Item Name		Posted By	Date Posted
Zimmerman, et al - Front-Line Ownership 2013 PDF (2.58 MB)  [ more ] [ hide ]		Administration	5/18/2013
Healthcare Papers Vol 13 No 1 - 2013 Front-Line Ownership: Generating a Cure Mindset for Patient Safety Brenda Zimmerman, Paige Reason, Liz Rykert, Leah Gitterman, Jennifer Christian and Michael Gardam
Anderson, et al - Case Study Research 2005 PDF (111.21 KB)  [ more ] [ hide ]		Administration	5/31/2011
Anderson, R.A., Crabtree, B.F., Steele, D.J., McDaniel, R.R. Complexity scholars Ruth Anderson, Benjamin Crabtree, David Steele and Reuben McDaniel merge elements of the case study method and complexity science to suggest new ways of examining health care organizations. Qualitative Health Research, Vol. 15, No. 5, May 2005, pp. 669-685; Sage Publications 2005
Anderson, et al - Power of Relationship 2005 PDF (273.73 KB)  [ more ] [ hide ]		Administration	5/31/2011
Anderson, R.A., Bailey, D.E., Corazzini, K., & Piven, M.L. Ruth Anderson and her colleagues examine quality and complexity science in long term care. Journal of Nursing Quality, Vol. 20, No. 2, pp 106-106. Lippincott Williams & Wilkuins, Inc., 2005
Begun-Zimmerman-Dooley - HC Orgs as CAS 2003 DOC (173 KB)  [ more ] [ hide ]		Administration	5/31/2011
Begun, James W., Zimmerman, Brenda, and Dooley, Kevin The authors introduce complexity science concepts and suggest its value in understanding and leading healthcare organizations. Begun, James W., Zimmerman, Brenda, and Dooley, Kevin. 2003, "Health Care Organizations as Complex Adaptive Systems", in Mick, S.S. and Wyttenbach, M. E. (eds), Advances in Health Care Organization Theory , San Fransisco, CA: Jossey-Bass.
Berwick - The Moral Test 2011 PDF (249.27 KB)  [ more ] [ hide ]		Administration	3/1/2012
The Moral Test Donald M. Berwick, MD IHI National Forum Orlando, Florida: December 7, 2011
Crabtree, et al- Survivors Guide 2009 PDF (534.33 KB)  [ more ] [ hide ]		Administration	5/31/2011
Crabtree, Benjamin; Miller, William; McDaniel, Reuben; Stange, Kurt; Nuting, Paul; Jaen, Carlos Building Office Relationships and interacting with the local landscape are keys to resiliency. This article explores the ways to do both. Journal of Family Practice, The; vol 58, no. 8, 2009
Jordan, et al - Role of Conversation 2009 PDF (257.02 KB)  [ more ] [ hide ]		Administration	5/31/2011
Jordan, Michelle; Lanham, Holly; Crabtree, Benjamin; Nutting, Pauk; Miller, William; Stange, Kurt; McDaniel, Reuben The authors argue that some unanticipated variation in healthcare interventions arise because unexpected conversations emerge during the intervention attempts. Implementation Science, 2009, 4:15
Lanham, et al - Improve Practice Relationshps 2009 PDF (2.19 MB)  [ more ] [ hide ]		Administration	5/31/2011
Lanham, Holly; McDaniel, Reuben; Crabtree, Benjamin; Miller, William; Stange, Kurt; Tallia, Alfred; and Nutting, Paul Quality is explored as an emergent property arising from relationships within healthcare organizations. Joint Commission Journal on Quality and Patient Safety, September, 2009, Vol. 35, No. 9
Lannamann, et al - End of Life Communication 2008 DOC (140 KB)  [ more ] [ hide ]		Administration	5/31/2011
Lannamann, John W., Harris, Linda M., Bakos, Alexis D., Baker, Kylene J. Provocative book chapter designed to help healthcare providers stimulate a shift in the pattern of conversation with patients near the end of life from a curative to a palliative, care-giving orientation. Appears in Cancer Communication and Aging, Sparks, Lisa, O'Hair, Dan and Kreps, Gary eds, Hampton Press
Lindberg, et al - Letting Go Gaining Control 2009 PDF (356.29 KB)  [ more ] [ hide ]		Administration	5/31/2011
Lindberg, Curt; Norstrand, Patricia; Munger, Mark T; DeMarsico, Christine; Buscell, Prucia This article, from the December 2009 of the journal Clinical Leader, reports on the first significant application of positive deviance in healthcare, notably on the issue of MRSA prevention. Lindberg, Curt; Norstrand, Patricia; Munger, Mark T; DeMarsico, Christine; Buscell, Prucia. 2009, "Letting Go, Gaining Control: Positive Deviance and MRSA Prevention", Clinical Leader , vol. 2, no. 2, pp. 60-67.
Lindberg - Insights for End of Life 2005 DOC (44.5 KB)  [ more ] [ hide ]		Administration	5/31/2011
Lindberg, Curt This article recounts the story of how family members used insights from the science of complexity to guide their efforts to plan and provide end of life care for a dying parent. American Journal of Hospice & Palliative Medicine, March/April 2005, Vol. 22, No. 2, pp. 150-152.
McDaniel-Driebe - Complexity and HC Mgt 2001 DOC (108.5 KB)  [ more ] [ hide ]		Administration	5/31/2011
McDaniel, Reuben and Driebe, Dean J. This article provides a comprehensive overview of complexity science and its implications for leadership in healthcare organizations. A terrific primer for healthcare professionals interested in new ways of understanding dynamics in healthcare organizations and new approaches to management of these complex organizations. McDaniel, Reuben and Driebe, Dean J. 2001, "Complexity Science and Health Care Management", in Blair, John; Fottler, Myron; Savage, Grant, Advances in Health Care Management , JAI Press.
Rubin, et al - Becoming Patient Centered 2011 PDF (113.38 KB)  [ more ] [ hide ]		Administration	10/4/2011
Irv Rubin, PhD, Alan Villiers, RN, MS, Brandy Caston, MPPA - Becoming Truly Patient Centered: Using Data to Drive Prescriptive Action 2011 In the beginning of fiscal year 2010, the Veterans Health Administration began implementation of the patient centered medical home model, now known as PACT (Patient Aligned Care Team). The overall goal of PACT is to transform our healthcare delivery system by providing a patient centric care model. At the heart of PACT is the relationship between healthcare providers and the Veteran.
Scott, et al - Healing Relationships 2008 PDF (215.92 KB)  [ more ] [ hide ]		Administration	5/31/2011
Scott, John G., et al Clinicians often have an intuitive understanding of how their relationships with patients foster healing. Annals of Family Medicine, Vol. 6, No. 4, July/August 2008 pp 315-322
Singhal - The Practice of Medicine 2006 PDF (2.27 MB)  [ more ] [ hide ]		Administration	5/31/2011
The Practice of Medicine is in the Interactions - A Day with Robert A. Lindberg, MD Singhal, Arvind Dr. Arvind Singhal, the noted communications scholar and Plexus Institute Advisor explores how Robert Lindberg, MD, has used insights from complexity science in his internal medicine practice. Read this issue of Deeper Learning to learn how ths science has affected how he interacts with patients, understands human physiology, and thinks about the operation of his medical practice. Singhal, A. 2007, "The Practice of Medicine is in the Interactions- A Day with Robert A. Lindberg, MD", Deeper Learning, vol 1, no, 2, pp. 1-20.
Suchman - Organizations as Machines 2010 PDF (175.2 KB)  [ more ] [ hide ]		Administration	5/31/2011
Suchman, Anthony L. The way an organization is envisioned, as machine or conversation, has powerful impact on what happens. This is a draft Dr. Anthony Suchman has permitted us to read prior to publication. It should not be disseminated or cited without checking first with him - asuchman@rchcweb.com.
Wetzel-Winaver - School Based Family Therapy 2002 PDF (7.76 MB)  [ more ] [ hide ]		Administration	5/31/2011
Wetzel, Norbert A, and Winawer, Hinda Read about the pioneering work of two family therapists who are bringing a complexity and relational orientation to family therpay and community work. Kaslow, I.W. (ed.), 2002, Comprehensive Handbook of Psychotherapy, Vol. 3, New York: John Wiley & Sons, pp. 205-230.
