IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v198y2018icp95-102.html
   My bibliography  Save this article

‘Complexity-compatible’ policy for integrated care? Lessons from the implementation of Ontario's Health Links

Author

Listed:
  • Grudniewicz, Agnes
  • Tenbensel, Tim
  • Evans, Jenna M.
  • Steele Gray, Carolyn
  • Baker, G. Ross
  • Wodchis, Walter P.

Abstract

Complex adaptive systems (CAS) theory views healthcare as numerous sub-systems characterized by diverse agents that interact, self-organize, and continuously adapt. We apply this complexity science perspective to examine the extent to which CAS theory is a useful lens for designing and implementing health policies. We present the case of Health Links, a “low rules” policy intervention in Ontario, Canada aimed at stimulating the development of voluntary networks of health and social organizations to improve care coordination for the most frequent users of the healthcare system. Our sample consisted of stakeholders from regional governance bodies and organizations partnering in Health Links. Qualitative interview data were coded using the key complexity concepts of sensemaking, self-organization, interconnections, coevolution, and emergence. We found that the complexity-compatible policy design successfully stimulated local dynamics of flexibility, experimentation, and learning and that important mediating factors include leadership, readiness, relationship-building, role clarity, communication, and resources. However, we saw tensions between preferences for flexibility and standardization. Desirable developments occurred only in some settings and failed to flow upward to higher levels, resulting in a piecemeal and patchy landscape. Attention needs to be paid not only to local dynamics and processes, but also to regional and provincial levels to ensure that learning flows to the top and informs decision-making. We conclude that implementation of complexity-compatible policies needs a balance between flexibility and consistency and the right leadership to coordinate the two. Complexity-compatible policy for integrated healthcare is more than simply ‘letting a thousand flowers bloom’.

