems • Identify aspects of complexity theory that have implications for how you conduct your practice and your research In sum, the goal is to be able to look at an issue from a perspective of complex systems, through a “complexity theory lens” so to speak In contrast to EDMP677 which addresses, among other things, “some of the complex interdependencies between human systems and natural systems,” EDMP will focus on human systems themselves Who Will Be Teaching the Course  I am in my 44th year of postgraduate training Most of my career has been in the medical field and I am a relatively recent addition to the Dept of Organizational Behavior In addition to an MD degree from Columbia, I obtained the M.S degree in Clinical Research Design and Statistical Analysis from the University of Michigan in 1995 So, no MBA degree! As a practicing physician (endocrinologist), researcher and former Chief of Medicine at the Louis Stokes Cleveland Veterans Affairs Medical Center (so no private sector business experience!), I have had the opportunity to experience firsthand the intersection and overlap between research and operations The relationship between the two has often been completely non-intersecting-two separate worlds To quote Charles Lindblom (author of Muddling Through, a classic paper): “Many suppliers and users of social research are dissatisfied, the former because they are not listened to, the latter because they not hear much they want to listen to (Lindblom & Cohen, 1979) Helping bridge the gap between the two worlds has become a major area of interest, although I have a rather short attention span and my research areas have been eclectic in the extreme In fact, as has often been the case in the past, exactly what I will be working on, even in the not too distant future cannot be predicted with any certainty (Sort of like a chaotic system with a strange attractor.) A Few Words of Caution  One of the characteristics of complex systems is the phenomenon of emergence, sometimes described by the maxim that the whole is greater than the sum of its parts, though it would be more accurate to consider an emergent property as being a different category than its parts This is part of the micro-/macroproblem that is the core problem of complex systems science (One could argue that Appendix: Syllabus for EDMP 673: Complex Systems 241 it is the core problem period.) Moreover, one cannot readily predict (or possibly predict at all) this emergent property How this class plays out will depend at least in part on our individual histories, our interactions, and unpredictable factors; the syllabus and assignments are subject to change at any time Something will emerge The syllabus of this class has been modified considerably compared with last year’s syllabus This reflects evolution of my own thinking about the topic as well as feedback from the class My goal is to facilitate our learning together in such a way that the insights you gain will inform your future work Readings: Required: • Mitchell M (2009) Complexity: A Guided Tour Oxford University Press, Oxford UK • Boulton JG, Allen PM, Bowman C (2015) Embracing Complexity: Strategic Perspectives for an Age of Turbulence Oxford University Press, Oxford UK Optional but recommended: • Bar-Yam Y.  Making Things Work Solving Complex Problems in a Complex World (2004) NECSI Knowledge Press, Boston MA I have listed specific chapters as required reading, but it is recommended that you read the books in their entirety Other readings (required and recommended) will consist of articles that will be posted on Canvas You are encouraged to peruse the annotated bibliography Course Software  There is none We will be taking a more qualitative/conceptual approach in general However, for those interested, there are some free programs that I may be using for some of the demonstrations and you may want to play around with them, e.g., Netlogo (for agent based modeling http://ccl.northwestern edu/netlogo/) Format  Class discussion will be the main format along with some lectures and exercises Discussions will be based on readings and I have provided some discussion questions to get things started; questions that you come up with are encouraged I will build enough flexibility into each class program so that we can deal will issues that emerge Course Requirements  Read, actively participate, complete assignments and have fun I am very serious about the fun part Evaluation  I have tried and failed at various schemes for evaluation and have settled on a purely qualitative approach I aim to provide helpful feedback, especially specific comments on your work These comments will often be in the form of questions If I think that you an assignment reflects an inadequate understanding of the underlying topic, I may ask for a revision Assignments will be given in the slides provided during each residency All assignments are due within 10  days after 242 Appendix: Syllabus for EDMP 673: Complex Systems r­ esidency during which they are assigned Just as important as my evaluation of you is your evaluation of me and the class itself It is not important what I teach; it is important what you learn If you are not learning, I have a responsibility to a better job teaching I will need your feedback to accomplish this Code of Ethics  Frankly, if you can’t tell right from wrong at this point in your life, providing you with the WSOM Statement of Academic Integrity is not going to help much Course Outline (Topics and Assignments) Jan 19, 2019 Residence Characteristics of complex systems Overview of course, definitions of complexity and characteristics of complex systems The first part of this session will address the questions of what is complexity and why is complexity theory/science worth studying in a doctoral program in management The second part will address some of the characteristics of complex systems Pre-session Reading: Required •  Mitchell – Chapters 1, 2, •  Boulton, Allen and Bowman – Chapters 1, 2, • Johnson S. The Ghost Map: The Story of London’s Most Terrifying Epidemic – and How It Changed Science, Cities, and the Modern World” (Riverhead) see Canvas for Chapters and You might like it so much that you obtain the book • Ramalingam B and Jones H with Reba T and Young J (2008) Exploring the science of complexity: Ideas and implications for development and humanitarian efforts 2nd ed Overseas Development Institute, London UK. Downloadable from: is describes a series of concepts of complexity Read Page • Richardson KA. Managing complex organizations: complexity thinking and the science and art of management E:CO 2008;10:13–26 • Boisot, M. H., & McKelvey, B (2010) Integrating modernist and postmodernist perspectives on organizations: A complexity science bridge Academy of Management Review, 35(3), 415–433 • Meyer AD, Gaba V, Colwell KA. Special Issue: Frontiers of Organization Science, Part of 2: Organizing Far from Equilibrium: Nonlinear Change in Organizational Fields Organization Science September/October 2005 16:456–473 • Jayanti EB. Through a different lens: a survey of linear epistemological assumptions underlying HRD models Human Resource Development Review 2011;10:101–114 Recommended • Morin, E (2007) Restricted Complexity, General Complexity, in: C. Gershenson, D. Aerts & B. Edmonds (eds) Worldviews, Science and Us, Philosophy and Complexity (London, World Scientific) pp. 5–29 • Hollingsworth R, Muller K. Transforming socio-economics with a new epistemology Socio-Economic Review 2008: 1–32 • Mathews MK, White MC, Long RG. Why study the complexity sciences in the social sciences? Human Relations 1999;52: 439–462 Appendix: Syllabus for EDMP 673: Complex Systems 243 In Class Questions for Discussion • What we mean by complexity, how does it differ from complicated, and how might we recognize it when we see it? • Why complexity theory(ies)? What are the limitations of classical (?) orthodox (?) methods of research that complexity theories try to address? • Which concepts of complexity (cited by Ramalingan and Jones (p. 8) are evident in the first two chapters of The Ghost Map? Post