RWJF Final report Plexus PD MRSA Project PDF (549.65 KB)  [ more ] [ hide ]		Administration	1/11/2011
RWJF Final Report on PD MRSA Prevention Partnership Bibliographic: Lindberg, C., Lloyd, J, & Buscell, P. "RWJF Final Report", Plexus Institute, October 2008. Description: In 2006 Plexus Institute received a grant from The Robert Wood Johnson Foundation to introduce Positive Deviance (PD) in the US healthcare system by helping a network of hospitals employ PD to tackle the challenging problem of MRSA transmissions. With the Positive Deviance Initiative, CDC, Delmarva Foundation, Albert Einstein Medical Center, Philadelphia, PA, Billings Clinic, Billings, MT, Franklin Square Hospital Center, Baltimore, MD, University of Louisville Hospital, Louisville, KY, The Johns Hopkins Hospital, Baltimore, MD, and VA Pittsburgh Healthcare System, a PD Prevention Partnership. The Partnership has worked actively to support PD efforts in the participating hospitals and to share with experiences and results with with hospitals and healthcare organizations dedicated to new ways of addressing this.
Rethinking the System PDF (99.12 KB)  [ more ] [ hide ]		Administration	1/11/2011
Rethinking the System Plsek, Paul and Edwards, Nigel Article/Report Bibliographic: October 2001, Leading Edge, NHS Confederation, Vol. 1, pp. 1-8 Contact Information: Nigel Edwards NHS Confederation Nigel.Edwards@nhsconfed.co.uk Article/Report This article, published by the NHS Confederation, explores organizations as complex systems, lessons for performance management, and problems which stem from viewing an organization, in this case the National Health Service in the UK, as machines. To access the full article, click on related document below..
Relationship-centered Care Newsletter PDF (120.8 KB)  [ more ] [ hide ]		Administration	1/11/2011
Relationship-Centered Care Initiative Newsletter, The Indiana University School of Medicine Article/Report Bibliographic: Winter 2005, the RCCI Newsletter, Volume 2, Issue 1 Description: Here is the opening statement from this newsletter: "We are approaching the end of the second year of the RCCI - the culture change initiative to transform Indiana University School of Medicine into the first relationship-centered medical school in the United States. An impressive array of activities, ideas and projects has emerged since January 2003, when the first 12-person Discovery Team was formed. The RCCI Dissemination Map illustrates the sweep of these developments. The map was first presented at the October 2004 Discovery Team Open Forum to illustrate the complexity of the essentially self-organized cascades of change occurring at IUSM. It also introduces IUSM community members to many of the diverse ongoing projects with the hope that they will be inspired to join.
Positive Deviance: Solutions for Complex Problems PDF (1.68 MB)  [ more ] [ hide ]		Administration	1/6/2011
Positive Deviance: An Elegant Solution for a Complex Problem Curt Lindberg and Thomas R. Clancy Article/Report Bibliographic: Lindberg, C., Clancy, Thomas R., 2010, "Positive Deviance: An Elegant Solution for a Complex Problem", JONA, vol. 40, no. 4, pp. 150-153. Description: Statistics from the partnership hospitals using the innovative PD intervention documented dramatic declines in MRSA infection rates.
Too Beautiful: Our Father's Last Days: PlexusCalls PDF (500.7 KB)  [ more ] [ hide ]		Administration	1/6/2011
PlexusCalls:"Too Beautiful" – Our Father's Last Days NOTE: the file is a transcript of the PlexusCall. Oct, 2003 - Lindberg, Curt; Lindberg, Robert In this conversation we will recount how members of one family used concepts inspired by complexity science to inform how they worked together to make the last days of their father comfortable, free of pain, and full with dignity, meaning, and love. The title of the PlexusCalls is "Too Beautiful" – Our Father's Last Days. Participating in this conversation will be Robert Lindberg, MD, Curt Lindberg, DMan, and David Introcaso, PhD
Biotech, Gene Therapy, Risk Assess: PlexusCalls MP3 (27.4 MB)  [ more ] [ hide ]		Administration	1/6/2011
PlexusCalls: Biotechnology and Risk Assessment Denise Caruso, Glenda Eoyang, Wayne Grody Denise Caruso is co-founder and executive director of The Hybrid Vigor Institute, a nonprofit research and consulting practice. Using genetic engineering as an example, Ms. Caruso delves into the scientific uncertainties that biotech risk evaluations don't always address. Innovation and technology are enormously complex and dependent upon known and unknown interactions. Glenda Holladay Eoyang, PhD, is a leading voice in the field of human systems dynamics. Her work, which focuses on the theory and practice of chaos and complexity, is represented in her recent book Facilitating Organization Change: Lessons from Complexity Science. Wayne W. Grody is a Professor in the Departments of Pathology & Laboratory Medicine, Pediatrics, and and Human Genetics at the UCLA School of Medicine. He is the founder and director of the Diagnostic Molecular Pathology Laboratory within the UCLA Medical Center.
