The Value of Systems and Complexity Sciences for Healthcare 1st Edition by Joachin Sturmberg 9783319262192 331926219X

Part I Complexity in Clinical Care

1 “Returning to Holism”: An Imperative for the Twenty-First Century

1.1 Models: Mental Representations of Reality

1.2 Distributions in Living Systems

1.3 Characteristics of CAS

1.4 Holism

1.5 Re-framing Health

1.5.1 Health as a Dynamic Entity

1.5.2 Health and Dis-ease as Experiential States

1.5.3 Operationalising Health as a Complex Adaptive State: The Somato-Psycho-Socio-Semiotic Model

1.5.4 Dynamics of Health

1.6 Health as the Organising Principle for a Twenty-First Century Health System

1.7 Implications for the Twenty-First Century

References

2 Systems Biology: Unravelling Molecular Complexity in Health and Disease

2.1 Introduction

2.2 Holism: An Imperative for the Twenty-First Century

2.2.1 Disease Complexity: Malfunction of Molecular Networks

2.2.2 Ethical Complexities in Systems Medicine

2.2.3 Improving Healthcare Through Complexity Science

2.3 Experimental Design for Systems Biology

2.4 Conclusions

References

3 Complicated vs. Complex, Disease vs. Illness: Rethinking Diagnosis, Therapy, and Restoring Health

3.1 Complex vs. Complicated Systems

3.2 The Primacy of Dynamic Patterns in Health and Illness

3.3 Disrupted Dynamic Patterns on the Pathway to Illness and Disease

3.4 Disease and Illness: Chicken or Egg?

3.5 The Complex Systems—Osteopathic Medicine Synergy: Treating Illness and Restoring Health

References

4 A System for Systems Epidemiology: The Example of Inference from Agent-Based Models

4.1 Systems and Epidemiology: The Conceptual Argument

4.2 Systems and Epidemiology: An Empirical Example

4.2.1 Model

4.2.2 Simulations

4.2.3 Findings

4.2.4 Implications

References

5 Coping with Complexity and Uncertainty: Insights from Studying Epidemiology in Family Medicine

5.1 Braun’s Law, Distribution, Grid and Protocols: An Implicit Handling of Epidemiological Complexit

5.1.1 Braun’s Law

5.1.2 Distribution

5.1.3 Grid

5.1.4 Protocols

5.2 Braun’s Work in Its Historical Context

5.3 Understanding Complexity in Clinical Practice

5.3.1 Fractality

5.3.2 The Linguistic Properties of the Braun’s Distribution and Their Practical Consequences

5.3.3 Uncertainty = Risk

5.3.4 Bayesian Heuristics Are Not the Answer to Managing Uncertainty/Risk in Primary Care

5.4 Coming to Terms with Uncertainty: The Challenge for the Future of Family Medicine

References

6 Anticipation in Complex Systems: Potential Implications for Improving Safety and Quality in Health

6.1 Simple and Complex Systems

6.2 Recursion

6.3 Anticipatory Systems

6.4 Most Complex Systems Are Also Anticipatory Systems

6.4.1 Failure Modes in Simple vs. Complex Systems

6.5 What Does Any of This Have to Do with Safety and Quality in Healthcare?

6.6 Conclusions and Implications

References

7 Extreme Variability is Typical Not Normal

7.1 Introduction

7.2 Two Different World Views

7.3 Medical Implications

7.4 Discussion and Conclusions

References

8 Monitoring Variability and Complexity at the Bedside

8.1 Uncertainty and Emergence

8.2 What is Variability?

8.3 Monitoring Multi-Organ Variability

8.4 Monitoring Variability and Sepsis

8.5 Monitoring Variability and Organ Failure

8.6 Monitoring Variability and Extubation

8.7 What is the Meaning of Altered Variability?

8.8 Meaning of Degree of Variability?

8.9 Meaning of Complexity of Variability?

8.10 Summary

Conflict of Interest

References

9 Heterogeneity Mediated System Complexity: The Ultimate Challenge for Studying Common and Complex D

9.1 Introduction

9.1.1 Re-evaluating the Biological Meaning of Heterogeneity

9.1.1.1 Genotype Heterogeneity Maintains the Phenotype Within a Dynamic Environment

9.1.1.2 Heterogeneity Provides Necessary Variation for Somatic Cell Evolution

9.1.1.3 Stress Induced Heterogeneity: The Evolutionary Trade-Off

9.1.2 How to Achieve the Multiple Levels of Genetic/Non-genetic Heterogeneity?

9.1.3 The Importance of Heterogeneity in Somatic Cell Evolution

9.2 Implications of Using Heterogeneity Mediated System Complexity to Understand Human Diseases

9.3 Conclusions

References

10 Multimorbidity: Through a Glass Darkly

10.1 What is Multimorbidity from a Clinico-Epidemiological Perspective?

10.1.1 The Centrality of Diagnosis and the Challenges it Brings

10.1.2 What Impact Does This Have on Practice?

10.2 The Emerging Paradigm of Systems Medicine

10.2.1 The Emerging Literature on Systems Medicine

10.2.2 The Emerging Literature on Biomarkers

10.3 An Integrative Model from a Complex Adaptive Health Systems Perspective

References

11 Viewing Mental Health Through the Lens of Complexity Science

11.1 Complexity Science in Mental Health

11.1.1 Dynamics and Mental Illness

11.1.2 Examining Mood Dynamics Among Primary Care Patients with Affective Disorders

11.1.2.1 Dynamic Patterns of Anxiety/Depression

11.1.2.2 Dynamic Co-variability of Anxiety and Depression

11.2 Imperative for Change

11.3 Conclusion

References

12 Quantitatively Demonstrating the Complex Nature of Intimate Partner Violence

12.1 Studying Partner Violence

12.2 IPV Dynamics and Predictions

12.3 Understanding IPV as a Complex Adaptive System: Outcomes

12.4 Imperative for Change

12.5 Future IPV Research

References

13 Depression: Not Just a Top–Down Phenomenon

13.1 Physiological Underpinnings

13.1.1 Neurotransmitter Imbalance

13.1.2 Disruption of Homoeostatic Hormones

13.1.3 Excessive Inflammation

13.1.4 Co-Morbidity

13.2 Psychosocial Environment

13.3 Predisposed to Depression?

13.4 Imperative for the Twenty-First Century

References

Part II Complexity and the Healthcare System Ethics, Organisation Policy, and Politics

14 Ethical Complexities in Systems Healthcare: What Care and for Whom?

References

15 Systematic Reviews: Beyond Cochrane to Complexity

15.1 Cochrane Reviews for Evaluating Health Interventions

15.2 Cochrane Reviews and Complex Interventions

15.3 Complex Interventions and Realist Reviews

15.4 Context and Transferability

15.5 The Complementarity of Cochrane Reviews and Realist Reviews

15.6 International Comparison and Realist Review

15.7 Conclusion

References

16 Agent-Based Modelling of Organizational Performance

16.1 Prior Investigations

16.2 The Current Model

16.3 Results

16.4 Discussion

References

17 Leading the Emergency Department as a Complex Adaptive System

17.1 Complex Adaptive System Concepts

17.2 The Emergency Department System

17.3 Applying Complex Adaptive Systems into the Emergency Department

17.4 Extending the Use of Complex Adaptive Systems Beyond the Emergency Department

References

18 The Value of Systems and Complexity Thinking to Enable Change in Adaptive Healthcare Organisation

18.1 The Problem

18.2 The Actors

18.3 The Argument

18.4 Research Strategy

18.5 Findings

18.5.1 Literature: An Overview of Complex Adaptive Systems

18.5.2 Clinical Governance

18.5.3 Electronic Health Records

18.5.4 Education: Through Shared Learning

18.6 Themed Results

18.7 Discussion

18.8 Conclusions

18.9 Impact and Imperatives

References

19 Using a Team Approach to Address Avoidable Emergency Department Utilization and Re-hospitalizatio

19.1 Introduction

19.2 ED Utilization

19.3 Avoidable Re-hospitalization

19.4 Reflections

19.5 Conclusion

References

20 Access to Primary Care: A Complex Adaptive Systems Lens on Acuity

20.1 Multiple Dimensions to Access

20.1.1 Patient Access Needs

20.1.2 Scheduling Studies

20.2 A Complex Adaptive Systems Lens

20.3 Imperatives for Change

References

21 “If the Facts Don’t Fit the Theory, Change the Theory”: Implications for Health System Reform

21.1 The Health Vortex: Conceptualising a Complex Adaptive Health System

21.1.1 The Role of “Core Values” and “Simple Rules”

21.1.2 “Fit for Purpose”

21.2 What Do the Facts Tell Us

21.3 If the Facts Don’t Fit the Theory, Change the Theory