Session Assignment to be submitted within 10 days after the residency Reflection paper about how complexity theory might apply in your area of interest research and/or practice The paper should integrate the readings, class presentations and discussions and either relate the subject matter to your own research and/or experience or provide a new idea or insight A summary of the readings or presentations does not meet this requirement Feb 23, 2019 Residence Characteristics of complex systems continued; Metaphors and models Pre-session Reading: Required •  Boulton chapters 4–6 • Ketterer JJ. Chaos and complexity: the uses of the foremost metaphor of the new millennium International Management Review 2006;2: 34–55 • Dolan SL, Garcia S, Diegoli S, Auerbach A.Organisational Values as “Attractors of Chaos”:, An Emerging Cultural Change to Manage Organisational Complexity J Economics • Houchin K., MacLean D. Complexity Theory and Strategic Change: an Empirically Informed Critique British Journal of Management Volume 16, Issue 2, pages 149–166, June 2005 • Page S. The Model Thinker (Prologue, Introduction and Chap 1) Basic Books 2018 There used to be a version available for free online, but it looks like he has monetized it •  Epstein J. Why Model? Recommended • Jonathan Rosenhead Complexity theory And Management Practice 1998 com/site/hetnieuwedenken/complexiteit In Class Questions for Discussion Why model? What are the models that you are applying to your problems of practice? 8-8:30 Reality check 8:30-11:30 Game play and debrief 11:30-12:00 Theories and Models Part Noon-12:30Lunch 12:30-1:30 Models Part 1:30-2:30 Group Work and presentations 2:30-3:00Questions/Wrap-up Post Session Assignment to be submitted within 10 days after the residency Conceptual model of your problem of practice as you originally thought about it before you started this semester and provide enough explanation so that anyone looking at it and the figure legend will understand it 244 Appendix: Syllabus for EDMP 673: Complex Systems ~ Mar 9, 2019 Residence Virtual Networks Pre-session Reading: Required •  Mitchell – Chapters 15,16 •  Christakis NA1, Fowler JH. The spread of obesity in a large social network over 32 years N Engl J Med 2007 Jul 26;357(4):370–9 NEJMsa066082 •  Barabási A-L, Bonabeau E Scale-Free Networks Scientific American 288, 50–59 (2003) •  Barabási A-L The network takeover Nature Physics 8, 14–16 (2012) •  A.-L. Barabási A-L Taming complexity Nature Physics 1, 68–70 (2005) • all the Barabasi articles can be downloaded from this site Assignment Connections to (Kevin) Bacon Go to the Oracle of Bacon Gregory Peck website ( It is quite intuitive For example, Gregory Peck has a Bacon number of (a low was in number) Your goal is to identify an actor with a very high The Big Country (1958) Bacon number View the lecture on Blackboard with Roddy McDowall was in The Big Picture (1989) with Kevin Bacon Recommended • Padgett JF, Ansell CK. Robust action and the rise of the Medici, 1400–1434 Am J Sociology 1993:98:1259–1319 • Brown T. Differences by degree: fatness, contagion and pre-emption Health (London) 2014 Mar;18(2):117–29 In Class Questions for Discussion Did you find an actor with a Bacon number > 4? How difficult was it? Why? Is obesity contagious? What about other examples of social contagion What questions are raised by the lecture? Post Session Assignment to be submitted by March 16 I am giving you extra time to find a good paper Find a scientific article on the topic of complexity as applied to your area of interest Creative searching with Google Scholar should readily identify such papers Write a three page paper critiquing the article Provide an introduction, summarize the article, then critique In particular, address how complexity is used If it is used metaphorically, then assess whether the metaphor works In addition, create a powerpoint presentation based on your critique – maximum 10 slides Submit your paper, the paper you are critiquing, and the powerpoint file (by March 16) Be prepared to present your