How we see complexity science in nursing can depend on your age and ongoing education. Recent graduates have met complexity science in their education programs and in the style of their teachers transfer of knowledge. In the uptake of knowledge the assessments we make describe an individual patient’s symptoms. From the diagnosis and their presentation we can have insight into their outcome with an illness, taking into account severity, timelines, response to treatments, and other co-existing conditions. Safety practices are woven into patient care to mediate and ideally prevent near misses or incidents to occur, the need to have a systems approach is superior to one that is punitive and focuses on an individual(s) performance(s).
Our organizations especially health systems that integrate hospitals, wellness centres, and diverse outpatient and ambulatory services are indeed complex and to be successful adaptive to changes; the current view is nothing is linear, they correlate, there is synergy, sadly silos still emerge and stymie the system to improve outcomes consistently. Complexity science opens up new approaches to studying complex entities such as healthcare organizations. What role does leadership have in complexity and is everyone a leader? Explore this in next blog entry.
Anyone who graduated in the 1980’s would not have heard about this way of framing complex systems, though experience is an excellent teacher. Colleagues who did not add any formal education programs to their foundation of knowledge in nursing, certainly learned in clinical practice that patients were trending sicker, busier due to increasing numbers of interventions. The pressure to discharge patients sooner thus increasing the acuity and complexity of the patients on the wards.
In the 1990s to now is when the explosive growth of analyzing complex health systems, to increase our knowledge and understanding of the patients’ experiences, their families, and to improve the interactions among patients, families, physicians, nursing and allied health. Also to include the support staff as they are the linchpins of moving materials, taking care of environments, key teams like staffing and scheduling, and the administrative assistants and clerks who keep employees and patients and families flowing through the system. In some hospitals there are thousands of employees who need to know where, when, how to work their skills and knowledge and be assured they’ll be paid, will have requests for time off granted, and replacements to cover the employees away.
Complexity science is an umbrella term and it is closely related to Complex Adaptive Systems (CASs) and chaos theory. Our world is in a state of rapid change, we’re constantly exposed to many influences i.e., media, social media, climate change, generational differences, technology etc. For nursing the past decades and the present are characterized as far from a state of equilibrium, many factors interact, exert, influence, and evolve separately or in multiple ways in dynamic and non-linear ways. The normalcy of synergy where 1 + 1 = 5 is very real. The typical shift in many medicine and specialty units are anything or anyone can change and simultaneously be members of several systems. Think about laboratory diagnostics they interact with inpatient, outpatient, human resources, occupational health & safety, housekeeping, external partners i.e., suppliers, community.
In fact busy does not fully capture what is taking place, due to budget constraints the status quo was to staff for census and use a smaller (increasingly) number of replacement staff to cover absences that were short term. The system is not (in a number of organizations) resourced to go above the census, and the science and principles of staffing and scheduling are not always the same. Ideally one does not enter a scheduling period with gaps in the coverage for census, vacations, leaves etc. When vacancies grow this becomes a greater hurdle, one cannot divide a staff member nor elongate time–a minute is a minute. The current exodus of nurses from the profession is acknowledged as a major issue post-pandemic.
How do we work in such “chaos” by creating and sustaining a high reliability organization. Come by soon another entry will build on this aim. Namaste
Registered Nurse Storyteller, Healer, Scribe, Transformational Leader