I. Examples of Applying CAS Agent Based Modeling to Providing Individual Patient Centered Care
Complex adaptive systems (CASs) refer to a unique and change-driven framework that places great emphasis on challenging simple and ineffective cause and effect assumptions, while at the same time, seeing healthcare and associated systems as a complicated, multifaceted, and dynamic process. According to CAS, healthcare remains characterized by relationships, as well as interactions of a broad range of components, which operate by simultaneously affecting and remain shaped by the very system (Sturmberg, 2011). In this context, responsible stakeholders can apply CAS agent-based modeling in healthcare with the sole purpose of providing the much-needed patient-centered care. The first example involving the application of a complexity-based approach to realize person-centered care is the understanding and appreciation of the fact that health, disease, and illness as complex adaptive states, which play a central role in impacting personhood. Available research has shown that the current healthcare systems continue to objectify diseases, seeing illnesses and associated conditions as any other commodity (Leykum et al., 2012; McDaniel, Lanham, & Anderson, 2009). In this way, healthcare providers firmly believe that they can manage a variety of discrete entities through the adoption and integration of standardized industrial approaches.
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Moving away from this traditional approach, CAS requires practitioners not only to identify but also consider the ever-changing and diverse nature of personal, as well as community contexts. For instance, CAS provides that numerous diseases tend to develop over a long period, meaning that the human body system adapts and remains functional in the changed or altered environment (Sturmberg, 2011). Given the changes, CAS agent-based modeling expects nurse practitioners not to rely on the few and already established clinically measurable factors and methods to treat a patient. Physicians in collaboration with other stakeholders in the health sector can achieve the much-needed individual patient-centered care by viewing the interconnection between disease, health, and illness in addition to appreciating the fact that each can be experienced under different circumstances and in the presence or absence of discrete diseases (Dong et al. 2012). By tracking a person’s disease, health, and illness experiences over time, nurses find the best possible opportunity to determine whether the patient in question suffers from psychosomatic turmoil, acute illness, or a given chronic disease.
The second example of applying CAS agent-based modeling involves the appreciation of the fact that the primary role of healthcare is growing health. According to Leykum et al. (2012), nurses should refocus healthcare by adopting and integrating the individualized approach into the diagnosis and treatment processes. They can realize this by accepting that health is not only a personal state but also remains dependent on a wide range of environmental, social, and community determinants. By identifying and gaining a proper understanding of the factors, NPs can follow the correct procedures and medications when it comes to treating and improving the condition of a patient.
The third example is the utilization of personal sense-making. Recent studies have so far revealed that systematic differences witnessed in key patient outcomes remain inextricably linked to the inability of physician teams to prioritize sense-making and improvisation when faced with dynamic healthcare condition (Leykum et al., 2012). CAS agent-based model requires nurses to use their improvisations, as well as sense-making abilities to accurately determine their patients’ length of stay, the need to transfer to an advanced care level, and the likelihood that their condition might worsen through the development of life-threatening complications. The decision to make sense of a patient’s current situation revolves around CAS’s principle that both illnesses and health both occur at a personal level or context (Thomson et al., 2016). In this regard, fostering sense –making goes a long way in ensuring the achievement of holistic care; given the responsible physician can make sense of the patient’s physical, emotional, social, and psychological statuses.
Apart from the identified and briefly discussed examples involving the application of CAS to achieve person-centered care, physicians and facilities can place much emphasis on the identification, treatment, and management of community and personal health problems. Although epidemiological research has failed to explain the various dynamics that cause illness experiences, NPs should understand that this constitutes a pathological change. In other words, they should direct their knowledge and available resources to the many stressors in the patient’s immediate and extended networks or socio-environmental factors (McDaniel, Lanham, & Anderson, 2009). For instance, a nurse should ask whether the patient’s illness resulted from global or weather changes. In essence, the ability to understand a person’s health experiences remains significant, as it helps physicians to utilize the most appropriate healing process, while at the same time, minimizing morbidity and mortality incidences.
In addition, the CAS agent-based approach can be applied to provide the much-needed patient-centered care through the creation of an efficient and effective healthcare system. Undoubtedly, the application of CAS to any given health care setting plays a fundamental role in changing the various improvement efforts and strategies from the traditional, individual approach to one characterized by complex relationships among individuals (Sturmberg, 2011). A complex system typically comprises the interconnections between different players since people tend to relate at personal, interpersonal, organizational, and community levels. By advocating an efficient system, CAS presents individual NPs and their respective teams with the best possible opportunity to identify with and promote a culture of patient-centeredness. At the same time, CAS revolves around seamlessly knitted or integrated healthcare systems, which perpetuates great diversity and the adaption of patient care needs to their local circumstances.
