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Rusoja E, Chad Swanson R, Swift M. Using Systems Thinking and Complexity Theory to understand and improve Emergency Medicine: Lessons from COVID-19 in a safety net health system. J Eval Clin Pract 2024; 30:330-336. [PMID: 37723831 DOI: 10.1111/jep.13920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/03/2023] [Indexed: 09/20/2023]
Abstract
RATIONALE COVID-19 has fundamentally changed the practice of Emergency Medicine (EM). Care delivery on the front lines has historically depended upon ostensibly reliable input-output models for staffing, supplies, policies, and therapies. Challenged by the complexity of healthcare during the pandemic, the fallibility of these reductionist models was quickly revealed. Providers and systems quickly had to reconceptualize their dependence on the wider, complex system in which healthcare operates and find adaptive solutions to rapid changes. AIMS/METHOD This papers seeks to review and describe how Systems Thinking and Complexity Theory (ST/CT)-concepts, principles, and tools that can be used to understand and impact our constantly evolving health system-can be applied to better understand and enact change in complex settings such as during COVID-19. Some of these ST/CT are described through the real world example of the Alameda Health System Vaccine Taskforce. RESULTS ST/CT concepts such as Unintended Consequences, Interrelationships, Emergent Behavior, Feedback Loops, and Path Dependence can help EM providers and planners understand the context in which their system operates. Key principles such as Collaboration, Iterative Learning, and Transformational Leadership can help these actors respond to current and future challenges. The integration of these concepts and principles into the Learning Health System offers a model for tying these key concepts and principles together into an adaptive, cross-sectoral organizational approach. CONCLUSION By integrating ST/CT into the practice of EM, we can not only improve our ability to care for patients but also our capacity to understand and strengthen our wider systems of care.
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Affiliation(s)
- Evan Rusoja
- Alameda Health System, Oakland, California, USA
| | | | - Mini Swift
- Alameda Health System, Oakland, California, USA
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Soklaridis S, Chowdhury M, Turco MG, Tremblay M, Mazmanian P, Williams B, Besa R, Sockalingam S. Pivoting Continuing Professional Development During the COVID-19 Pandemic: A Narrative Scoping Review of Adaptations and Innovations. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2024:00005141-990000000-00104. [PMID: 38205969 DOI: 10.1097/ceh.0000000000000539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Most formal continuing professional development (CPD) opportunities were offered in person until March 2020 when the COVID-19 pandemic disrupted traditional structures of CPD offerings. The authors explored the adaptations and innovations in CPD that were strengthened or newly created during the first 16 months of the pandemic. METHODS The objectives of the narrative review were to answer the following questions: (1) what types of adaptations to CPD innovations are described? and (2) what may shape future innovations in CPD? The following databases were searched: Medline, Embase, CINAHL, and ERIC to identify the literature published between March 2020 to July 2021. The authors conducted a comprehensive search by including all study types that described adaptations and/or innovations in CPD during the stated pandemic period. RESULTS Of the 8295 citations retrieved from databases, 191 satisfied the inclusion criteria. The authors found three categories to describe adaptations to CPD innovations: (1) creation of new online resources, (2) increased use of the existing online platforms/software to deliver CPD, and (3) use of simulation for teaching and learning. Reported advantages and disadvantages associated with these adaptations included logistical, interactional, and capacity building elements. The review identified five potential future CPD innovations: (1) empirical research on the effectiveness of virtual learning; (2) novel roles and ways of thinking; (3) learning from other disciplines beyond medicine; (4) formation of a global perspective; and (5) emerging wellness initiatives. DISCUSSION This review provided an overview of the adaptations and innovations that may shape the future of CPD beyond the pandemic.
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Affiliation(s)
- Sophie Soklaridis
- Dr. Soklaridis: Senior Scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, and The Wilson Centre, University Health Network/University of Toronto, Toronto, Ontario, Canada. Ms. Chowdhury: PhD (cand.), Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Turco: Associate Professor of Medicine, Department of Medicine, Dartmouth-Hitchcock Medical Centre/Geisel School of Medicine at Dartmouth, Lebanon, NH. Dr. Tremblay: Senior Research and Innovation Advisor, Fédération des médecins spécialistes du Québec, Montréal, Québec, Canada. Dr. Mazmanian: Professor Emeritus, Department of Preventive Medicine and Community Health, Virginia Commonwealth University, Richmond, VA. Dr. Williams: Clinical Program Director, Professional Renewal Centre, Lawrence, KS, and Department of Psychiatry, School of Medicine, University of Kansas, Kansas City, KS. Ms. Besa: Information Specialist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Sockalingam: Vice-President Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, and The Wilson Centre, University Health Network/University of Toronto, Toronto, Ontario, Canada
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