A complex adaptive systems approach to patient safety

Summary

Hospitals are complex adaptive systems. They are industrial environments where it isn't always possible to expect predictable responses to inputs. Patient safety management practices need to adapt to align with the environment in which events occur. It is time to reimagine safety event reporting and management solutions that guide, not prescribe, investigations and improvement actions.

Content

Hospitals are environments where resources are concentrated for the purposes of delivering care at an industrial level. In the US, the shift towards a pay-for-performance ecosystem has motivated health systems to pursue initiatives like operational standardisation and mergers — both horizontal and vertical, with little to show in terms of improvements in quality of healthcare delivered.

The job of the chief safety and quality officer in such an industrial environment is complicated and therefore difficult. Opportunities for leaders and staff to learn from safety events in hospitals are limited. Systems and leaders have tried to “process” and “workflow” (structured follow ups, root cause analyses, FMEA analyses, etc.) their way through the complex hospital environment using deterministic approaches that are best suited for mechanistic, rather than adaptive systems. 

Isn’t it time for us to see hospitals as the complex adaptable systems they are: environments where there is high outcome variability in the Zone of Complexity (Stacey, 1996); where staff respond to safety events in unpredictable ways? A complex adaptive system is one where a variety of actors with diverse skills, experience and knowledge follow simple rules of engagement to learn and innovate in unpredictable ways based on unit and system-level feedback loops and is one where people are densely interconnected by virtue of their varied roles in managing patients.  

Hospitals need solutions that can adapt to the complexity involved in safety event management practices, solutions that support the insights that actors need to innovate and collaborate while supporting the basic principles of managing in a complex adaptive system environment that is a hospital:

• They should allow safety event management practices to evolve over time by creating simple frameworks rather than prescriptive workflows for activities, such as structured follow-up, and cause analyses initiatives.
• They should provide safety teams the ability and the collaboration spaces necessary for innovative ideas to emerge at the local and system levels.
• They should have the ability to support processes that generate variation while simultaneously helping stem the proliferation of ineffective or inefficient ideas related to improving patient safety within the system.