DNP Collaborative Projects

Benham-Hutchins, M. & Clancy ,T. R. (2010). Managing organizational complexity. social networks as embedded complex adaptive systems. The Journal of Nursing Administration, 40(9), 352. The authors of this article, both of whom are faculty at Texas Women's University School of Nursing, identify social network analysis (SNA) as a tool that is complementary to the theatrical underpinnings of complexity science. They assert that interprofessional communication is influenced not only by two individuals in communication with one another, but also by the social networks of which each is a part. The authors focus on the non-linear processes involved in communication between professionals and units when transferring a patient. Incorporating the theories of complexity sciences into research on communication networks could increase the applicability to healthcare organizations. Recognizing the complex nature and influence of social networks within an organization will assist the nurse leaders in our case study formulate solutions for the non-linear challenges they face.

I thought the dynamic figures in this article were telling. However in the patient centered environment, it was odd to me that very little attention was paid to the patient in the midst of this complex transfer especially in Figure 3. I think we all must be aware that the true definition of a CAS is the ability to learn and adapt based on environmental cues, feedback or events. We often have complex systems but not complex adaptive systems.

This article, written by Dr. Thomas Clancy, a Clinical Professor at the University of Minnesota's School of Nursing discusses complexities within healthcare systems (specifically hospitals) as it relates to directing. Using a complex systems perspective, the author suggests innovative methods in directing high functioning teams. In congruence with characteristics and models of complex adaptive systems as presented by the Institute of Healthcare Improvement Modules and Dr. Bonnie Jennings (2013), the author gives a clear depiction of how nurses function within these systems. Rapid cognition and structured spontaneity are two skills the author suggests are crucial for nurse administrators to develop among teams within complex environments (high potentials). This article suggests the development of these skills will enable "nurses to make independent decisions within limits defined by policy" (p. 62). In other words, decision making would be less autocratic and more participatory which would enable the director to higher levels of directing. Data from this series of articles are relevant to today's practice and may be particularly resources for healthcare leaders as they redesign and implement innovatieve techniques within macro, mess, or microsystems. Clancy ,T. R. (2008). Managing organizational complexity. Directing: A complex systems perspective. The Journal of Nursing Administration, 38(2), 61-63.

A great article and what an interesting contribution to nursing education with use of simulation to develop the rapid cognition and structured spontaneity.

This article is a useful example of a complex adaptive system. From a personal business perspective, the author discusses several reasons as to why the implementation of The Affordable Care Act has been challenging. This example of a macro system exhibits the need for multiple aspects within the system to work in collaboration with key stakeholders including government parties, insurance companies, business and individuals. Seib, G. (2013). Why new health law is so complicated. The Wall Street Journal. Retrieved from http://online.wsj.com/articles/SB10001424052702303755504579205800232065892

This article also provides insight into how the macro, micro and meso systems become so intertwined in such a large undertaking and how its implementation philosophically is even more complex as it advances both parties polar opposite desires of privatization and unification of health care delivery. Great short read!

The government is beginning the third year of fining hospitals for having too many readmissions of patients with Medicare, and penalties, as well as the categories of patients included in the data measured, are increasing. The goal is to encourage healthcare systems and care providers within them to manage chronic disease better. The problem is a complex one. Safety-net hospitals, which tend to have sicker patients with less resources, may not be able to meet the same bench marks that hospitals catering to the wealthy can. However, to set a lower goal for these hospitals would be tantamount to the government enforcing a lower standard of care for the poor. In addition, managing chronic disease to reduce readmission will reduce overall admissions, and some hospitals cannot remain financially stable if they do so. The article was produced for Kaiser Health News (KHN) in association with the Scan Foundation, whose stated mission is to promote aging with dignity and independence. It relates to another story published on KHS about a hospital system who has hired a nurse just to talk with people about their diabetes in an effort to promote patient self-care and knowledge, and reduce hospital admissions (McCammon, 2014). Reference McCammon, S. (2014). Personal attention seen as antidote to rising health costs. Georgia Public Radio & Kaiser Health News. Retrieved from http://kaiserhealthnews.org/news/care-coordinators-try-to-save-hospitals-money/

Erin, such a telling article and relates to the complexity of the entire process of self care, desire to change, and personal empowerment. Knowledge skills and attitudes are at the core of some of the issues but one also has to consider the socio-cultural-economic environment as well. Identifying those who are at the highest risk for readmission based on multiple inputs may be the next step--both for financial relief for hospital and improved outcomes for patients.

With companies set to face fines next year for not complying with the new mandate to offer health insurance, some are pursuing strategies like enrolling employees in Medicaid to avoid penalties and hold down costs. This is the first sentence in the WSJ article that published on 10/21/14. It also discusses how some employers are adopting bare bones insurance plans, changing their work force to part time to minimize those needed to be covered or accepting the fines for not covering their employers.