work in class Appendix: Syllabus for EDMP 673: Complex Systems 245 Mar 23, 2019 Residence Resilience, Research with Complex Systems Pre-session Reading: Required •  Taleb N • Decker S, Cilliars P, Hofmeyr J-H. The complexity of failure: implications of complexity theory for safety investigations Safety Science 2011;49,939–945 • Bendell T. Building anti-fragile organisations: Risk, opportunity and governance in a turbulent world (this used to be available for download; I will see if I can put it on blackboard.) • Johnson J, Gheorghe AV. Antigragility analysis and measurement framework for systems of systems Int J Disaster Risk Sci 2013;4: Recommended • Eve Mitleton-Kelly, (2011) “A complexity theory approach to sustainability: A longitudinal study in two London NHS hospitals”, Learning Organization, The, Vol 18 Iss: 1, pp.45–53 • Luci K Leykum, Jacqueline Pugh, Valerie Lawrence, Michael Parchman, Polly H Noël, John Cornell and Reuben R McDaniel Jr Implementation Science 2007, 2:28 doi:https://doi org/10.1186/1748-5908-2-28 In Class Questions for Discussion •  Why all companies eventually fail, but cities usually don’t? Post Session Reading Post SessionAssignment to be submitted by April 18 Paper: Analyze your problem of practice through a complexity lens In a sense this is a reflection paper which integrates the readings, class presentations and discussions and applies them to your problem of practice How has your conceptualization of your problem of practice changed (if at all)? You may wish to draw a new model In addition to a paper (3–4 pages) due April 18, prepare a series of powerpoint slides (no more than 10) for presentation at the last residence ~ Apr 13, 2019 Residence Virtual Wicked Problems Pre-session Reading: Required •  Boulton chapters 7–10 •  Mitchell – chapter 19 •  Conklin J. Wicked problems and social complexity  •  Camillus JC. Strategy as a Wicked Problem HBR 20018:May: 99–106 • Dentonia D, Ross RB Towards a Theory of Managing Wicked Problems through MultiStakeholder Engagements: Evidence from the Agribusiness Sector International Food and Agribusiness Management Review Volume 16, Special Issue A, 2013 • Ireland V, Rapaport B, Omarova A. Addressing wicked problems in a range of project types Procedia Computer Science 12 (2012) 49–55 • Grint K. Wicked Problems and Clumsy Solutions: the Role of Leadership Clinical Leader, Volume I Number II, December 2008 Keith-Grint-Wicked-Problems-handout.pdf Recommended • Rittell HWJ, Webber MM. Dilemmas in a general theory of planning Policy Sciences 1973;4:155–169 246 Appendix: Syllabus for EDMP 673: Complex Systems In Class Questions for Discussion • What is the significance of the concepts “emergence,” “nonlinearity” and self-organization for our understanding of wicked problems? • How does the concept of complex adaptive system inform your understanding of your wicked problem and your ability to cope with it? • What is your own wicked problem? What makes it wicked? How are you going to approach it? Post Session Assignment See prior assignment Apr 27, 2019 Residence Sensemaking, Applications of Complexity, and Wrap-Up Pre-session Reading: Required •  Boulton chapter 11 • Snowden, D., & Boone, M. E (2007) A leader’s framework for decision making Harvard Business Re-view, 85(11), 68–76 • Glouberman S, Zimmerman B. Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like? Commisssion on the Future of Health Care in Canada Discussion Paper 2002 Read the introductory material and the Brazil Case pp 1–20 Systems_What_Would_Successful_Reform_of_Medicare_Look_Like • Ali, I (2014) Methodological approaches for researching complex organizational phenomena Informing Science: the International Journal of an Emerging Transdiscipline, 17, 59–73 • Klieb L, Rhoades M, McKelvey B. Towards a more rigorous foundation of complex adaptive systems in management science: dealing with misnomers and metaphors Adaptive 2014: The Sixth International Conference on Adaptive and Self-Adaptive Systems and Applications 2014 • M. San