Tuesday, May 3, 2011

Future Patient Care Delivery Committee: Care Complexity

Concerned about increased patient care safety issues in your workplace? Have you seen a rise in medication errors without an obvious cause? Wondering how you’ll improve productivity and patient outcomes in your newly formed ACO? Have you thought about the science behind that all-too-familiar term “multitasking”?

Complexity Science is a current attempt to understand and explain the behavior and dynamics of systems composed of many interacting elements. Complexity Science studies adaptive systems that contain components in a constant state of change with outcomes that are not totally predictable. This is in contrast to linear methods where change can be measured and predicted. Our nursing practice is both predictable and unpredictable. Dr. Atul Gawande gives a very generalized analogy in his book, The Checklist Manifesto. He says a simple process equates to a recipe. A complicated process, he states, would be one with many linear processes or recipes or checklists added together, like sending a rocket to the moon. A complex process, he describes, is like raising a child -- no recipe is the same for each child!

This is sounding more and more like nursing’s work as our staff are faced with competing goals and priorities, stressful demands, technical challenges, facility design flaws, operational failures, etc. In what ways can we, as nurse leaders, understand the work and design environments of care, respectful of the complex work nurses perform? Many of you have “interruption-free zones” that outline when and where distractions and interruptions are not acceptable. Other examples I’ve heard are: decreasing non-value added services; increasing visual scanning capabilities; and increasing access to timely information. These are all great examples of practice complexity acknowledgement and change at the point of service. What else is happening out there to stimulate innovation and creativity for others related to nursing’s cognitive work and complex practice?

At the AONE 44th Annual Meeting and Exposition last month, Patricia Ebright and Mary C. Sitterding presented their analysis on complexity and how they are studying it through a Cognitive Practice of Nursing model. They would benefit from descriptive feedback on their methodology. Also, the AONE Future Patient Care Delivery Committee encourages you to give us feedback on activities presently occurring in the field.

If you’re looking for additional resources, check out AONE’s 2011 Toolkit for Future Care Delivery with examples to get you and your staff involved in future change.


  1. AHRQ has an article about Primary Care Complexity: "Point-of-Care Complexity Assessment Helps Primary Care Clinicians Identify Barriers to Improved Health and Craft Integrated Care Plans." See it at http://www.innovations.ahrq.gov/content.aspx?id=2496. It includes a reference link to a tool to meausre complexity for the patient.

  2. Very interesting study on a tool to assess clinical complexity in a patient…I wonder if a tool could be or has been developed to assess complexity in environmental or interactive scenarios for nurse leaders to predict, forecast and intervene, thanks for stimulating our discussion. - BJ Bartleson