Suggested Citation

  • Grudniewicz, Agnes & Tenbensel, Tim & Evans, Jenna M. & Steele Gray, Carolyn & Baker, G. Ross & Wodchis, Walter P., 2018. "‘Complexity-compatible’ policy for integrated care? Lessons from the implementation of Ontario's Health Links," Social Science & Medicine, Elsevier, vol. 198(C), pages 95-102.
    • Handle: RePEc:eee:socmed:v:198:y:2018:i:c:p:95-102
    DOI: 10.1016/j.socscimed.2017.12.029
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953617307736
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2017.12.029?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Nugus, Peter & Carroll, Katherine & Hewett, David G. & Short, Alison & Forero, Roberto & Braithwaite, Jeffrey, 2010. "Integrated care in the emergency department: A complex adaptive systems perspective," Social Science & Medicine, Elsevier, vol. 71(11), pages 1997-2004, December.
    2. Lanham, Holly Jordan & Leykum, Luci K. & Taylor, Barbara S. & McCannon, C. Joseph & Lindberg, Curt & Lester, Richard T., 2013. "How complexity science can inform scale-up and spread in health care: Understanding the role of self-organization in variation across local contexts," Social Science & Medicine, Elsevier, vol. 93(C), pages 194-202.
    3. Teppo Felin & Steve W. J. Kozlowski & Georgia T. Chao, 2012. "The Dynamics of Emergence: Cognition and Cohesion in Work Teams," Managerial and Decision Economics, John Wiley & Sons, Ltd., vol. 33(5-6), pages 335-354, July.
    4. Sabatier, Paul A., 1986. "Top-Down and Bottom-Up Approaches to Implementation Research: a Critical Analysis and Suggested Synthesis," Journal of Public Policy, Cambridge University Press, vol. 6(1), pages 21-48, January.
    5. Paul Cairney, 2012. "Complexity Theory in Political Science and Public Policy," Political Studies Review, Political Studies Association, vol. 10(3), pages 346-358, September.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Embuldeniya, Gayathri & Gutberg, Jennifer & Sibbald, Shannon S. & Wodchis, Walter P., 2021. "The beginnings of health system transformation: How Ontario Health Teams are implementing change in the context of uncertainty," Health Policy, Elsevier, vol. 125(12), pages 1543-1549.
    2. Shaw, James & Gutberg, Jennifer & Wankah, Paul & Kadu, Mudathira & Gray, Carolyn Steele & McKillop, Ann & Baker, G. Ross & Breton, Mylaine & Wodchis, Walter P., 2022. "Shifting paradigms: Developmental milestones for integrated care," Social Science & Medicine, Elsevier, vol. 301(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ogada, Maurice Juma, 2012. "Forest Management Decentralization in Kenya: Effects on Household Farm Forestry Decisions in Kakamega," 2012 Conference, August 18-24, 2012, Foz do Iguacu, Brazil 126319, International Association of Agricultural Economists.
    2. daSilva, Madelyn & Dissanayake, Melanie & Sibbald, Shannon L., 2024. "Beyond implementation: A collective case study exploring the conceptions and facilitators of sustainability in a quality improvement collaborative," Evaluation and Program Planning, Elsevier, vol. 102(C).
    3. Jiunyan Wu & Tomoki Sekiguchi, 2020. "A multilevel and dynamic model of intragroup conflict and decision making: application of agent-based modeling," Frontiers of Business Research in China, Springer, vol. 14(1), pages 1-26, December.
    4. West, Robert M. & House, Allan O. & Keen, Justin & Ward, Vicky L., 2015. "Using the structure of social networks to map inter-agency relationships in public health services," Social Science & Medicine, Elsevier, vol. 145(C), pages 107-114.
    5. Crabolu, Gloria & Font, Xavier & Eker, Sibel, 2023. "Evaluating policy complexity with Causal Loop Diagrams," Annals of Tourism Research, Elsevier, vol. 100(C).
    6. Wang, Hsiao-Fan & Sung, Meng-Ping & Hsu, Hsin-Wei, 2016. "Complementarity and substitution of renewable energy in target year energy supply-mix plannin–in the case of Taiwan," Energy Policy, Elsevier, vol. 90(C), pages 172-182.
    7. E R Alexander & A Faludi, 1989. "Planning and Plan Implementation: Notes on Evaluation Criteria," Environment and Planning B, , vol. 16(2), pages 127-140, June.
    8. Yi, Fangxin & Deng, Dong & Zhang, Yanjiang, 2020. "Collaboration of top-down and bottom-up approaches in the post-disaster housing reconstruction: Evaluating the cases in Yushu Qinghai-Tibet Plateau of China from resilience perspective," Land Use Policy, Elsevier, vol. 99(C).
    9. Sovacool, Benjamin K. & Van de Graaf, Thijs, 2018. "Building or stumbling blocks? Assessing the performance of polycentric energy and climate governance networks," Energy Policy, Elsevier, vol. 118(C), pages 317-324.
    10. Lin, Wanlin & Lin, George C.S., 2023. "Strategizing actors and agents in the functioning of informal property Rights: The tragicomedy of the extralegal housing market in China," World Development, Elsevier, vol. 161(C).
    11. Hilligoss, Brian, 2014. "Selling patients and other metaphors: A discourse analysis of the interpretive frames that shape emergency department admission handoffs," Social Science & Medicine, Elsevier, vol. 102(C), pages 119-128.
    12. repec:ocp:rpaper:pp-1704 is not listed on IDEAS
    13. Mæhle, Per Magnus & Smeland, Sigbjørn, 2021. "Implementing cancer patient pathways in Scandinavia how structuring might affect the acceptance of a politically imposed reform," Health Policy, Elsevier, vol. 125(10), pages 1340-1350.
    14. Alvaro Pina Stranger & German Varas & Gaëlle Mobuchon, 2023. "Managing Inter-University Digital Collaboration from a Bottom-Up Approach: Lessons from Organizational, Pedagogical, and Technological Dimensions," Sustainability, MDPI, vol. 15(18), pages 1-20, September.
    15. Carolus, Johannes Friedrich & Hanley, Nick & Olsen, Søren Bøye & Pedersen, Søren Marcus, 2018. "A Bottom-up Approach to Environmental Cost-Benefit Analysis," Ecological Economics, Elsevier, vol. 152(C), pages 282-295.
    16. Pečarič Mirko, 2020. "Regulatory Cybernetics: Adaptability and Probability in the Public Administration’s Regulations," NISPAcee Journal of Public Administration and Policy, Sciendo, vol. 13(1), pages 133-156, June.
    17. Mathilde Collinet-Ourthe & David Carassus & Pierre Marin, 2017. "Vers un nouveau pilotage des politiques sociales," Post-Print hal-02142217, HAL.
    18. Mladen Djuric & Marina Dobrota & Jovan Filipovic, 2020. "Complexity-based quality indicators for human and social capital in science and research: the case of Serbian Homeland versus Diaspora," Scientometrics, Springer;Akadémiai Kiadó, vol. 124(1), pages 303-328, July.
    19. Kieslich, Marcus & Salles, Jean-Michel, 2021. "Implementation context and science-policy interfaces: Implications for the economic valuation of ecosystem services," Ecological Economics, Elsevier, vol. 179(C).
    20. Hildebrand Sean, 2015. "Coerced Confusion? Local Emergency Policy Implementation After September 11," Journal of Homeland Security and Emergency Management, De Gruyter, vol. 12(2), pages 273-298, June.
    21. Gakou-Kakeu, Josiane & Di Gregorio, Monica & Paavola, Jouni & Sonwa, Denis Jean, 2022. "REDD+ policy implementation and institutional interplay: Evidence from three pilot projects in Cameroon," Forest Policy and Economics, Elsevier, vol. 135(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:198:y:2018:i:c:p:95-102. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.