Precision Medicine and Rough Justice: Wicked Problems

What exactly is a "wicked problem"? It is a social or economic problem that is so complex and so interconnected with other issues that it is extraordinarily difficult or impossible to resolve. This is because all proposed resolutions generate equally complex, equally wicked problems. In this essay, I argue that precision medicine, especially in the context of the U.S. healthcare system, generates numerous wicked problems related to distributive justice. Further, I argue that there are no easy solutions to these wicked problems. The need for trade-offs is inescapable. Rough justice is the best outcome we can hope for, and that outcome requires a commitment to processes of public reason that are fair and inclusive.

Proposal of guidelines to assist managers to face pressing challenges confronting Latin American universities: a complexity theory perspective

The Covid-19 pandemic exacerbated pre-existing problems in Latin America and posed unprecedented challenges for Latin American universities (LAU). These challenges can be characterised as complex problems that cannot be understood through reductionist approaches. This paper aims (i) to provide a complex system perspective of the challenges confronting LAUs and (ii) to propose guidelines for managers of LAUs to address them in practice. A multidisciplinary group was formed and conducted an iterative process of research, brainstorming and debate of potential solutions to the following problems considered particularly important by their universities: mental health issues in the university environment, student learning gaps, brain drain, and anti-science movements. Complexity theory and E/HF concepts are integrated to demonstrate that understanding what LAUs are experiencing in a fragmented manner is impossible, and that the interactions between the challenges should be at the centre of the managers' actions plans. Practitioner summary: Managers of LAUs can benefit from the guidelines proposed to understand the pressing challenges confronting universities and develop systemic approaches to address them.

Presenting wicked problems in a science museum: A methodology to study interest from a dynamic perspective

Science centers and science museums have an important social role in engaging people with science and technology relevant for complex societal problems-so called wicked problems. We used the case of personalized medicine to illustrate a methodology that can be used to inform the development of exhibitions on such wicked problems. The methodology that is presented is grounded in dynamic theories of interest development that define interest as a multidimensional construct involving knowledge, behavior (personal and general) value, self-efficacy, and emotion. The methodology uses a mixed method design that is able to (1) study the predictive effects of background variables on interest, (2) study the interest dimensions predicting individual interest, and (3) identify the most influential interest dimensions. We set up focus groups (N = 16, age = 20-74, low SES) to design a survey study (N = 341, age 19-89 years olds with a broad range of SES) about people's interest in personalized medicine. Results of a network analysis of the survey data show that despite the variety in emotions and knowledge about subtopics, these dimensions do not play a central role in the multidimensional interest construct. In contrast, general value and behavior (related to understanding scientific research) seem to be interesting candidates for eliciting situational interest that could have an effect on the more long term individual interest. These results are specific for the case of personalized medicine. We discuss ways in which results of studies with the presented methodology might be useful for exhibition development.

How to use mixed methods in oral health research

Wicked problems exist in the realm of oral health research. Due to their inherent complexity, using qualitative or quantitative methods alone may not be adequate for resolving them. Mixed methods approaches combine qualitative and quantitative methods, and thus, can provide a powerful tool for understanding and solving complex problems in dental public health. However, using mixed methods does not come without its challenges. This commentary outlines four main tips for researchers to consider when applying mixed methods to their research projects.

A Theoretical Discussion of How Common Understanding and Reflection Upon Need for Resources Can Prevent Risks Underlying Social Innovations

The welfare state is facing complex challenges. Social innovation is considered as the solution to social challenges and so-called wicked problems, problems in the welfare state that are important, but difficult to solve. This implies being willing to take the risk that is involved when being innovative. A discussion of how different kinds of social innovations carry various risks and how some of these can be prevented, is still limited. This article looks at experiences from previous social innovations and ask what we can learn from them. It elaborates on why social innovation is challenging and what we can do to reduce the risk of failure. The research question is: What risks are at stake in different social innovations, and how can these be prevented? The article highlights risks and issues associated with social or collaborative innovation related to welfare services. It is theoretical and based on innovation theory and previous research, with examples from Norwegian welfare services. The purpose is to explore challenges and risks involved in 4 stereotype versions of social innovation as a result of crossing 2 dimensions of social innovation described above: (a) the degree of novelty and (b) who has initiated the innovation. The article enlightens some aspects of the implementation phase that are important to be aware of if we want to minimize the risk of failure. This concerns the importance of creating a common understanding of the innovation and reflecting on the need for extra resources.

