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Health Care Context for CASPER: Children with Complex Conditions: The care team for children with complex conditions is diverse, including not only physicians but also the child's primary caregiver usually a parent , other types of medical providers e. The care team members vary in their extent and duration of involvement as well as expertise, and they seldom all meet together.

Teamwork and effective communication of health information are essential to good care, but not well supported by existing health care systems. Systems challenges include eliciting goals and plans from the care team, providing effective mechanisms for updating patient status related to goals, and determining when and with whom to share information as patient status changes. Fundamental CS challenges include designing effective information sharing mechanisms for multi-agent systems and designing appropriate human-computer interaction HCI methods.

The CAS framework also enhances our understanding of two key elements of professional practice: medical professionalism and physician autonomy.

Autonomy is not just society's quid pro quo for altruistic services rendered by professionals or an indication of respect for the profession's expertise; it is an essential practice condition providing space for adaptive behaviour complex problem solving and innovation. Finally, the CAS framework redefines the roles of knowledge and technology in practice. Reductionist knowledge and expertise do not define the professional; these characteristics cannot distinguish the professional from the technician.

Systems behaviour characterised by adaptive capacity and a shared value system distinguishes the professional from the technician Fig. This adaptive view of the medical professional has significant implications for both medical education and practice. Using the adaptive model of professional practice Fig. The last section of the paper will look at several general approaches to accomplishing this support.

Each approach is illustrated by an intervention. The complex nature of medical practice suggests that adaptability can and should be a specific focus of holistic admissions and recruitment efforts across the continuum. Adaptive capacity is integral to success in the modern workplace. Here, the word epistemic refers to the nature of one's knowledge and humility is an acknowledgement of uncertainty. Over the last several decades, this concept has been applied to the use of science in clinical decision making.

Physicians are obliged to acknowledge this uncertainty in the ethical and intellectually rigorous care of patients. Traditional medical training often fails to adequately account for this uncertainty. Students and physicians are urged to use evidence and guidelines in practice, but less attention is paid to the limits of even the highest quality evidence. Epistemic humility respects the value of knowledge but does not hesitate to be critical in its application. In this sense it is both limiting and liberating.

It encourages physicians and scientists to acknowledge the limits of imperfect science. At the same time, in acknowledging the limits of deterministic science, physicians and scientists are liberated to adapt , explore and innovate in order to meet the needs of the patient and society. A curriculum that moves beyond the textbook teaching of statistics and includes a critical analysis of largely reductionist assumptions made with scientific inference is needed.

Systematisation is a common response to stubborn problems. In fact, the more stubborn and complex the problem, the more systematic and reductionist we are inclined to be. One example of excessive systematisation in medical education is the use of standardised methods for evaluating trainees. However, although CBME has been shown to be effective for many aspects of practice, - there have been concerns about the ability of this approach to evaluate more complex competencies. Assessing adaptive competence separately from technical competencies would permit more valid assessment of both groups of behaviours.

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Such an approach would avoid conflating the strategy of medical practice with the tools of medical practice. It would also avoid incentivising rigid maladaptive behaviours when more flexible and responsive approaches are in order.

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Finally, such an intervention could address challenges that have been identified in the independent assessment of individual competencies and offer more meaningful direction regarding goals and methods of remediation. Which behaviours should professionals aspire to? The notion of perfect, standardised behaviour has no meaning in complex systems; there is no place for perfection in constantly changing, opaque and unpredictable systems where goals are often at cross purposes. This perspective raises serious questions about the structure of the traditional medical curriculum.

Such an approach to training would enhance training transfer, increase opportunity for the development of core professional values, provide a more pragmatic understanding of evidence, and better prepare students for habits needed for complex problem solving and lifelong learning. We are on the cusp of a new era in medical practice. The Flexner century delivered an important commitment to reductionist biomedicine as a core tenet of practice. In the next century we must augment the impact of this essential tool through an accounting of complexity in medicine.

