A complexity perspective on health care improvement and reform in general practice and primary health care
Barbara J. Booth A C , Nicholas Zwar B and Mark Harris AA Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
B School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
C Corresponding author. Email: bj.booth@student.unsw.edu.au
Australian Journal of Primary Health 16(1) 29-35 https://doi.org/10.1071/PY10003
Published: 17 March 2010
Abstract
Health care improvement is always on the planning agenda but can prove frustrating when ‘the system’ seems to have a life of its own and responds in unpredictable ways to reform initiatives. Looking back over 20 years of general practice and primary health care in Australia, there has been plenty of planning and plenty of change, but not always a direct cause and effect relationship between the two. This article explores in detail an alternative view to the current orthodoxy of design, control and predictability in organisational change. The language of complexity is increasingly fashionable in talking about the dynamics of organisational behaviour and health care improvement, but its popular use often ignores challenging implications. However, when interpreted through human sociology and psychology, a complexity perspective offers a better match with everyday human experience of change. As such, it offers some suggestions for leaders, policy makers and managers in health care: that uncertainty and paradox are inherent in organisational change; that health care reform must pay attention to the constraints and politics of the everyday; and that change in health systems results from the complex processes of relating among those involved and that neither ‘the system’ nor a few individuals can be accountable for overall performance and outcomes.
Alakeson V
(2008) America’s health choices. British Medical Journal 337, a1563.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[Verified 22 July 2009]
Schneider M, Somers M
(2006) Organizations as complex adaptive systems: Implications of complexity theory for leadership research. The Leadership Quarterly 17, 351–365.
| Crossref | GoogleScholarGoogle Scholar |
Sturmberg JP
(2007) Systems and complexity thinking in general practice: part 1 – clinical application. Australian Family Physician 36(3), 170–173.
| PubMed |
Tetenbaum T
(1998) Shifting paradigms: from Newton to chaos. Organizational Dynamics 26, 21–32.
| Crossref | GoogleScholarGoogle Scholar |
Wagner EH,
Austin BT, Von Korff M
(1996) Organizing care for patients with chronic illness. The Milbank Quarterly 74(4), 511–544.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
CAS |
Weick KE, Quinn RE
(1999) Organizational change and development. Annual Review of Psychology 50, 361–386.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
CAS |