Pathways to Prevention: Social Network Analysis PDF (1.17 MB)  [ more ] [ hide ]		Administration	1/5/2011
Pathways to Prevention Oct, 2008 - Buscell, Prucia Article/Report Bibliographic: Prevention Strategist, a publication of theAssociation for Professionals in Infection Control and Epidemiology, Autumn, 2008, Vol. 1, No. 3, pp 41-45 Description: Social network mapping at the VA Pittsburgh Healthcare System and at Billings Clinic, in Billings, Montana, offers some visual and theoretical clues to how certain patterns of connectivity emerge when people in many units of a healthcare organization work together successfully to combat the spread of infection. June Holley, a social network analyst, has found that networks with a moderately dense core comprised of people in different roles and a periphery of loose connections tend to be most effective at generating innovation and spreading new ideas.
PD Informed Prevention: Hospital El Tunal, Bogota PDF (392.05 KB)  [ more ] [ hide ]		Administration	1/5/2011
Notes & Reflections on Positive Deviance Informed Prevention Effort at Hospital El Tunal, Bogota, Colombia Jul, 2009 - Lindberg, Curt, and Urrea, Carlos Article/Report Description: The staff at Hospital El Tunal has created a strong and vibrant infection prevention culture. Nurses and other staff routinely remind each other and physicians to wash their hands, where physicians thank the staff for these reminders, where hand gel is called “holy water‘’, where community members are seen as genuine partners, where data on infection practices and rates are shared with everyone, where it is considered unethical to collect hand hygiene compliance rates in an “undercover fashion” because everyone who sees a colleague not performing proper infection control is obligated to intervene, where security officers are members of the infection control team, where new staff soon notice that diligent infection prevention practice is just the “way it is around here”
New Foundation for Patient-centered Care PDF (86.85 KB)  [ more ] [ hide ]		Administration	1/5/2011
New Theoretical Foundation for Relationship-centered Care, A Suchman, Anthony L. Article/Report Bibliographic: Journal of General Internal Medicine, 2006, Vol. 21:S40-44 Description: From the Abstract: "Relationship-centered care (RCC) is a clinical philosophy that stresses partnership, careful attention to relational process, shared decision-making, and self-awareness. A new complexity-inspired theory of human interaction called complex responsive processes of relating (CRPR) offers strong theoretical confirmation for the principles and practices of RCC, and thus may be of interest ot communications researchers and reflective practitioners. It points out the nonlinear nature of human interaction and accounts for the emergence of self-organizing patterns of reltaing." Contact Information: Anthony Suchman asuchman@rochester.rr.com
Multiscale Entropy Analysis of Biological Signals PDF (245.97 KB)  [ more ] [ hide ]		Administration	1/3/2011
Multiscale Entropy Analysis of Biological Signals Costa, Madalena, Goldberger, Ary, and Peng, C.K. Article/Report Bibliographic: Physical Review E 71, February 18 2005 Traditional approaches to measuring the complexity of biological signals fail to account for the multiple time scales inherent in such time series. These algorithms have yielded contradictory findings when applied to real-world datasets obtained in health and disease states. Authors details the basis and implemenetation of themultiscale entropy (MSE) method used. The method consistently indicates a loss of complexity with aging, and a results support a general "complexity-loss" theory of aging and disease
MRSA Issue of "Emerging" PDF (338.03 KB)  [ more ] [ hide ]		Administration	1/3/2011
MRSA Issue of emerging Buscell, Prucia Article/Report Bibliographic: Buscell, P. 2006, "The MRSA Issue", emerging, winter, pp. 1-24. How can complexity-inspired insights help in the effort to prevent suffering, death and financial loss from preventable infections? In 2005 The Robert Wood Johnson Foundation awarded Plexus Institute a $294,000 grant to begin an innovative initiative using complexity-inspired processes to combat hospital-acquired infections. The effort involves a partnership among Plexus Institute, the federal Centers for Disease Control and Prevention, the Positive Deviance Initiative at Tufts University, the Delmarva Foundation and the Maryland Patient Safety Center and the Southwest Pennsylvania MRSA Prevention Collaborative. In addition, the effort includes a network of as many as 40 hospitals, six of which will be "beta sites" that have agreed to follow three specific prevention guidelines and use the social change process called Positive Deviance.
More We Than Me: New Collaboration at Einstein Med PDF (3.05 MB)  [ more ] [ hide ]		Administration	1/3/2011
More We Than Me: How the Fight Against MRSA Led to a New Way of Collaborating at Albert Einstein Medical Center Jan, 2008 - Buscell, Prucia Article/Report Description: Albert Einstein Medical Center is a Beta Site in the Plexus Institute PD MRSA Prevention Partnership supported by The Robert Wood Johnson Foundation. This Partnership involves 6 Beta Sites and 40 Partner hospitals dedicated to pioneering the use Positive Deviance in MRSA prevention. The partnership is a collaboration involving Plexus Institute, Positive Deviance Initiative, CDC, Delmarva Foundation/Maryland Patient Safety Center, and the Southwestern PD/MRSA Prevention Collaborative. In addition to encouraging outcomes in declining MRSA infections and transmissions, the PD/MRSA initiative at the hospital has brought about increased collaboration and new relationships among members of the hospital staff.
How Common Sense Thinking Can Lead to a Mess DOC (121 KB)  [ more ] [ hide ]		Administration	1/3/2011
Little Hope: How Common Sense Thinking Can Lead to a Mess Dec, 2000 - Plsek, Paul Speech/presentation Bibliographic: Plenary Address at IHI's 12th Annual Forum on Improvement in Healthcare, San Francisco, CA, December 8, 2000 Contact Information: Paul Plsek Paul E. Plsek & Associates, Inc pplsek@IHI.org
Linearity, Complexity, and Well-being PDF (16.05 KB)  [ more ] [ hide ]		Administration	1/3/2011
Linearity, Complexity and Well-being Suchman, Anthony Article/Report Bibliographic: Medical Encounter 2002;16(4):17-19. Contact Information: Anthony Suchman Relationship Centered Health Care asuchman@rochester.rr.com Excessive and inappropriate use of linear thinking contributes to an enormous amount of anxiety and suffering for healthcare professionals. A non-linear perspective helps us embrace paradox and unpredictability; as we let go of expectations of control, there's room for more spontanetity, curious observation, discovery and delight. Complexity reminds us to pay attention to our surroundings and our relationships. It helps us set realistic expectations for ourselves, reducing shame and fear, thus improving well-being
Limits of Reductionism in Medicine: Systems Bio. PDF (279.63 KB)  [ more ] [ hide ]		Administration	1/3/2011
Limits of Reductionism in Medicine: Could Systems Biology Offer an Alternative?, The Ahn, Andrew C.; Tewari, Muneesh; Poon, Chi-Sang; Phillips, Russell S. Article/Report Bibliographic: June 2006, PLoS Medicine, Vol. 3, Issue 6, e208 Contact Information: Andrew C. Ahn Harvard Medical School aahn@hms.harvard.edu
Jazz: Improvisation in the Medical Encounter PDF (295.7 KB)  [ more ] [ hide ]		Administration	12/31/2010
Jazz and the Art of Medicine: Improvisation in the Medical Encounter Article/Report Dr.Paul Haidet, an internist, educator and researcher at the Michael DeBakey VA Medical Center and an assistant professor at Baylor College of Medicine in Houston, TX, has reseaerched cross cultural communication in the medical encounter, the culture of medical education, and active learnign strategies in medical education. An avid jazz fan,former disc jockey and amateur jazz historian, he applies his understanding of jazz improv to the essentials of the doctor-patient encounter.