CISUC - Intelligent and Adaptive Systems in Medicine

These efforts have already begun in the systems approach to medical research, the development of new information technologies and the introduction of systems concepts to practice. However, it is contingent upon leaders in medical education to become more familiar with these concepts and to integrate these concepts into education practices.

The time has arrived for adaptive leadership in medical education. I personally take full responsibility for the accuracy and integrity of the work. This is a paper on theory. Tools and concepts supporting adaptive behaviour in medical training and practice. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries other than missing content should be directed to the corresponding author for the article.

Volume 53 , Issue 9. The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account.

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Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Abstract Context Medicine is practised in complex systems.

Methods Using concepts from complexity science, the history of science and psychology, this problem is outlined and a theoretical model of professional development is proposed. Results This model proposes that complex problem solving and adaptive behaviour, not technical expertise, are distinguishing features of professionalism. Discussion The impact of this model on our understanding of physician autonomy, professionalism, teamwork and continuous quality improvement is discussed.

Introduction Systems thinking aims to close the gap that exists between our reductionist knowledge of biomedical systems and the complex reality of patient care. Part I: Complex Problems and Medical Practice Complex problem solving In life and in clinical medicine we are confronted with complex problems on a daily basis.

Engineering analysis of the frame for multi-level selection of material objects. Certain amount of energy gets dissipated in course of those The comparative analysis of the results of the neurophysiology researches of Rotenberg-Arshansky Ref 11, The coordination of stress-release behavioral reaction between numerous interconnected fragments is realized via adapting sustaining DKS to the causual changes the energy-exergy conversion-or e-e conversion from here and further, or production of available work by physiological-behavioral activity of the Functional System carries out in order to release to stress from the contact with surrounding environment.

The effect of that activity gets fixed by the changes in surrounding conditions. These changes may get either released or not the deviative stress effect on social behavior. After being processed by Functional system of interconnected neuron of brain the reasons would get realized as Probabilistic Difference Maker by changes in physiological-behavioral patterns.

Their Probabilistic nature may either lead to stress-release, or not, and that depends on the surrounding outer to the system current conditions of the moment. The long-term period of time running in course of this search for optimal options in various surrounding conditions gradually decrease the significance of the influence of the outer factors to FI. Save to Library. Micro Strategies and Hospital Management an analysis through the lens of complexity.

Hospital organizations play an important social role. Its management, however, has been challenged to seek greater efficiency, quality and relevance of health services provided. The purpose of this study has been the analysis of The purpose of this study has been the analysis of innovative strategic practices that have affected performance of a hospital as an organization.

This is a case study, focusing a community hospital, located in the State of Parana in Brazil. Data were collected through interviews, non- participant observation and document analysis. The analysis revealed that introducing innovative strategies in cost, medical and nursing areas have contributed decisively to the improvement in resource allocation and quality of the health services delivered. Factors such as the practice of micro strategies, support of top management and favorable organizational climate were decisive in this process.

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Results revealed that micro strategies employed in terms of cost contributed to the reduction of operational expenses, better reallocation of resources and greater investment in health services. Changes in patient care in the nursing sector promoted a higher quality of service. The strategy of introducing the hospitalist provided better management of complications and of care of patients and their families. Finally, we found a greater humanization of health services and improvement of organizational performance and image.

The major contribution of this article is the finding that, in complex systems such as hospitals, the practice of micro strategies tends to be more effective in health services management. In the university setting, strategies take on a different configuration due to a permanent dispute between top administration and the academic sector.

This triggers a conflict between macro intentions and micro actions at the academic This triggers a conflict between macro intentions and micro actions at the academic level. In this study, we examined to what extent academic strategic actions are impacted by tensions triggered by the macro intentions of top management and micro actions in the academic management. This research is based on a comparative study involving three Brazilian universities. We identified key sources of tension between top managers and academic managers, such as organizational complexity, the political context, a loosely coupled structure and professional autonomy.

The outcome revealed a difficult alignment between intentions and actions while relevant strategies were practiced in the academic sector.