Miguel, J.H. Johnson, J. Kertesz, K. Kaski, A. Dıaz-Guilera, R.S. MacKay, V. Loreto, P ´Erdi, and D. Helbing Challenges in complex systems science Eur Phys J. Special Topics 214, 245–271 (2012) Recommended • Lepmets M, et al A Cynefin based approach to process model tailoring and goal alignment • Weick, K. E 1993 The collapse of sensemaking in organizations: The Mann Gulch disaster Administrative Science Quarterly, 38: 628–652 • Maitlis S, Sonenshein S. Sensemaking in Crisis and Change: Inspiration and Insights From Weick (1988)joms_908 551–580 Journal of Management Studies 47:3 May 2010 • D. Helbinga Accelerating scientific discovery by formulating grand scientific challenges Eur Phys J. Special Topics 214, 41–48 (2012) Appendix: Syllabus for EDMP 673: Complex Systems 247 In Class Guest Speaker: Lee Hoffer, PhD Dept of Anthropology Complexity and the Drug Epidemic Questions for Discussion (if there is time) The Brazil Case: It is a nice story, but is it an application of complexity theory? What is/are the role/s of a leader in a complex system? What you think about Pollitt’s three questions: (1) What kind of animal is complexity theory – epistemologically and ontologically? (2) How is one supposed to “do” complexity theory? What are the most typical and appropriate methods? (3) What is the added value of complexity theory – how and for what does it generate more powerful explanations than the alternative theories which are already available? Post Session Assignment Apply in the future what you have learned And have fun There is a myriad of books on complexity and complex systems that range from historical overviews to highly mathematical treatises Here is a very brief annotated bibliography I will add to this on Blackboard Annotated Bibliography A. Reference Texts Allen P, Maguire S, McKelvey B (Eds) (2011) The Sage handbook of complexity and management A comprehensive text Meyers RA, editor Encyclopedia of complexity and systems science New York: Springer; 2009 Over 10,000 pages on concepts and methods related to complex systems (primarily from a quantitative perspective) It is available in the CWRU electronic books section Sturmberg J, Martin C. Handbook of systems and complexity in health New York: Springer; 2013 Many chapters are relevant to management in general Downloadable from OhioLink Erdi P. Complexity explained 2008 [ISBN (H) 13–978-3-540-35777-3 Full Text is available for free download on OhioLink] Highly mathematical B. Other Books There Are Many, Many More Ball P. Why society is a complex matter: meeting twenty-first century challenges with a new kind of science New York: Springer; 2012 Application of complex systems approaches to a selection of interesting issues, e.g., cities, finance, disease, social contagion, war Downloadable from OhioLink Barabasi A-L Linked: the new science of networks New York: Basic Books; 2014 Beautement P, Broenner C Complexity demystified Axminster UK: Triarchy Press; 2011 Colander D, Kupers R. Complexity and the art of public policy: solving society’s problems from the bottom up Princeton: Princeton University Press; 2014 Extremely interesting Gleick J. Chaos New York: Penguin Books; 1987 A new edition is out, but only the forward is different This is basically a quick and fun read Goldstein J, Hazy J, Lichtenstein BB.  Complexity and the Nexus of Leadership Leveraging Nonlinear Science to Create Ecologies of Innovation New York: Palgrave-Macmillan; 2010 Jackson MC. Systems Thinking: Creative Holism for Managers Chichester, West Sussex: Wiley; 2003 Has a chapter on complexity that puts it in context Kuhn L. Adventures in complexity For organizations near the Edge of Chaos Axminster, UK: Triarchy Press; 2009 Miller JH, Page SE. Complex adaptive systems: an introduction to computational models of social life 2007 Miller JH. A crude look at the whole New York: Basic Books; 2015 A fairly easy read 249 250 Annotated Bibliography Mossman KL. The complexity paradox Oxford: Oxford University Press; 2014 Focused on biology in the broadest sense Nason R. It’s not complicated: the art and science of complexity in business Toronto: University of Toronto Press; 2017 Norberg J, Cumming GS, editors Complexity theory for a sustainable future New York: Columbia University Press; 2008 Page SE. The model thinker What you need to know to make data work for you New York: Basic Books; 2018 Ramalingam B. Aid on the edge of chaos Oxford: Oxford University Press; 2013 Application of complexity to international aid and development Strogatz S.  Sync: how order emerges from chaos 2003 [ISBN (P) 0-7868-6844-9 available in paperback] Waldrop MM. Complexity: the emerging science at the edge of order and chaos 1992(But a new edition has come out with a new afterward by the author) C. Other Bibliographies Chaos & Complexity Bibliography Complexity: an Annotated Bibliograpy Complexity – Annotated Bibliography Prepared for the Center for the Study of the Presidency Project on National Security Reform Fall 2008 very detailed Complexity/Dynamical Systems Annotated Bibliography in Progress http://darkwing.uoregon edu/~harrow/Complexity.htm Index A Acute leukemias, 159 Acute lymphoblastic leukemia (ALL), 163 Adrenocorticotropic hormone (ACTH), 4, 36 Aggregate complexity, 15–16, 50 AIDS, 163, 164 American Medical Association, 195 Analogy, 90 Anemia, 233 B Bacon study, 190 Biomedical model, 11, 151, 165 Biopsychosocial model, 13, 78 Broad Street pump, 181 Burning platform, 108 C Carbonic anhydrase inhibitors, 34 Cardiovascular diseases, 54 Causality, 124 Centers for Disease Control (CDC), 41, 191 CFTR Functional Landscape (CFFL), 155 Chaos theory, 203, 204 Chimeric antigen receptor T-Cell (CAR T), 161 Chronic disease, 43, 44 Chronic myelogenous leukemia (CML), 158 Cleveland Clinic (CCF), 210 Clinical diagnosis clinical reasoning, 35 hypoglycemia, 34 hypothyroidism and psychosis, 36 insulin, 34 © Springer Nature Switzerland AG 2020 D C Aron, Complex Systems in Medicine, Clinical inertia, 142 Clinical pathologic conference (CPC), 32 Clinical reasoning, 35, 36 Community-based outpatient clinics (CBOCs), 118, 119 Comorbidity, 38 Complex systems, 10, 145–147, 180, 181 chaos theory, 203, 204 cultures, 203 definition, 17 empirical data, 201 influential essay, 201 leading, 222–226 learning, 220–222 mathematical modeling, 204 metaphor, 204 qualitative analyses, 202 quantitative data, 201, 202 schools, 202 sophisticated mathematical modeling, 201 thinking, 217–220 Complexity CBOCs, 118, 119 Cleveland VAMC, 117, 118 Cobb’s paradox, 116 communication, 120 conceptual framework, 119 definition of, deterministic model, 16 diabetes patients, 120, 121 Diabetes Telemedicine Clinic, 117 diagnosis of, 16 health services research, 121 implementation and maintenance, 117 innovative intervention, 118 251 252 Complexity (cont.) International Project Leadership Academy, 116 joint-clinics teleconsultation intervention, 118 joint consultation, 121 non-VA-affiliated specialist, 120 patient-provider dyad, 118 PCPs, 121 quality improvement, 116 ramp of, referral process, 120 responsibilities and accountability, 115 telemedicine, 118 under-emphasis, 117 Complexity-inspired approach, 233 Compositional complexity, 14 Compositional context, 156 Conceptual models, 21, 22 Consolidated framework for implementation research (CFIR), 104 Context, 9, 134 active change process, 105 adaptable periphery, 105 authority, 103 best practices, 110–111 CFIR, 105 CICI framework, 106, 107 clinical trials, 102 collaboration, 104 complex adaptive systems, 108 decisions and recommendations, 101 domains, 104 environmental characteristics, 105 examples, 104 factors, 102 healthcare organizations, 105 health services research gibberish, 102 hypertension, 102 implementation science researcher, 101, 102, 104 inner setting, 105 interventions, 105, 106 in vitro, 102 knowledge translation, 102 organizational charts, 103 organizational/complex social interventions, 106 outer setting, 105 quality improvement project, 106, 107 SMA, 108 socio-technical interface, 101 study groups, 102 Index sustainability, 110 theories, models, and frameworks, 102 thumb - heuristics, 110 2-dimensional diagram, 105 Context and Implementation of Complex Interventions (CICI) framework, 106, 107 Context interaction, 125 Context trumps evidence, 125 Contingent events, 178 Contract bridge, 125 Cumulative Illness Rating Scale, 37 Curriculum, 77–80 Cybernetic systems, 140 Cystic fibrosis transmembrane conductance regulator gene (CFTR), 155 D Degeneracy, 92 Deterministic complexity, 15 Diabetes epidemiology of, 12 health care quality, 84 (see Hierarchical living systems) insulin resistance, 11 learning clinical experiences, 81 clinical medicine, 80 curriculum, 79 nested system and issues, 80 life expectancy, 82 microvascular complications, 42 Diabetes mellitus, 10 DNA damage response system, 93–95 DNA polymerase, 93 Doctorate in management (DM) program, 178, 179 Dual process theory, 35 E Earthquake, 184 Ecological model, 191, 192 Endocrine system pathways, 189 Endogenous insulin, 34 Environmental context, 156 Epistemic modes, 14 Equifinality, 133, 134 Ethical context, 106 Evidence-based management (EBMgt), 68 Evidence-based medicine, 69, 72, 126 clinical research evidence, 64 Index criticisms, 68 five step approach, 64 patient circumstances, 65 F Facebook, 185 Fast thinking, 35 Financial sufficiency, 124 Foresight model, 220 Foundations of Clinical Medicine, 89 G Generalizability, 125–127 Ghost Map, 181, 182 Glucose measuring system, 141 Group conversation, 134 H Healthcare system, 95, 142 Health services research, 125, 127 Hemolytic anemia (HA), 233 Hierarchical living systems aggregate complexity, 50 biological organization, 50 definitions, 48 diabetes communities, 55 family circumstances, 54 influence of social networks, 55 society-level factors, 55 structures and patterns of behavior, 49 High impact journals, 124 Hospital staffing implications, 124 Host context, 156 HSR&D enterprise, 130 Humanity, 211 Hypoglycemia, 33, 34, 42 Hypogonadotrophic hypogonadism, 212 Hypothalamic-pituitary axis (HPA), Hypothyroidism, 67 I Implementation science, 126 Insulin production and release, 140–141 J Juvenile diabetes, 10 253 K Kitcher, Philip, 22 L Leadership, 124, 125, 222–226 Leadership training program, 178 Learning, 79, 80, 220–222, 233 Legal context, 107 Logic models, 219 M Management’s decision and analysis (MD&A), 115–116 Managerialism, 147 Material recovery methods, 182 Mathematical modeling, 201 Medicine CCF, 210 clinical description, 211 complexity-based theory, 213 CT scan, 210 diabetes, 210 diagnosis, 209 humanity, 211 hyperawareness, 209 hypogonadotrophic hypogonadism, 212 laboratory evaluation, 211 medications/systemic illness, 212 nursing, 208 physical examination, 212 PNEA, 214 post-traumatic hypopituitarism, 212 rotor dysfunction, 212 Mental models, 229 Metaphor, 203, 204 Models conceptual models, 21, 22 framework and theory, 27 map, 23 in science, 27 Multifinality, 133, 134 Multimorbidity, 38 N Nat Ross, 230 Natural systems, 145 Nested systems, 80 Network biology, 186 Network medicine, 186 Nursing, 208 254 O Obesity, 54, 193–196 Occupancy, 143 Office of Research & Development (ORD), 127 Ontological modes, 14 Organizational/complex social interventions, 125 Osler, William, 37 P Paramedics, 210 Patient complexity asthma and diabetes, 41 clinical dominance, 43 criteria, 41 diabetes, 43 HIV and tuberculosis, 42 short term consultative care, 42 vector model, 44 Patient safety adaptability, 96 degeneracy, 92 DNA damage, 91, 93 DNA polymerase, 93 healthcare system, 95 medical error, 87–89 redundancy, 92 resilience, 92 robustness, 92 PCPs, 121 Performance indicators, 140 Performance measurement, 144 Persistence, 233 Personalized medicine advertisements, 150 AIDS, 163, 164 alcoholic cirrhosis, 166 ALL, 163 cancer, 158, 159, 162 CAR T, 161 chemical specificity, 160 cigarette manufacturer, 167 clinical features, 166 definition, 150 degree of specificity, 151 diabetes, 154, 157 diagnosis and treatment, 151 DNA structure, 153 drugs, 161 evidence-based medicine, 152 exposome, 156, 157 general/constitution anomalies, 151 Index genome-driven treatment, 161, 162 heart failure, emphysema, and cirrhosis, 165 hidden curriculum, 165, 166 history and physical examination, 151 human genome sequencing project, 154 immune surveillance system, 161 implementation, 160, 161 Institute of Experimental Therapy, 159 Klinefelter’s syndrome, 157, 158 machine metaphor, 151 mathematical modeling, 151 past medical advances, 151 populations, 151 Precision Medicine Initiative, 155, 156 qualitative descriptive nomenclatures, 150 quantitative indicators, 150 reductionist philosophy, 162, 163 rules-based therapies, 152 sickle-cell disease, 153 TSH level, 152 VA/DoD Diabetes Practice Guidelines, 164, 165 Philosophical digression, 14, 15 Plan-Do-Study-Act (PDSA) cycle, 6, 115 Political context, 106 Population growth, 181 Positive deviance approach, 131–134 Positive/negative emotional attractor (PNEA), 214 Post-traumatic hypopituitarism, 212 Primary hypothyroidism, 36 Problem solving, 65, 217 A Process of Ongoing Improvement, 220 Protein fold management system, 156 Proteostasis network (PN), 156 Pseudo-equifinality, 133 Q Qualitative comparative analysis (QCA), 131, 132 Quality and Safety Education for Nurses, 190 Quality Enhancement Research Initiative (QUERI), 127–130 Quality improvement (QI) project, 131 Quality indicators, 142, 143 Quality metrics, 143, 144 R Randomized controlled trials, 70 Redundancy, 92 Refraction clinical epidemiology, 231 Index clinical research design and statistical analysis, 232 complexity-inspired approach, 233 CT scan, 231 funded projects, 230 hemolytic anemia, 233 learning, 233 medicine, 230 mental models, 229 patient’s journey, 234 roles, 233 rules, 232 Resilience, 92 Robustness, 92 Robust-yet-fragile effect, 93, 94 Rosetta Stone, 91 Rotor dysfunction, 212 S Scavenger economy, 181 Science's filing system, 219 Scientific certainty, 123 Second Law of Thermodynamics, 202 Self-organising unit, 134 Shared Medical Appointments (SMAs), 82, 107–108 Simple emergence, 146 Simple system, Site distribution results, 132 Slow thinking, 36 Snow’s map, 182 Social network (SN), 156 complex system, 181 Facebook, 185 goals and learning objectives, 180 health care finance, marketing, and policy, 177 leadership training program, 178 material recovery methods, 182 medical and business groups, 180 obesity, 184 Twitter, 185 visualization, 185 Society for Medical Decision Making, 220 Socio-cultural context, 106 Socio-economic context, 106 Spatial sufficiency, 124, 125 Spooky emergence, 146 255 Standards for QUality Improvement Reporting Excellence (SQUIRE), 131 Strong emergence, 146 Structural complexity, 14 Structure of Evolutionary Theory, 178 Swiss cheese model, 96 Syphilis treponemes, 160 System, definition of, Systems thinking, 217–220 balance scale, 191 ecological model, 191 ER, 190 obesity, 191, 193, 195, 196 Systems Thinking Scale, 190 T Testosterone replacement therapy, 211 Theory of Constraints approach, 220 Thinking, 35 Thyroid hormone deficiency, 64 Twitter, 185 Type diabetes, 11, 83 Type diabetes, 11, 12, 54, 79 U UK Foresight Project, 192 Undertreatment, 133 Unintended consequences, 139, 140, 145 V VA Quality Scholars Program, 189 Venous thrombosis, 210 Visualization, 185 W Water consumption, 181 Weak emergence, 146 Wicked problems, 194 World Health Organization’s Innovative Care for Chronic Disease Model, 44 X Xeroderma pigmentosum, 93 ... 3-6 70695801/ from-hedgehog-to-fox-clinicians -in- the-age-of-complexity Baeroe K. Medicine as art and science In: Schramme T, Edwards S, editors Handbook of the philosophy of medicine.. .Complex Systems in Medicine David C. Aron Complex Systems in Medicine A Hedgehog’s Tale of Complexity in Clinical Practice, Research, Education, and Management David C. Aron School of Medicine... Center Cleveland, OH USA ISBN 97 8-3 -0 3 0-2 459 2-4     ISBN 97 8-3 -0 3 0-2 459 3-1  (eBook) 8-3 -0 3 0-2 459 3-1 © Springer Nature Switzerland AG 2020 This work is subject to copyright
- Xem thêm -

Xem thêm: Complex systems in medicine, 1st ed , david c aron, 2020 3951 , Complex systems in medicine, 1st ed , david c aron, 2020 3951

Mục lục

Xem thêm

Gợi ý tài liệu liên quan cho bạn