IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v71y2010i11p1997-2004.html
   My bibliography  Save this article

Integrated care in the emergency department: A complex adaptive systems perspective

Author

Listed:
  • Nugus, Peter
  • Carroll, Katherine
  • Hewett, David G.
  • Short, Alison
  • Forero, Roberto
  • Braithwaite, Jeffrey

Abstract

Emergency clinicians undertake boundary-work as they facilitate patient trajectories through the Emergency Department (ED). Emergency clinicians must manage the constantly-changing dynamics at the boundaries of the ED and other hospital departments and organizations whose services emergency clinicians seek to integrate. Integrating the care that differing clinical groups provide, the services EDs offer, and patients' needs across this journey is challenging. The journey is usually accounted for in a linear way - as a "continuity of care" problem. In this paper, we instead conceptualize integrated care in the ED using a complex adaptive systems (CAS) perspective. A CAS perspective accounts for the degree to which other departments and units outside of the ED are integrated, and appropriately described, using CAS concepts and language. One year of ethnographic research was conducted, combining observation and semi-structured interviews, in the EDs of two tertiary referral hospitals in Sydney, Australia. We found the CAS approach to be salient to analyzing integrated care in the ED because the processes of categorization, diagnosis and discharge are primarily about the linkages between services, and the communication and negotiation required to enact those linkages, however imperfectly they occur in practice. Emergency clinicians rapidly process large numbers of high-need patients, in a relatively efficient system of care inadequately explained by linear models. A CAS perspective exposes integrated care as management of the patient trajectory within porous, shifting and negotiable boundaries.

Suggested Citation

  • 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.
  • Handle: RePEc:eee:socmed:v:71:y:2010:i:11:p:1997-2004
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(10)00637-4
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    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. Paul Cilliers, 2001. "Boundaries, Hierarchies And Networks In Complex Systems," International Journal of Innovation Management (ijim), World Scientific Publishing Co. Pte. Ltd., vol. 5(02), pages 135-147.
    2. Nugus, Peter & Braithwaite, Jeffrey, 2010. "The dynamic interaction of quality and efficiency in the emergency department: Squaring the circle?," Social Science & Medicine, Elsevier, vol. 70(4), pages 511-517, February.
    3. Paula Hyde, 2006. "Managing across boundaries: identity, differentiation and interaction," International Journal of Innovation and Learning, Inderscience Enterprises Ltd, vol. 3(4), pages 349-362.
    4. Hewett, David G. & Watson, Bernadette M. & Gallois, Cindy & Ward, Michael & Leggett, Barbara A., 2009. "Intergroup communication between hospital doctors: Implications for quality of patient care," Social Science & Medicine, Elsevier, vol. 69(12), pages 1732-1740, December.
    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. Sarah M. Bonzo & David McLain & Mark S. Avnet, 2016. "Process Modeling in the Operating Room: A Socio‐Technical Systems Perspective," Systems Engineering, John Wiley & Sons, vol. 19(3), pages 267-277, May.
    2. 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.
    3. Peter Tsasis & Jenna M. Evans & Linda Rush & John Diamond, 2013. "Learning to Learn: towards a Relational and Transformational Model of Learning for Improved Integrated Care Delivery," Administrative Sciences, MDPI, vol. 3(2), pages 1-23, June.
    4. 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.
    5. 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.

