title: Complex adaptive systems (CAS): an overview of key elements, characteristics and application to management theory.
abstract: OBJECTIVE
  To identify key elements and characteristics of complex adaptive systems (CAS) relevant to implementing clinical governance, drawing on lessons from quality improvement programmes and the use of informatics in primary care.
  
  
  METHODS
  The research strategy  includes a literature review to develop theoretical models of clinical governance of quality improvement in primary care organisations (PCOs) and a survey of PCOs.
  
  
  RESULTS
  Complex adaptive system theories are a valuable tool to help make sense of natural phenomena, which include  human responses to problem solving within the sampled PCOs. The research commenced with a survey; 76% (n16) of respondents preferred to support the implementation of clinical governance initiatives guided by outputs from general practice electronic health records. There was considerable variation  in the way in which consultation data was captured, recorded and organised. Incentivised information sharing led to consensus on coding policies and models of data recording ahead of national contractual requirements. Informatics was acknowledged as a mechanism to link electronic health record  outputs, quality improvement and resources. Investment in informatics was identified as a development priority in order to embed clinical governance principles in practice.
  
  
  CONCLUSIONS
  Complex adaptive system theory usefully describes evolutionary change processes, providing insight  into how the origins of quality assurance were predicated on rational reductionism and linearity. New forms of governance do not neutralise previous models, but add further dimensions to them. Clinical governance models have moved from deterministic and 'objective' factors to incorporate cultural  aspects with feedback about quality enabled by informatics. The socio-technical lessons highlighted should inform healthcare management.
authors: School of Health, University of Central Lancashire, Preston, UK. BSEllis@uclan.ac.uk
authors: Beverley
authors: B
authors: Ellis
authors: Stuart Ian
authors: SI
authors: Herbert
mesh_terms: D006801:Humans; D007256:Information Systems / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration*