title: Complex adaptive systems: a tool for interpreting responses and behaviours.
abstract: BACKGROUND
  Quality improvement is a priority for health services worldwide. There are many barriers to implementing change at the locality level and misinterpreting responses and behaviours can effectively block change. Electronic health records will influence the means by which  knowledge and information are generated and sustained among those operating quality improvement programmes.
  
  
  OBJECTIVE
  To explain how complex adaptive system (CAS) theory provides a useful tool and new insight into the responses and behaviours that relate to quality improvement programmes  in primary care enabled by informatics.
  
  
  METHODS
  Case studies in two English localities who participated in the implementation and development of quality improvement programmes. The research strategy included purposefully sampled case studies, conducted within a social constructionist  ontological perspective.
  
  
  RESULTS
  Responses and behaviours of quality improvement programmes in the two localities include both positive and negative influences associated with a networked model of governance. Pressures of time, resources and workload are common issues, along with  the need for education and training about capturing, coding, recording and sharing information held within electronic health records to support various information requirements.
  
  
  CONCLUSIONS
  Primary care informatics enables information symmetry among those operating quality improvement  programmes by making some aspects of care explicit, allowing consensus about quality improvement priorities and implementable solutions.
authors.affiliation: School of Health, University of Central Lancashire, Preston, UK. BSEllis@uclan.ac.uk
authors.forename: Beverley
authors.initials: B
authors.lastname: Ellis
mesh_terms: D006801:Humans; D007256:Information Systems / Q000458:organization & administration*; D008491:Medical Informatics Applications; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration*