Systems Theory and Practice Issues
Many of you have experience in complex adaptive systems whether you realize it or not. Thinking about your current or future practice area (Family Nurse Practitioner), identify an issue or concern. In your initial response, please describe the concern. Does the concern primarily occur at the micro, meso, or macro level? How would you address this issue? What impact might your solution have on the other levels of the system? In what ways could interprofessional collaboration be used to resolve the issue?
Information that you can use as guide
nterprofessional practice within complex systems is key competency for the APN (NONPF, 2011). A variety of perspectives exist today regarding the concept of collaboration, particularly from the standpoint of the physician: nurse relationship. Collaboration has evolved to a model of integrative practice (Zaccagnini & Waud White, 2015). In order to understand the advanced practice nurse’s (APN) current role in interprofessional collaboration, it is necessary to understand the historical development of the concept of collaboration. Although collaboration is intended to provide meaning regarding the relationships that exist among a variety of healthcare providers who work together to provide delivery of healthcare services, it is frequently characterized by unique features demonstrated primarily in the physician: nurse relationship.
A common practice model is parallel practice. In parallel practice, one sees very little collaboration between healthcare providers. Parallel practice is similar to the concept that nurses readily recognize in toddlers as parallel play. Each provider functions independently, even when working in a collaborative setting. Providers work within their independent scope of practice, but they do not collaborate in the delivery of healthcare. In this model, there is little recognition of the unique contributions that a variety of healthcare team members can make to delivery of healthcare.
A second practice model is one of consultative practice. In this type of practice, one scope of practice may be dependent on another and one provider is seen as expert over another. For example, in some states, APNs are constrained by boards of nursing and/or boards of medicine to demonstrate physician oversight of APN healthcare delivery using a consultative role. Depending on the situation, a consultative practice may be as restrictive as a formalized chart audit, or as professional as a referral. In this model, the collaboration is situational, depending on regulation or professional expectations and depending on the situation, there may be little recognition of the unique contributions that a variety of healthcare team members can make to delivery of healthcare.
A third practice model is one of collaborative practice. In this type of practice, one scope of practice may be dependent on another, but there is less emphasis on hierarchical roles. As with the consultative practice model, APNs in some states are constrained by boards of nursing and/or boards of medicine to demonstrate that a physician oversees APN healthcare delivery using a collaborative role. Also, depending on the situation, a collaborative practice may be as restrictive as a formalized chart audit, or as professional as a referral. Similarly, in this model, the collaboration is situational, depending on regulation or professional expectations; and depending on the situation, there may be little recognition of the unique contributions that a variety of healthcare team members can make to delivery of healthcare.
A fourth practice model is one of coordinated practice. In this type of practice, there is an administrative process that manages collaboration between healthcare providers. Each provider functions independently but collaborates in patient care under a coordinated or case management umbrella. This type of practice permits providers to work within their independent scopes of practice, but also offers some recognition of the unique contributions that a variety of healthcare team members can make to delivery of healthcare.
A fifth practice model is one of multidisciplinary practice. In this type of practice, there is a team approach that leads to collaboration between healthcare providers. Each provider functions independently but collaborates in patient care under a teamwork umbrella. This type of practice allows providers to work within their independent scopes of practice, but also offers recognition of the unique contributions that a variety of healthcare team members can make to delivery of healthcare.
A sixth practice model is one of interdisciplinary practice. In this type of practice, there is a group approach that fosters collaboration between healthcare providers. Each provider functions independently but collaborates in patient care under a consensus umbrella. This type of practice allows providers to work within their independent scopes of practice, but also offers mutual recognition of the unique contributions that a variety of healthcare providers can make to delivery of healthcare.
A seventh practice model is one of integrative practice. In this type of practice, there is a commitment to a philosophy driven Structure-Process-Outcomes (SPO) approach that empowers collaboration between healthcare providers. Each provider functions independently and collaborates in patient care under the SPO umbrella. This type of practice allows providers to work within their independent scopes of practice, and also demonstrates mutual respect for the unique contributions that a variety of healthcare providers can make to delivery of healthcare.
Today’s practice model goal is one of interprofessional practice. In this type of practice, one would expect significant collaboration between healthcare providers. Each provider functions independently and within his or her independent scope of practice, yet each fully collaborates as needed to produce high-quality, cost-effective delivery of healthcare. In this model, there is shared decision making and mutual respect for the unique contributions that all healthcare professionals can make to delivery of healthcare.
Complexity Science and Complex Adaptive Systems
The structure of contemporary organizations can be explained through complexity science. Complexity science evolved from several scientific disciplines, including systems theory, mathematics, theoretical biology, and physics (Marshall, 2016). Complexity science recognizes the unpredictability and chaos inherent in complex, adaptive systems. Important concepts in complexity science include self-organization, multi-dimensionality, system history, emergence, and interconnected relationships. Complexity science helps explain the relationship between macro-level structures, such as organizations, and behavior at the micro- or individual level (Chandler, Rycroft-Malone, Hawkes, & Noyes, 2015).
Complex adaptive systems are flexible and fluid in nature. Organizations are adaptive systems that are integral parts of their environments. They are not static, but rather, are in constantly shifting states which can create uncertainty and unpredictability. Complex adaptive systems are learning organizations that embrace uncertainty and can adapt to emerging change. Master’s prepared advanced practice nurses must become comfortable with ambiguity and uncertainty and learn to accept, manage, and benefit from uncertainty which encourages creativity, innovation, and risk taking that leads to emergence of new order and process within the organization (NLN, 2012). Common characteristics of complex adaptive systems include: parts of systems interact; new behaviors, patterns, and ideas emerge from relationships; results are nonlinear and unpredictable; and self-organization occurs with connective leadership and simple rules (Crowell, 2015). From a complex adaptive system perspective organizations are living systems. Healthcare and healthcare related organizations must be open and receptive to the unpredictable, dynamic, and fluid nature of their environments if they are to survive.
A hospital may be complex adaptive systems within a larger healthcare system or network. The hospital has individuals directly involved in various types of patient care and service activities (microsystem). The hospital is organized into units or departments (mesosystem), which interact with the individuals working within them, with one another, and with the larger healthcare system or community (macrosystem). Changes occurring within units or departments (microsystem) affect activities and outcomes in the hospital (mesosystem). Likewise, changes in the greater community (macrosystem) can influence activities and outcomes in the hospital or hospital system.