Scaling digital solutions for wicked problems: Ecosystem versatility

Digital solutions are increasingly used to address "wicked problems" that are locally embedded but require global approaches. Scaling these solutions internationally is imperative for their success, but to date we know little about this process. Using a qualitative case study methodology, our paper analyzes how four digital solutions driven by the United Nations are built and how they scale internationally. These solutions address wicked problems through artificial intelligence, blockchain, and geospatial mapping, and are embedded in networks of partners which evolve during scaling to create unique ecosystem roles and configurations. We identify different ecosystem roles and find that the specific properties of digital solutions - modularity, generativity and affordances - enable either adaptation or replication during scaling. Building on these insights, we derive a typology of four different types of international scaling, which vary in their ecosystem versatility (how the ecosystem changes across locations) and the local adaptation of the application (the problems the solution addresses). This study presents a new way to examine the replication and adaptation dilemma for ecosystems and extends internationalization theory to the digital world.

Question storming: The power of Questions-A method to increase options for action in uncertainty

RATIONALE

Question Storming offers a method that enables one to hold the condition of uncertainty in reflection without the need for resolution. Global interdependencies and unprecedented access to information, social media and multiple forms of communications challenge our ability to see, understand and influence change effectively and efficiently. The tension and need to cope effectively with massive uncertainties cannot be resolved with current methods leading to a necessity for people to seek new ways to transform their understanding and explore new options for action. Problem-solving and facilitation of the past are not flexible or rapid enough to meet the current demands of decision making and action taking in the face of massive uncertainties. As a result, people face 'wicked unsolvable' issues in their personal and professional lives.

AIMS AND OBJECTIVES

An international group of scholar-practitioners has adapted and tested an enquiry process. Question Storming-The Power of Questions is based on principles of complex adaptive systems, human systems dynamics, and self-organization.

METHOD

A three-step method of inquiry and reflection opens new possibilities.

RESULTS AND CONCLUSIONS

Question Storming has helped people see their wicked issues from new perspectives, understand them in useful ways and generate new options for action. This paper introduces Question Storming-the Power of Questions as a practical method for group inquiry in the presence of individual and group uncertainties/wicked issues. The Container, Difference, Exchange (CDE) model and Pattern Logic are presented to explain the paradigm-shifting dynamics experienced by participants, both individuals and members of the group. It concludes with emerging questions for future consideration. Question Storming generates a divergent problem space that decreases constraint and increases degrees of freedom to allow practical exploration of new and often surprising options for action.

"How you keep going": Voluntary sector practitioners' story-lines as emotion work

The voluntary sector acts as the last line of defense for some of the most marginalized people in societies around the world, yet its capacities are significantly reduced by chronic resource shortages and dynamic political obstacles. Existing research has scarcely examined what it is like for voluntary sector practitioners working amidst these conditions. In this paper, we explore how penal voluntary sector practitioners across England and Scotland marshaled their personal and professional resources to "keep going" amidst significant challenges. Our analysis combines symbolic interactionism with the concept of story-lines. We illuminate the narratives that practitioners mobilized to understand and motivate their efforts amidst the significant barriers, chronic limitations, and difficult emotions brought forth by their work. We position practitioners' story-lines as a form of emotion work that mitigated their experiences of anger, frustration, overwhelm, sadness, and disappointment, enabling them to move forward and continue to support criminalized individuals. Our analysis details three story-lines-resignation, strategy, and refuge-and examines their consequences for practitioners and their capacities to intervene in wicked social problems.

Expanding collaborative autoethnography into the world of natural science for transdisciplinary teams

Wicked problems such as climate change and the COVID-19 pandemic require authentically transdisciplinary approaches to achieving effective collaboration. There exist several research approaches for identifying the components and interactions of complex problems; however, collaborative autoethnography provides an empirical way to collect and analyze self-reflection that leads to transformative change. Here, we present a case study of collaborative autoethnography, applied as a tool to transform research practice among a group of natural and social scientists, by constructively revealing and resolving deep, often unseen, disciplinary divides. We ask, "How can natural and social scientists genuinely accept, respect, and share one another's approaches to work on the wicked problems that need to be solved?" This study demonstrates how disciplinary divisions can be successfully bridged by open-minded and committed collaborators who are prepared to recognize the academic bias they bring to their research and use this as a platform of strength.

