Resources in Healthcare
Positive Deviance: A New Strategy for Improving Hand Hygiene Compliance
Article/Report
A positive defiance strategy yielded significant improvement in hand hygiene, which wa associated with a decrease in overall incidence of healthcare acquired infections. .
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Applying Complexity Science to Health and Healthcare
Article/Report
Read an engaging summary of the 2003 Plexus Institute International Summit - Complexity Science in Practice: Understanding and Acting to Improve Health and Healthcare, cosponsored by Mayo Clinic and the Center for the Study of Healthcare Management at the University of Minnesota..
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Beyond Structural Reductionsim in Biology: Complex Routes to Medical Applications
Article/Report
The authors explore why the promise of structural reductionism in molecular biology has yielded few benefits for patient care and suggest an alternative "integrative paradigm focusing on biocomplexity and systems biology" that may yield more meaningful results. Howard Petty is a leading reseacher in physiologic dynamics..
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Case Study Research: The View From Complexity Science
Article/Report
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 .
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Chaos and Fractals in Human Physiology
Article/Report
This pioneering work was among the first to suggest how developments in nonlinear dynamics, fractal geometry and chaos theory could lead to advances in understanding of human physiology..
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Chaos and the Limits of Modern Medicine
Article/Report
A provocative short piece which suggests that chaos and complexity theory can contribute to advancing the practice of medicine by viewing people as complex systems and going beyond traditional scientific medicine.
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Clinical Applications of a Systems Approach, The
Article/Report
This article, the second in a series, examines the clinical significance of a systems biology appraoch to clinical medicine and when such an orientation is helpful. This orientation is contrasted with the traditional reductionist approach to medicine.
Muneesh Tewari, one of the coauthors, is a member of the Science Advisory Board of Plexus Institute..
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Clinical evaluation: constructing a new model for post-normal medicine
Article/Report
Science certainly has certainly made some spectacular technical advances. The media and politicians, for example, have all hailed the achievements of many scientific projects: the human genome project is no exception. In this paper, Sweeney and Kernicj argue that "neither reductionism nor linearity is sufficient to explain the nature of a world which is relentlessly non-linear and complex". In particular, the authors take up the idea that science deals in generalities whereas, clinical medicine is about the individual. The authors take up the complexity sciences as a basis for a different explanatory model of medicine, defining the characteristics of such a model and illustrating its applications..
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Community of the Self, The
Article/Report
You can tell by the title that Tim Buchman is a wonderful writer. By reading the article you'll see that he is also an incredibly insightful physician and scientist.
In the context of the general development of biology, systems theory, and physiology, this review article presents some of the latest thinking about the dynamics of health and disease stemming from systems biology and systems physiology. Emphasis is placed on the importance of scale-free networks, coupling, and variability in the maintenance of health..
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Complex Healthcare Systems and Information Technology: The Benefits of Computational Modeling and Simulation in Predicting Performance Outcomes
Book
Thomas R. Clancy, a longtime student of medical informatics and complexity science, has produced rigorous research that suggests use of electronic health records, with embedded clinical guidelines, can improve the use of human and financial resources while achieving quality patient care. This book is directed towards healthcare administrators, informatics specialists, nurses, physicians and other medical professionals.
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Complex Systems Analysis: A Tool For Shock Research
Article/Report
This clincal article begins by noting that the treatment of shock induced multiple organ system failure continues to challenge physicians and researchers. Despite extensive efforts, little progress has been made in identifying therapies directed at specific mediators, challenging the notion that multiple organ dysnfunction is "due to a malfunction of a specfic regulator, pathway or molecule. This article suggests that the search for understanding and effective therapies to treat shock and multiple organ failure may be found "through the prism of complex systems science.".
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Complexity as a Management Tool
Article/Report
In the September 1, 2004 issue of the online journal Hospitals and Health Networks, long-standing Plexus members John Tobin and James Taylor explore their insights into nonlinear dynamics in organizations and how these insights inform their management views and practices..
