Tuesday, 28 June 2011

Making health care safer: learning from social and organisational research (Day 1) - Part 1 Complexity

The Social Dimension is Health Institute has put on a great event here in St Andrews and I am able to present some of my ideas around complexity in health care as a poster (pdf handout). The idea of the poster session was less to present traditional posters but rather find ways to trigger conversations – and I had some very interesting conversations indeed once my poster finally arrived (my luggage only got here 29h after myself, Easyjet had forgotten it in Luton).

The plenary sessions were also very interesting – I find it particularly interesting (and reassuring) that researchers from different backgrounds, such as the medical sociologists Mary Dixon-Wood and Naomi Fulop, come to similar conclusions to the ones I drew from my PhD work.

Mary talked about theories of change and how they are often not explicit or not articulated which leads to enthusiasm at the executive level while the frontline staff is not aware of the underlying rational and subsequently much less enthusiastic. Mary referred to the intervention which she and her team studied as a complex intervention. I think in particular the healthcare improvement community often uses the term for problems or interventions which are merely complicated (I will try to write a future post on this) but Mary did point out that the intervention does not just consist of the multiple components but also how it functions socially.

This is similar to the message of my poster: the real complexity of an organization lies in its social functioning. This social functioning emerges around the structure set through the formal organizational structure. The latter ticks all the boxes of a complicated system (and not the ones of a complex one) and thus it should be able to apply design principles to it.

Naomi raised a related point in her talk by pointing out the need to conceptualize and manage the coexistence of formal governance processes and informal professional processes.

I think one comparison could be a wisteria where the formal structure provides the scaffolding. Through the scaffolding I can exert some influence on how my wisteria will grow. A good scaffolding will increase the chances of having it grow the way I want it to (which can be further aided by pruning), with a bad scaffolding it will definitely be a mess.

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