'Systems approach' plant breeding illustrated by trees

The linkage in new and creative ways of existing plant breeding methods responsive to different global trends and values provides a 'systems approach' to address a broad set of global production challenges more effectively. Here, we illustrate such an approach through its application to trees, chosen because of their extensive diversity in features, uses, users, production contexts, and domestication pathways. We coin the resulting strategy 'tree diversity breeding' and consider it with reference to trends and values related to participation, environment, biotechnology, and markets as examples. Features of the approach for trees are applicable to plant breeding more widely, as we seek to address complex problems through strategic biodiversity use.

Wicked Problems in Pharmacy Education

Wicked problems are unstructured, cross-cutting, and relentless. While problem-solving is an expected outcome of pharmacy education programs, are we, as pharmacy educators, acknowledging the "wicked" problems we have in the Academy? This commentary provides examples of wicked problems in pharmacy practice and education and suggestions for engaging with wicked problems in an effort to solve them. Pharmacy educators must hold a summit on wicked problems in pharmacy education in order to address the complex problems we are currently facing in order to shape the profession for the future.

Hiding in plain sight: Vulnerability, public administration, and the case of Covid‐19 hotel quarantine

I examine how failures surrounding a quarantine detention program for returned travellers from overseas brought a deadly second wave of the Covid‐19 virus into existence in Victoria, Australia. In addition to providing insights into the ways in which public administration organizations (PAO) can plan for and respond to wicked problems, I propose that they can learn to manage latent failures and equivocal circumstances before, during, and after such crisis events. This is important as locally and globally PAO face emergencies, crises, and disasters triggered by natural and non‐natural hazards which remind us that we need to find new ways of learning while living in challenging times.

This article examines the ways that public administration can bring accidents into existence when seeking to address wicked problems such as managing the transmission of the Covid‐19 virus.

The challenges of providing certainty in the face of wicked problems: Analysing the UK government's handling of the COVID-19 pandemic

Positioning Covid-19 as a wicked problem we analyse the extent that the UK government adhered to the guidelines for dealing with such problems and the extent to which the management of the pandemic exacerbated the crisis. We argue the management of the pandemic saw a continuance of political communication as usual, focusing on emphasising the optimistic rhetoric which underpinned the Brexit narrative and 2019 election campaign which delivered Boris Johnson a majority. The failure to break out of a narrow permanent campaigning mindset which saw the pandemic as a brief interlude during a period when the focus was on delivering Brexit led to public confusion as optimistic claims were proven to be inaccurate and promises unreachable. Johnson's government's attempts to offer certainty despite a situation characterised by volatility, uncertainty, complexity and ambiguity led to numerous U-turns that seriously damaged their credibility while the politicisation of the response led to poor decision making at key points. We therefore highlight the deficiencies of Johnson's strategy and highlight key lessons for communications professionals who navigate an increasingly volatile and uncertain world beset by wicked problems. In particularly we highlight the importance of depoliticising crises, seeking a diverse range of ideas and expertise, developing an empathic leadership style, starting a public conversation that recognises uncertainty and so develop a framework where wicked problems are a feature of public debate. We argue that failure in all of these areas contributed to the UK's poor comparative performance during the Covid-19 pandemic.

Silver linings: how mental health activists can help us navigate wicked problems

This article explores how 'wicked problems' such as climate change might force psychiatry to rethink some of its fundamental ideas and ways of working, including clinical boundaries, understandings of psychopathology and ways of organising. We use ethnographic evidence to explore how mental health service 'survivor' activists are already rethinking some of these issues by therapeutically orienting themselves towards social problems and collective understandings of well-being, rejecting 'treatment as usual' approaches to distress. In this way we provide an example of the potential of activists to help psychiatry negotiate the climate crisis.

Engaging Multiple Worldviews With Quantitative Decision Support: A Robust Decision-Making Demonstration Using the Lake Model

Many of today's most pressing policy challenges are usefully characterized as wicked problems. With contested framings parties to a decision disagree not only on potential solutions, but on the nature of the problem they are trying to solve. The quantitative tools of risk and policy analysis, commonly designed to develop and compare choices within a single decision framing, are poorly designed to bring quantitative information into debates with contested framings. This study aims to build on recent advances in decision making under deep uncertainty (DMDU) to demonstrate methods and tools that may help resolve the tension between quantitative decision support and multiworldview approaches for addressing wicked problems. The study employs robust decision making (RDM), one common DMDU method, and a new version of the lake model, a simple and widely used model of a coupled human and natural system, to conduct a stylized analysis that reflects three different worldviews. The RDM analysis solves the decision challenge independently for each worldview and then compares each set of solutions from the vantage of the other worldviews. The resulting utopia-dystopia matrix informs problem reframing that seeks robust, adaptive strategies independently consistent with each worldview and thus provides a locus for agreement. The study describes how stakeholder engagements might use such analytic tools and their information products to provide overlapping but alternative entry points for groups with fundamentally different worldviews to engage with each other in deliberative processes appropriate for wicked problems.

