Selecting a change and evaluating its impact on the performance of a complex adaptive health care delivery system.
Complexity science suggests that our current health care delivery system acts as a complex adaptive system (CAS). Such systems represent a dynamic and flexible network of individuals who can coevolve with their ever changing environment. The CAS performance fluctuates and its members' interactions continuously change over time in response to the stress generated by its surrounding environment. This paper will review the challenges of intervening and introducing a planned change into a complex adaptive health care delivery system. We explore the role of the "reflective adaptive process" in developing delivery interventions and suggest different evaluation methodologies to study the impact of such interventions on the performance of the entire system. We finally describe the implementation of a new program, the Aging Brain Care Medical Home as a case study of our proposed evaluation process.
Boustani
Malaz A
MA
Indiana University Center for Aging Research, Department of Medicine, Division of General Internal Medicineand Geriatrics, Indiana University Medical Group-Primary Care, Indianapolis, IN, USA.
Munger
Stephanie
S
Gulati
Rajesh
R
Vogel
Mickey
M
Beck
Robin A
RA
Callahan
Christopher M
CM
D000375:Aging; D003071:Cognition; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007196:Indiana; D019982:Organizational Case Studies; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000458:organization & administration*; D015397:Program Evaluation; D014481:United States