    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. Omid Omidvar & Roman Kislov, 2016. "R&D Consortia As Boundary Organisations: Misalignment And Asymmetry Of Boundary Management," International Journal of Innovation Management (ijim), World Scientific Publishing Co. Pte. Ltd., vol. 20(02), pages 1-24, February.
    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. Gifford, Rachel & Molleman, Eric & van der Vaart, Taco, 2024. "It's a jungle out there: Understanding physician payment and its role in group dynamics," Social Science & Medicine, Elsevier, vol. 350(C).
    4. Reiss, Michael & Greene, Carolyn A. & Ford, Julian D., 2017. "Is it time to talk? Understanding specialty child mental healthcare providers' decisions to engage in interdisciplinary communication with pediatricians," Social Science & Medicine, Elsevier, vol. 175(C), pages 66-71.
    5. Ovretveit, John, 2009. "The contribution of new social science research to patient safety," Social Science & Medicine, Elsevier, vol. 69(12), pages 1780-1783, December.
    6. 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.
    7. Richard Meissner & Inga Jacobs, 2016. "Theorising complex water governance in Africa: the case of the proposed Epupa Dam on the Kunene River," International Environmental Agreements: Politics, Law and Economics, Springer, vol. 16(1), pages 21-48, February.
    8. Mark A. Phillips & Jagjit Singh Srai, 2018. "Exploring Emerging Ecosystem Boundaries: Defining ‘The Game’," International Journal of Innovation Management (ijim), World Scientific Publishing Co. Pte. Ltd., vol. 22(08), pages 1-21, December.
    9. Francesca Froy, 2023. "Learning from architectural theory about how cities work as complex and evolving spatial systems," Cambridge Journal of Regions, Economy and Society, Cambridge Political Economy Society, vol. 16(3), pages 495-510.
    10. Keith R. Skene, 2021. "No goal is an island: the implications of systems theory for the Sustainable Development Goals," Environment, Development and Sustainability: A Multidisciplinary Approach to the Theory and Practice of Sustainable Development, Springer, vol. 23(7), pages 9993-10012, July.
    11. Powell, Alison E. & Davies, Huw T.O., 2012. "The struggle to improve patient care in the face of professional boundaries," Social Science & Medicine, Elsevier, vol. 75(5), pages 807-814.
    12. Richard Marcantonio & Agustin Fuentes, 2020. "A Clear Past and a Murky Future: Life in the Anthropocene on the Pampana River, Sierra Leone," Land, MDPI, vol. 9(3), pages 1-17, March.
    13. Ron Martin & Peter Sunley, 2010. "Complexity Thinking and Evolutionary Economic Geography," Chapters, in: Ron Boschma & Ron Martin (ed.), The Handbook of Evolutionary Economic Geography, chapter 4, Edward Elgar Publishing.
    14. Nugus, Peter & Greenfield, David & Travaglia, Joanne & Braithwaite, Jeffrey, 2012. "The politics of action research: “If you don't like the way things are going, get off the bus”," Social Science & Medicine, Elsevier, vol. 75(11), pages 1946-1953.
    15. Agovino, Massimiliano & Musella, Gaetano & Scaletti, Alessandro, 2022. "Equilibrium and efficiency in the first aid services market: The case of the emergency department of Sorrento," Socio-Economic Planning Sciences, Elsevier, vol. 82(PB).
    16. Quan Liu & Ayeley Tchangani & François Pérès & Vicente Gonzalez-Prida, 2018. "Object-oriented Bayesian network for complex system risk assessment," Journal of Risk and Reliability, , vol. 232(4), pages 340-351, August.
    17. Stefanini, Alessandro & Aloini, Davide & Gloor, Peter & Pochiero, Federica, 2021. "Patient satisfaction in emergency department: Unveiling complex interactions by wearable sensors," Journal of Business Research, Elsevier, vol. 129(C), pages 600-611.
    18. Peter Wehnert & Christoph Kollwitz & Christofer Daiberl & Barbara Dinter & Markus Beckmann, 2018. "Capturing the Bigger Picture? Applying Text Analytics to Foster Open Innovation Processes for Sustainability-Oriented Innovation," Sustainability, MDPI, vol. 10(10), pages 1-24, October.
    19. Rhodes, Tim & Lancaster, Kari, 2019. "Evidence-making interventions in health: A conceptual framing," Social Science & Medicine, Elsevier, vol. 238(C), pages 1-1.
    20. Krzakiewicz Kazimierz & Cyfert Szymon, 2012. "The Role of Leaders in Managing Organisation Boundaries," Management, Sciendo, vol. 16(1), pages 7-22, May.

    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:71:y:2010:i:11:p:1997-2004. 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.