How Could Future AI Help Tackle Global Complex Problems?

How does AI need to evolve in order to better support more effective decision-making in managing the many complex problems we face at every scale, from global climate change, collapsing ecosystems, international conflicts and extremism, through to all the dimensions of public policy, economics, and governance that affect human well-being? Research in complex decision-making at an individual human level (understanding of what constitutes more, and less, effective decision-making behaviors, and in particular the many pathways to failures in dealing with complex problems), informs a discussion about the potential for AI to aid in mitigating those failures and enabling a more robust and adaptive (and therefore more effective) decision-making framework, calling for AI to move well-beyond the current envelope of competencies.

Evidence-based policymaking and the wicked problem of SDG 5 Gender Equality

Evidence-based policymaking (EBP) contends that policy decisions are successful when informed by evidence. However, where policy problems are “wicked” (systemic, ambiguous, complex, and conflictual), politics trumps evidence and solutions are never first best or permanent. Applying an EBP approach to solving wicked problems (WPs) therefore appears to be a daunting, impossible task. Despite the difficulties, we contend that blending insights from the EBP and WP literatures can provide actionable and practical policy advice to governments and MNEs for dealing with the WPs of the UN Sustainable Development Goals (SDGs). We support our thesis with a case study applying EBP to the WP of SDG 5 Gender Equality. We compare the statistical evidence from gender inequality indexes to SDG 5’s targets and indicators. We provide five insights from the EBP and WP literatures into why and how good evidence is necessary but not sufficient for progress on SDG 5. Building on these insights, we recommend that governments adopt an EBP approach employing public–private partnerships to address SDG 5. We also recommend that MNE executives use our new SDG Materiality Matrix, designed on EBP principles, to build SDG 5 into their global corporate social responsibility strategies.

Using design thinking to respond to crises: B2B lessons from the 2020 COVID-19 pandemic

We examine the value of design thinking in times of crisis. Drawing on examples of firm innovations during the 2020 Covid-19 lockdown, we propose that disruptive events represent wicked problems that require managers to break out of established patterns of thinking. Design thinking, or the problem solving approaches and tools of designers, represents one such approach. Drawing on extant research, we identify a three-stage process of design thinking: disrupt, develop and deliver, and transform. We examine each stage, identifying how careful disruptive thinking with a focus on understanding problems within their context can give rise to innovative solutions, resulting in a more resilient organisation.

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Identifies methods and practices for managing wicked problems in times of crisis.

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Identifies how to implement design thinking across three-stages to quickly pivot during crisis events

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Identifies how B2B marketers can build greater brand resilience to deal with future crises

Developing Creativity to Enhance Human Potential in Sport: A Wicked Transdisciplinary Challenge

The challenge of developing creativity to enhance human potential is conceptualized as a multifaceted wicked problem due to the countless interactions between people and environments that constitute human development, athletic skill, and creative moments. To better comprehend the inter-relatedness of ecologies and human behaviors, there have been increasing calls for transdisciplinary approaches and holistic ecological models. In this paper we explore an ecological dynamics rationale for creativity, highlighting the conceptual adjacency of key concepts from transdisciplinarity, dynamic systems theory, ecological psychology and social-cognitive psychology. Our aim is to extend the scope of ecological dynamics and contextualize the application of non-linear pedagogy in sport. Foregrounding the role of sociocultural constraints on creative behaviors, we characterize the athlete-environment system as an ecological niche that arises from, and simultaneously co-creates, a form of life. We elaborate the notion that creative moments, skill and more generally talent in sport, are not traits possessed by individuals alone, but rather can be conceived as properties of the athlete-environment system shaped by changing constraints. This re-conceptualization supports a pedagogical approach predicated on notions of athletes and sports teams as complex adaptive systems. In such systems, continuous non-linear interactions between system components support the exploration of fluent and flexibly creative performance solutions by athletes and sports teams. The implications for practice suggest that cultivating a constellation of constraints can facilitate adaptive exploration of novel affordances (opportunities/invitation for action), fostering creative moments and supporting creative development in athletes. Future models or frameworks for practice contend that pedagogies should emerge from, and evolve in, interaction with the sociocultural context in which practitioners and athletes are embedded.