II. Examples of Local Units in a Hospital or Clinic Setting Applying Concepts of Self-Organization to Establish More Adaptive Approaches to Situational Demands for Change
Self-organizing serves as one of the crucial elements of CAS. The property in question exists on the premise that CASs lack a hierarchy of command; given they tend to undergo constant reorganization with the sole purpose of finding the best possible fit with the surrounding environment. According to Sturmberg (2011), self-organization depends a great deal on multiple interactions, recursive feedback, and the exploitation-exploration balance. Empirical research has established that systems that lack the much-needed understanding of change management principles for CASs continue to fail when it comes to achieving the desired patient outcomes (Buonocore, 2004). In this sense, local units in hospital settings should understand the various actions and self-organization principles to develop and maintain the most adaptive approaches when tasked with the responsibility of addressing situational demands for change.
The first example of how these local units can identify and establish flexible and adaptive frameworks for ensuring change involves their ability to prioritize primary care practices. According to the findings from a recent study by Leykum et al. (2012), NPs and other health care providers should conceptualize primary care and associated practices as one of the effective CASs, which comprises a core, attentiveness to the immediate or local environment, and adaptive reserve. By availing the necessary resources and building a strong organizational structure, the local units can create functional processes characterized by resilience. With such a result-oriented approach, they remain well positioned to adapt their change strategies to the prevailing situational demands.
Another concept of self-organization that local units in a hospital should utilize revolves around interpersonal interactions. In their study to system modeling in critical care medicine, Dong et al. (2012) corroborate that healthcare organizations are macro systems, meaning their management cannot depend on the widely held but ineffective linear thought patterns. Given the complexity of situational demands for change, interpersonal interactions allow NPs to remain innovative, as they connect the macro system with each of the microsystems (Pype, 2018). In this way, the local units can realize positive changes gradually through the creation of an adaptive system or approach.
Local units in any given hospital can focus on the principle of workplace development with the sole purpose of developing a change-oriented approach to each of the situational demands. Self-organization plays a pivotal role in defining the roles, as well as interrelationships of the healthcare workforce. When faced with a pressing situational demand for change, for instance, departments in a health facility can facilitate nursing, rehabilitation, and primary care teams to organize local networks. According to Dong et al. (2012), the most powerful initiatives, programs, or processes in health care organizations rend, to begin with its staff members. Through workplace development, local units can generate, implement, and maintain new solutions.
III. Advance Practice Nurse (APN) Applying the Concepts of a CAS to Individual Patient Care
The first two CAS concepts that APN can apply to individual patient care include professional hierarchy and behavior change. CAS advocates peaceful coexistence and effective communication and collaboration among health care practitioners (Bosworth et al., 2009). In this sense, APN should spend adequate time deliberating a variety of treatment and follow-up options with the physician. By creating the much-needed horizontal collaborative relationship, APN finds the opportunity to facilitate open interactions with patients, which, in turn, translates to person-centered care. At the same time, ANP should not see health behavior and associated changes as one of the linear and effect models. Instead, they should appreciate their complexity. For instance, they should acknowledge and appreciate the fact that behavior change remains a highly variable and difficult-to-predict process. In this way, APN can use the correct tool to ensure a change of behavior in a given patient. Besides the identified concepts, APN can apply the concept of a shared mission of offering quality care. According to Anderson et al. (2014), practitioners should act in their patients’ best interests by stimulating shared-decision making and result-driven discussions. For instance, they should appreciate other practitioners’ knowledge and experiences to know when to support their efforts.
IV. Action steps you would take as an APN to begin implementing change in the organization while considering the concepts of CAS that you have identified
The three action steps that I would take given my position and role as an APN include employee involvement, removal of barriers, and adoption of nursing technologies. I firmly believe that all change efforts in our healthcare organization should involve every stakeholder, especially individual employees, who remain tasked with the responsibility of implementing changes. Regardless of its size, the organizational change should not only be communicated but also explained to workers, informing them about the potential effects on their well-being and roles (Pype, 2018). At the same time, employees often face a broad range of challenges when creating and implementing changes. The barriers can assume different forms, including lack of experience in a particular area, high costs, and inability to access vital information (Woo, Lee, & Tam, 2017). In response, I would focus on adequate training in addition to availing necessary equipment. Additionally, I would identify the most effective medical or nursing technology, including electronic health record (EHR) system. If the facility has suffered a damaged public image due to poor recording keeping, I strongly believe that ERPs would help in reducing wait time and other patient outcomes.
V. Summary
Conclusively, it is evident that the application of a CAS agent-based model to the healthcare system plays a central role in ensuring the achievement of individual patient-centered care. In particular, CAS requires NPs to view health, disease, and illness as complex adaptive states, which typically occur in various circumstances and the absence or presence of discrete diseases. At the same time, it expects healthcare to promote health. Through the adoption of self-organization concepts, including a focus on primary care practices, local units in any given hospital setting can develop the most effective approaches when it comes to bringing change prompted by situational demands. Moreover, an APN can apply a variety of CAS concepts, including professional hierarchy to achieve the much-needed individual person-centered care. At the same time, they can implement organizational change through employee involvement, removal of barriers, and adoption of nursing technologies.
References
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