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This unique title explores complex systems in clinical medicine and the subsequent implementation of that knowledge into practice. Written conversationally and as a reflection on the journey of learning about complex systems, the book explores how knowledge of these systems can be applied to four key roles in academic medicine: clinical practice, education, research, and administration. Further, this title emphasizes how gaining an understanding of complex systems can greatly help a physician deal with the many challenges found in academic medicine. Unlike other books on complexity in medicine, which tend to focus on only one aspect of the management of patients, Complex Systems in Medicine deals with the multifaceted roles of a physician. The approach in this book is uniquely qualitative rather than mathematical, and is written to make it not only of interest to physicians, trainees, and allied health providers, but also to make it more accessible to a non-medical audience. The inclusion of personal anecdotes by the author provides concrete examples of the application of knowledge of complex systems in academic medicine. A first-of-its-kind contribution to the literature, Complex Systems in Medicine: A Hedgehog’s Tale of Complexity in Clinical Practice, Research, Education, and Management is not only a novel reference for medical professionals, it is an accessible tool for the non-medical audience hoping to learn more about complex systems and their direct relevance to medicine, a field that deals with the infinite variety of humans and their ills. It illustrates the consequences of the interactive elements of patient care that make medicine both a science and an art.
This open access book is a unique resource for health professionals who are interested in understanding the philosophical foundations of their daily practice. It provides tools for untangling the motivations and rationality behind the way medicine and healthcare is studied, evaluated and practiced. In particular, it illustrates the impact that thinking about causation, complexity and evidence has on the clinical encounter. The book shows how medicine is grounded in philosophical assumptions that could at least be challenged. By engaging with ideas that have shaped the medical profession, clinicians are empowered to actively take part in setting the premises for their own practice and knowledge development. Written in an engaging and accessible style, with contributions from experienced clinicians, this book presents a new philosophical framework that takes causal complexity, individual variation and medical uniqueness as default expectations for health and illness.
Improving our nation's healthcare system is a challenge which, because of its scale and complexity, requires a creative approach and input from many different fields of expertise. Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system-one that increasingly is more effective, more efficient, safer, and higher quality-is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the Institute of Medicine's Roundtable on Value and Science-Driven Health Care and the National Academy of Engineering, hosted a workshop on lessons from systems and operations engineering that could be applied to health care. Building on previous work done in this area the workshop convened leading engineering practitioners, health professionals, and scholars to explore how the field might learn from and apply systems engineering principles in the design of a learning healthcare system. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary focuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward a learning healthcare system.
This book is an introduction to health care as a complex adaptive system, a system that feeds back on itself. The first section introduces systems and complexity theory from a science, historical, epistemological, and technical perspective, describing the principles and mathematics. Subsequent sections build on the health applications of systems science theory, from human physiology to medical decision making, population health and health services research. The aim of the book is to introduce and expand on important population health issues from a systems and complexity perspective, highlight current research developments and their implications for health care delivery, consider their ethical implications, and to suggest directions for and potential pitfalls in the future.
Implementing safety practices in healthcare saves lives and improves the quality of care: it is therefore vital to apply good clinical practices, such as the WHO surgical checklist, to adopt the most appropriate measures for the prevention of assistance-related risks, and to identify the potential ones using tools such as reporting & learning systems. The culture of safety in the care environment and of human factors influencing it should be developed from the beginning of medical studies and in the first years of professional practice, in order to have the maximum impact on clinicians' and nurses' behavior. Medical errors tend to vary with the level of proficiency and experience, and this must be taken into account in adverse events prevention. Human factors assume a decisive importance in resilient organizations, and an understanding of risk control and containment is fundamental for all medical and surgical specialties. This open access book offers recommendations and examples of how to improve patient safety by changing practices, introducing organizational and technological innovations, and creating effective, patient-centered, timely, efficient, and equitable care systems, in order to spread the quality and patient safety culture among the new generation of healthcare professionals, and is intended for residents and young professionals in different clinical specialties.
Lead effectively in today's complex health systems! As hospitals and healthcare organizations strive to meet standards to achieve status in the Magnet Hospital Recognition Program and address the issues in the Institute of Medicine’s Nursing Work Force Issues Initiative, they must be able to respond in ways that embrace rapid change. The 3rd Edition of this groundbreaking text addresses the leadership roles advanced practice nurses can assume in this new environment. It defines the concept of complexity and teaches the leadership skills that are best suited for complex adaptive systems, while also enabling you to build the self-awareness you need to learn new ways to lead. Case studies help you apply your new skills and prepare for your advanced practice roles.
Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review-guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.
Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being, and recommendations for the field.
In this profound work, Vittorio Guidano expands upon his earlier seminal contributions on the application of cognitive and developmental principles to individuals struggling with various forms of psychopathology. Here, he fully develops the idea that individuals' experience, both positive and negative, are powerfully influenced by their personal ``psychological organizations.'Focusing primarily on the eating disorders, the phobias (with agoraphobia as the prototype) obsessive-compulsive patterns, and depression, Guidano illustrates how early developmental experiences and ongoing psychological processes may collude to perpetuate dysfunctional patterns and personal distress. The central and perhaps most exciting thesis in this new expression of Guidano's thinking is that the ``deep structure' or ``core organizing processes`` that constrain human psychological experience may be at the heart of successful intervention as well as the classical problems of resistance, relapse, and refractory behaviors. Guidano's contention is at once simple and powerful: those psychological processes involved in the development and maintenance of personal identity, or ``self' that should be the primary foci of research and intervention in psychological disorders. The meaning of Guidano's perspective for clinical practice is perhaps best expressed in the author's own words: ``Knowing the basic elements of the personal cognitive organization that underlie the pattern of disturbed behavior and emotions, the therapist can behave, from the beginning, in such a way as to build a relationship as effective as possible for that particular client. In other words, the therapist should be able to establish a relationship that respects the client's personal identity and systemic coherence and that, at the same time, does not confirm the basic pathogenic assumptions. For example, in working with agoraphobics, the therapist has to respect their self-images centered on the need to be in control. He/she can do this by avoiding any direct attack on their controlling attitudes and by leaving them a wide margin of control in the relationship. At the same time the therapist should avoid confirming their assumptions about the somatic origin of their emotional disturbances or about their inborn fragility. In short, the therapist who can anticipate the models of self and reality tacitly entertained by the client is surely better able to help the development of a cooperative and secure therapeutic relationship than the therapist who cannot make such anticipations. This timely and provocative volume offers exciting new ideas about how to conceptualize and facilitate change in the ``self system.' With the rare combination of his Renaissance intellect and integrative practical expertise, Guidano has been able to draw together many disparate themes from object relations theory, ego psychology, attachment theory, constructivist models of human cognition, and lifespan developmental psychology. It is must reading for the practicing professional, the helping apprentice, and anyone interested in glimpsing the cutting edge at the growing interface between cognitive and clinical science.
America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost. The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009-roughly $750 billion-was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances. About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care. This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.