The wicked problem of healthcare student attrition

The early withdrawal of students from healthcare education programmes, particularly nursing, is an international concern and, despite considerable investment, retention rates have remained stagnant. Here, a regional study of healthcare student retention is used as an example to frame the challenge of student attrition using a concept from policy development, wicked problem theory. This approach allows the consideration of student attrition as a complex problem derived from the interactions of many interrelated factors, avoiding the pitfalls of small‐scale interventions and over‐simplistic assumptions of cause and effect. A conceptual framework is proposed to provide an approach to developing actions to reduce recurrent investment in interventions that have previously proved ineffective at large scale. We discuss how improvements could be achieved through integrated stakeholder involvement and acceptance of the wicked nature of attrition as a complex and ongoing problem.

Blending integrated knowledge translation with global health governance: an approach for advancing action on a wicked problem

BACKGROUND

The persistence of health inequities is a wicked problem for which there is strong evidence of causal roots in the maldistribution of power, resources and money within and between countries. Though the evidence is clear, the solutions are far from straightforward. Integrated knowledge translation (IKT) ought to be well suited for designing evidence-informed solutions, yet current frameworks are limited in their capacity to navigate complexity. Global health governance (GHG) also ought to be well suited to advance action, but a lack of accountability, inclusion and integration of evidence gives rise to politically driven action. Recognising a persistent struggle for meaningful action, we invite contemplation about how blending IKT with GHG could leverage the strengths of both processes to advance health equity.

DISCUSSION

Action on root causes of health inequities implicates disruption of structures and systems that shape how society is organised. This infinitely complex work demands sophisticated examination of drivers and disrupters of inequities and a vast imagination for who (and what) should be engaged. Yet, underlying tendencies toward reductionism seem to drive superficial responses. Where IKT models lack consideration of issues of power and provide little direction for how to support cohesive efforts toward a common goal, recent calls from the field of GHG may provide insight into these issues. Additionally, though GHG is criticised for its lack of attention to using evidence, IKT offers approaches and strategies for collaborative processes of generating and refining knowledge. Contemplating the inclusion of governance in IKT requires re-examining roles, responsibilities, power and voice in processes of connecting knowledge with action. We argue for expanding IKT models to include GHG as a means of considering the complexity of issues and opening new possibilities for evidence-informed action on wicked problems.

CONCLUSION

Integrated learning between these two fields, adopting principles of GHG alongside the strategies of IKT, is a promising opportunity to strengthen leadership for health equity action.

Wicked conflict: Using wicked problem thinking for holistic management of conservation conflict

Conservation conflict is widespread, damaging, and has proved difficult to manage using conventional conservation approaches. Conflicts are often "wicked problems," lacking clear solutions due to divergent values of stakeholders, and being embedded within wickedly complex environments. Drawing on the concept of wicked environmental problems could lead to management strategies better suited to tackling conflict. However, it is unclear whether managers are embracing ideas from the wicked problems concept. There is currently a lack of guidance for applying strategies to tackle particular wicked problems, such as conservation conflict. We explored the suitability of wicked problems-inspired management, using eight contemporary conflict case studies. Conservation conflict was managed predominantly using conventional approaches suited to tackling single objectives in simple environments, rather than balancing competing objectives in complex environments. To deal with different characteristics of wickedness, we recommend that managers develop strategies combining distributed decision-making, diverse opinions, pattern-based predictions, trade-off-based objectives, and reporting of failures. Recent advances in conservation conflict research have focused on improving interactions among stakeholders. We believe that such stakeholder-focused approaches would dovetail with the whole-system focus of a wicked problems framework, allowing conservationists to move toward a holistic strategy for managing conservation conflict.

Mental Health Related Stigma as a 'Wicked Problem': The Need to Address Stigma and Consider the Consequences

Recent reviews on the evidence base for mental health related stigma reduction show that under certain conditions interpersonal contact is effective in promoting more positive attitudes, reduced desire for social distance, and increased stigma related knowledge (knowledge which disconfirms beliefs based on stereotypes). Short-term interventions may have effects that are attenuated over time; longer term programmes may support sustained improvements, but research following up long-term interventions is scarce. However, the effectiveness of these interventions should not obscure the nature of stigma as a social problem. In this article we describe stigma as a 'wicked problem' to highlight some implications for intervening against stigma and evaluating these efforts. These include the risks of unintended consequences and the need to continually reformulate the concept of stigma, to ensure that tackling stigma at the structural, interpersonal, and intrapersonal levels become part of the core business of stakeholder organisations. We compare the main targets of anti-stigma programmes with what is known about the sources of stigma and discrimination and their impacts to identify targets for future intervention. In some cases, interventions have been directed at the interpersonal level when structural level intervention is also needed; in others, systematic reviews have not so far identified any interventions.

