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CDA 07-022 – HSR&D Study

 
CDA 07-022
The Role of Complexity Science in Improving Clinical Microsystems
Luci Leykum MD MBA MSc
South Texas Health Care System, San Antonio, TX
San Antonio, TX
Funding Period: April 2008 - March 2013

BACKGROUND/RATIONALE:
We believe that health care organizational research has not been grounded in the theoretical model that represents the clinical microsystems in which care is delivered. Growing evidence suggests that these systems are complex adaptive systems, characterized by nonlinear dynamics between inputs and outputs. This lack of proportionality makes prediction of outcomes more difficult, and introduces an inherent level of uncertainty that cannot be eliminated with planning or process reengineering. We hypothesize that an implication of this uncertainty may be that interventions that improve individuals' ability to make sense of what is happening ("sensemaking") will be more effective in improving outcomes than those that do not. We propose a career development award that will be a first step in understanding the ways in which conceptualizing clinical settings as complex adaptive systems changes the way we intervene in such systems.

OBJECTIVE(S):
The purpose of the proposed research will be to apply techniques from other fields to health care settings in an effort to observe and measure characteristics of complex systems in health care, and to allow us to analyze the non-linear data that will result from such observations. In this award, we propose the following specific objectives, which we plan to carry out in inpatient medical settings:

Objective # 1a: To use observation, interview and survey techniques to observe and describe the non-linear phenomena of self-organization and co-evolution in clinical microsystems.
Objective # 1b: To use observation, interview and survey techniques to observe and describe sense-making in clinical microsystems.

Objective # 2: To explore the use of existing non-linear data analysis techniques, including agent-based modeling, multiscale analysis, and phase-space plots to healthcare settings, in order to:
a.compare these settings on the activities (was dimensions) of self-organization, co-evolution, and sensemaking
b. relate performance of these activities to process indicators and clinical outcomes

METHODS:
Data collection on this project has been completed. Data entry and initial analyses have been completed. Initial analyses explore the association between physician team relationships and length of stay, unnecessary length of stay, and complication rates. A manuscript based on these analyses is almost complete. Additional analyses examining differences in sensemaking among teams is also underway.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Our analyses suggest that improving provider relationships may be an important strategy for improving the care of hospitalized Veterans. We will be resubmitting a VA grant proposal of an intervention to improve physician sensemaking as a strategy to improve patient outcomes as an outcome of this work.



External Links for this Project

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PUBLICATIONS:

Journal Articles

  1. Leykum LK, Huerta V, Mortensen E. Implementation of a hospitalist-run observation unit and impact on length of stay (LOS): a brief report. Journal of hospital medicine. 2010 Nov 1; 5(9):E2-5. [view]
  2. Leykum LK, Pugh JA, Lanham HJ, Harmon J, McDaniel RR. Implementation research design: integrating participatory action research into randomized controlled trials. Implementation science : IS. 2009 Oct 23; 4:69. [view]
  3. Leykum L. Procalcitonin. Hospital medicine clinics. 2012 Jul 1; 1(3):e301-e312. [view]
  4. Lanham HJ, Leykum LK, McDaniel RR. Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting. Journal of the American Medical Informatics Association : JAMIA. 2012 May 1; 19(3):382-91. [view]
  5. McKenna K, Leykum LK, McDaniel RR. The role of improvising in patient care. Health care management review. 2013 Jan 1; 38(1):1-8. [view]
  6. Leykum L, Parchman ML, Lanham HJ. Use of Agent-Based Model to Understand Clinical Systems. Journal of Artificial Societies and Social Simulation. 2012 Jun 30; 15(3):2. [view]
Journal Other

  1. Leykum L, Mortensen E. Exploring the potential causes of the emergence of hospitalists: chicken vs. egg. Journal of general internal medicine. 2010 May 1; 25(5):378-9. [view]
VA Cyberseminars

  1. Leykum L, Terpstra J. Systems thinking for implementation research and practice (follow up discussion - intranet). QUERI Implementation Research. [Cyberseminar]. 2009 Jul 14. [view]
  2. Leykum L, Terpstra J. Systems thinking for implementation research and practice. QUERI Implementation Research. [Cyberseminar]. 2009 Jul 7. [view]
Conference Presentations

  1. Lanham HJ, Leykum L. An investigation of between-physician differences in electronic health records use in an ambulatory care setting: Linking physicians' views of uncertainty with patterns of EHR use. Poster session presented at: AcademyHealth Annual Research Meeting; 2012 Jun 24; Orlando, FL. [view]
  2. Lanham HJ, Makam A, Batchelor K, Leykum L, Halm E. Attitudes toward and use of a common ambulatory EHR system: The role of early adopters. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2012 May 9; Orlando, FL. [view]
  3. McAllister C, McDaniel RR, Leykum L. Do Physician Relationships Matter: An analysis of differences in relationships among inpatient medical teams. Paper presented at: Society of Hospital Medicine Annual Meeting; 2012 May 1; San Diego, CA. [view]
  4. Lanham HJ, Leykum L, McDaniel R. Exploring the linkage between practice relationships and EHR use: A comparison of primary care and specialty care practices. Poster session presented at: North American Primary Care Research Group Annual Meeting; 2011 Nov 14; Banff, Canada. [view]
  5. Lanham HJ, Leykum L, Taylor B, McCannon J. How complexity science can inform scale-up and spread: Understanding the role of self-organization in variation across local contexts. Paper presented at: Academy of Management Annual Meeting; 2012 Aug 6; Boston, MA. [view]
  6. Palmer R, Leykum L, McDaniel R, Nutting P, Strange K, Crabtree B, Miller W, Jaen C, Lanham HJ. Testing a conceptual model of practice relationships: The importance of trust and reflection in primary care practice redesign. Paper presented at: AcademyHealth Annual Research Meeting; 2012 Jun 26; Orlando, FL. [view]
  7. McAllister C, Leykum L, Lanham HJ, Reisinger H, Agar M, Pugh JA, Provost S, McDaniel RR. The impact of physician relationships on the length of stay of hospitalized patients. Paper presented at: AcademyHealth Annual Research Meeting; 2012 Jun 1; Orlando, FL. [view]
  8. Lanham HJ, Leykum L, McAllister C, Reisinger H, Pugh JA, Agar M, McDaniel R. The impact of physician relationships on the length of stay of hospitalized patients. Paper presented at: University of Texas at Austin McCombs School of Business Annual Health Care Research Symposium; 2012 Apr 26; Austin, TX. [view]
  9. Lanham HJ, Palmer R, Leykum L, McDaniel R, Nutting P, Strange K, Crabtree B, Miller W, Jaen C. The importance of trust and reflection in primary care practice redesign. Paper presented at: University of Texas at Austin McCombs School of Business Annual Health Care Research Symposium; 2012 Apr 27; Austin, TX. [view]
  10. Leykum L. Use of an Agent-Based Model to Understand Inpatient Clinical Systems. Presented at: Society for Chaos Theory in Psychology and Life Sciences Annual International Conference; 2010 Jul 15; San Marcos, TX. [view]
  11. LaFreniere J, Boonyasai T, Harrison R, Southern W, Leykum L. Work-life balance in academic hospital medicine. Paper presented at: Society of General Internal Medicine Annual Meeting; 2012 May 1; Orlando, FL. [view]


DRA: Health Systems
DRE: Treatment - Observational
Keywords: none
MeSH Terms: none

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