Open Space Technology and Healthcare DOC (73.5 KB)  [ more ] [ hide ]		Administration	12/31/2010
Healthcare and Open Space Technology Jul, 2009 - Larry Peterson Article/Report Bibliographic: First Canadian Healthcare Conference, August, 2009 Report URL:http://www.thefirstcanadianhealthcareconference.ca/index.php?/Healthcare-and-Open-Space-Technology Description: Complexity science has been giving us some clues as to why Open Space Technology (OST) has such value for heathcare systems. Order or pattern emerges naturally in complex adaptive systems through the interaction of the parts. Stewart Kauffman, a leading complexity scientist, believes that the interaction in each moment of the atoms in molecules, the components of cells or the elements of a global economy lead to the self-organized wholes (Kauffman, 2008). No one atom, cell component or country economy imposes the whole order. So, it is not a stretch to see that the moment by moment interactions of people (and things) in our healthcare organizations actually come together to provide the care.
Healthcare Orgs. as Complex Adaptive Systems DOC (173 KB)  [ more ] [ hide ]		Administration	12/28/2010
Health Care Organizations as Complex Adaptive Systems Begun, James W., Zimmerman, Brenda, and Dooley, Kevin Article/Report Bibliographic: Begun, James W., Zimmerman, Brenda, and Dooley, Kevin. 2003, "Health Care Organizations as Complex Adaptive Systems", in Mick, S.S. and Wyttenbach, M. E. (eds), Advances in Health Care Organization Theory, San Fransisco, CA: Jossey-Bass. Description: The authors, all scholars of complexity science and organizations, explore the value of using a complexity science perspective to study complex organizations. After reviewing some basic concepts of complexity, they explore its relevance to understanding, studying, and managing health care organizations. They also point out that the study of "the world's most complex human organizations" can contribute to the science of complexity.

Item Name		Posted By	Date Posted
Lindberg, et al - Letting Go, Gaining Control PDF (356.29 KB)  [ more ] [ hide ]		Administration	5/31/2011
Letting Go, Gaining Control: Positive Deviance and MRSA Prevention Lindberg, Curt; Norstrand, Patricia; Munger, Mark T; DeMarsico, Christine; Buscell, Prucia This article, from the December 2009 of the journal Clinical Leader, reports on the first significant application of positive deviance in healthcare, notably on the issue of MRSA prevention.
Marra, et al - Positive Deviance A New Strategy PDF (194.9 KB)  [ more ] [ hide ]		Administration	5/31/2011
Positive Deviance: A New Strategy for Improving Hand Hygiene Compliance Marra, Alexandre R., et al. Infection Control and Hospital Epidemiology, January 2010, Vol. 31, No. 1 A positive defiance strategy yielded significant improvement in hand hygiene, which wa associated with a decrease in overall incidence of healthcare acquired infections.
Singhal, et al - Do What You Can PDF (3.09 MB)  [ more ] [ hide ]		Administration	5/31/2011
Do What You Can, With What You Have, Where You Are: A Quest to Eliminate MRSA at the VA Pittsburgh Healthcare System Singhal, Arvind, Greiner, Karen, and Buscell, Prucia Deeper Learning, Plexus Institute Hospital acquired infections are a serious and growing threat to patients. Read about the successful efforts of one hospital, VA Pittsburgh Healthcare System, to stem the tide of infections using a social change process called Positive Deviance. This process fosters engagement of staff at all levels and builds on what is working.
Singhal et al - Spanning Silos PDF (1.23 MB)  [ more ] [ hide ]		Administration	5/31/2011
Spanning silos and spurring conversation: positive deviance for reducing infecction levels in hospitals Singhal, Arvind; McCandless, Keith; Buscell, Prucia; Lindberg, Curt Performance 2 (3):78-83 An Ernst & Young 2009 Publication Some U.S. hospitals using the behavior change process positive deviance, have been able to engage every person in their own environments to join the work of infection fighting. As a result, the incidence of healthcare-associated MRSA infections has dropped as much as 84 per cent.