Navigating systems ideas for health practice: Towards a common learning device

Systems thinking and reference to complexity science have gained currency in health sector practice and research. The extent to which such ideas might represent a mere passing fad or might more usefully be mobilized to tackle wicked problems in health systems is a concern underpinning this paper. Developing the usefulness of the systems idea requires appreciating how systems ideas are used essentially as constructs conceptually bounded by practitioners. Systems are used for purposes of understanding and engaging the reality of health issues, with the intent of transforming the reality into one that is more manageable, equitable, and sustainable. We examine some manifestations of the systems idea in health practice and the traditions of systems practice that variously make use of them. This provides a platform for proposing a systems thinking in (health) practice heuristic: a learning device supporting how different tools and methods can address "wicked problems" in health praxis. The device is built on the use of "conversation" as a metaphor to help practitioners use systems ideas in tandem with existing disciplinary and professional skills and methods. We consider how the application of the heuristic requires, and helps to develop, human characteristics of humility, empathy, and recognition of fallibility.

The use of case studies to drive bottom-up leadership in community-oriented integrated care and health promotion (COIC)

London Journal of Primary Care is supporting a collaborative network of multidisciplinary colleagues with an interest in community-oriented health care and health promotion (COIC). Case study methodology is well suited to generating knowledge from the frontline of health and social care service delivery and is a much under-developed resource. It is most effective when dealing with wicked problems, namely, the sort of complex, entangled and multi-faceted problems that successful COIC programmes must overcome. Used collaboratively, it supports effective networking across professional and community boundaries.

Climate Change and Children's Health: A Commentary

This commentary describes the likely impacts on children's health and wellbeing from climate change, based on the solid science of environmental child health. It describes likely climate change scenarios, why children are more vulnerable than older people to these changes, and what to expect in terms of diseases (e.g., infections, asthma) and problems (e.g., malnutrition, mental illness). The common antecedents of climate change and other detrimental changes to our society mean that in combatting them (such as excessive consumption and greed), we may not only reduce the harmful effects of climate change but also work towards a better society overall—one that values its children and their futures.

An interactive governance and fish chain approach to fisheries rebuilding: a case study of the Northern Gulf cod in eastern Canada

Rebuilding collapsed fisheries is a multifaceted problem, requiring a holistic governance approach rather than technical management fixes. Using the Northern Gulf cod case study in eastern Canada, we illustrate how a "fish chain" framework, drawn from the interactive governance perspective, is particularly helpful in analyzing rebuilding challenges. The analysis demonstrates that factors limiting rebuilding exist along the entire fish chain, i.e., the pre-harvest, harvest, and post-harvest stages. These challenges are embedded in both the ecological and social systems associated with the Northern Gulf cod fisheries, as well as in the governing systems. A comparative analysis of the pre- and post-collapse of the cod fisheries also reveals governance opportunities in rebuilding, which lie in policy interventions such as integrated and ecosystem-based management, livelihood transitional programs, and cross-scale institutional arrangements. Lessons from the Northern Gulf cod case study, especially the missed opportunities to explore alternative governing options during the transition, are valuable for rebuilding other collapsed fisheries.

Transitions in a wicked environment

AIM

The aim of this review is to synthesize the current body of knowledge concerning transitional care for patients 65 years of age and older moving from the acute care setting to home.

BACKGROUND

Transitional care is a timely topic as hospital days of care decrease whereas patient needs grow more complex as a result of aging populations.

EVALUATION

This review considers evidence-based research as well as reports, case studies and literature reviews related to transitional care. International articles are included.

KEY ISSUES

The authors explore transitional care through the lens of wicked problems; problems that appear seemingly intractable and are characterized by inter-related dilemmas, contradictory agendas, and multi-layered societal, economic and political influences. Outcome measures of success, barriers to achieving successful transitional care and effectiveness of interventions are investigated.

CONCLUSIONS

While the literature offers specific strategies that positively affect transitional care, there are few strategies that do not negatively affect an alternate agenda. Conscientious leaders should consider transitional care in the context of its wicked nature in order to achieve optimal patient care.

IMPLICATIONS

Stakeholders include: hospital administrators, nurse leaders, direct-care nurses, acute care and primary care clinicians, patients, caregivers, community agencies, health sciences educators and insurers.