Application of simplified Complexity Theory concepts for healthcare social systems to explain the implementation of evidence into practice
Application of simplified Complexity Theory concepts for healthcare social systems to explain the implementation of evidence into practice
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DOI：
10.1111/jan.12815
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发表时间：
2016-02-01
影响因子：
3.8
通讯作者：
Noyes, Jane
中科院分区：
文献类型：
--
作者：
Chandler, Jacqueline;Rycroft-Malone, Jo;Noyes, Jane
瞄准为了研究复杂性理论的核心概念的应用，以解释在一项评估减少手术禁食时间建议的实施策略的试验中进行的过程评估的结果。循证指南的扩散需要更加注重其执行。理论需要解释跨多个医疗保健组织层次的复杂过程。这种社会医疗背景涉及专业人员，患者和组织系统之间的相互作用，在医疗服务。复杂性理论可以提供一个解释性的框架来解释在社会医疗背景下实施中固有的复杂性。二次专题分析的定性过程评价数据告知复杂性理论。将复杂性理论应用于社会背景的种子文本进行了注释，提取了关键概念，并确定了复杂性理论的核心概念。这些核心概念被用作理论透镜，以提供对一项试验过程评价主题的解释，该试验评价了减少手术禁食时间的策略的实施。抽样的实质性文本提供了复杂性理论的理论发展和应用从20世纪90年代末至2013年在社会科学，医疗保健，管理和哲学的代表性传播。复杂性理论的五个核心概念是“自组织”、“互动”、“涌现”、“系统历史”和“暂时性”。这些概念的应用表明，常规手术禁食实践在社会医疗保健系统中已经习惯，因此不容易逆转。减少禁食时间需要一种激励的新方法来出现在外科系统完成手术列表的优先级中。复杂性理论的应用为禁食实践的抗拒提供了一个有用的解释。它在执行研究中的效用值得进一步关注和评价。
Aim. To examine the application of core concepts from Complexity Theory to explain the findings from a process evaluation undertaken in a trial evaluating implementation strategies for recommendations about reducing surgical fasting times.Background. The proliferation of evidence-based guidance requires a greater focus on its implementation. Theory is required to explain the complex processes across the multiple healthcare organizational levels. This social healthcare context involves the interaction between professionals, patients and the organizational systems in care delivery. Complexity Theory may provide an explanatory framework to explain the complexities inherent in implementation in social healthcare contexts.Design. A secondary thematic analysis of qualitative process evaluation data informed by Complexity Theory.Method. Seminal texts applying Complexity Theory to the social context were annotated, key concepts extracted and core Complexity Theory concepts identified. These core concepts were applied as a theoretical lens to provide an explanation of themes from a process evaluation of a trial evaluating the implementation of strategies to reduce surgical fasting times. Sampled substantive texts provided a representative spread of theoretical development and application of Complexity Theory from late 1990's-2013 in social science, healthcare, management and philosophy.Findings. Five Complexity Theory core concepts extracted were 'self-organization', 'interaction', 'emergence', 'system history' and 'temporality'. Application of these concepts suggests routine surgical fasting practice is habituated in the social healthcare system and therefore it cannot easily be reversed. A reduction to fasting times requires an incentivised new approach to emerge in the surgical system's priority of completing the operating list.Conclusion. The application of Complexity Theory provides a useful explanation for resistance to change fasting practice. Its utility in implementation research warrants further attention and evaluation.