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Complexity for Clinicians
Book
This book sets the principles of nonlinear dynamics and complexity theory into the context of clinical healthcare, covering areas such as cardiology, diabetes, mental health, consultation dynamics, decision making and health informatics..
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Complexity in Primary Care Group
Website
The Complexity in Primary Care Group is an informal association of UK-based practitioners and researchers from a wide range of disciplines related to primary care. Group members share an interest in exploring the use of complexity and related theories to increase our understanding of primary healthcare..
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Complexity Science & Health Care Research
Speech/presentation
As the final plenary speaker at the First Annual Plexus Institute Summit Conference, Reuben McDaniel takes center stage with his own unusual mix of storytelling, humor and some more serious insights in using and applying complexity science prinicples in research..
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Complexity Science and Chronic Disease
Article/Report
A reflective report written by prominent science journalist on the Plexus conference held in December 2004 "Improving Health of the Chronically Ill: Insights From Complexity Science"..
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Complexity Science and Health Care Management
Article/Report
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..
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Complexity Science Primer, A
Article/Report
A good first step in a painting project is to lay down a coat of primer. This prepares the surface, so the paint will go on better. The same is true in learning. This introductory paper prepares your mind with a context and a base-level understanding of complexity science and its relevance to human organizations. Later, the more challenging concepts are much more likely to stick..
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Complexity Science Series
Article/Report
Plsek P.E. and Greenhalgh T., The challenge of complexity in health care, pp. 625-628. Online at http://bmj.com/cgi/content/full/323/7313/625
Wilson T., Holt T, and Greenhalgh T., Complexity and clinical care, pp. 685-688. online at http://bmj.com/cgi/content/full/323/7314/685
Plsek P.E. and Wilson T., Complexity, leadership, and management in healthcare organizations., pp, 746-749. Online at http://bmj.com/cgi/content/full/323/7315/746
Fraser S.W. and Greenhalgh T., Coping with complexity: educating for capability, pp. 799-803. Online at http://bmj.com/cgi/content/full/323/7316/799
A thoughtful, timely series from the prestigious British Medical Journal that introduces health care leaders and practitioners to complexity science and it's widespread implications for clinical care improvement, leadership, and education..
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Complexity, Chaos & Nonlinear Dynamics in Health and Disease: Homeostasis Revisited
Speech/presentation
Take a look at the presentation material used by Ary L. Goldberger, MD, at the December 2004 Plexus Conference - Improving Health of the Chronically Ill: Insights from Complexity Science..
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Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like?
Article/Report
Authors Glouberman and Zimmerman have written a discussion paper on health care reform in Canada in response to the Commission on the Future of Health Care in Canada. The paper presents a history of the Canadian health system, and suggests how an alternative theoretical frame is needed for viewing and understanding the complexities of health care. They take a look at some of the "intractable choices" or opposing views appearing in the health care debates, and present a few case studies to highlight governmental approaches to health care concerns: first, through a study of France's ranking in WHO health care systems; the second, is a look at Brazil's attempts to address HIV/AIDS. The final section of the paper addresses how complexity might be taken up in reforming Canada's health care system..
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Creating Healthcare Environments Where Nurses Thrive
Article/Report
On Sepember 30 and October 1, 2004 Plexus Institute sponsored a workshop that explored what complexity science and the experiences of nursing leaders and scholars can contribute to the creation of better working envrionments for nurses and hence, improvement in the quality of patient care.
Proceedings from this workshop attended by nursing leaders, nursing researchers, nursing school faculty, complexity scientists, PhD students in nursing, and organizational leaders were prepared by Susan Hull and are presented below as an associated document. Also shown for those interested in more backgroud is the conference brochure.
The workshop was hosted by Hunterdon Medical Center, Flemington, New Jersey and cosponsored by The College of New Jersey School of Nursing..
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Crossing the Quality Chasm: A New Health System for the 21st Century
Book
An important report from the Institute of Medicine of the National Academy of Sciences that suggests the US health care system can be better understood from a complex adaptive system perspective. Included in the recommendations are a series of new simple rules for guiding improvements in the health care system..
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Diabetes Control: A Complexity Perspective
Speech/presentation
Take a look at a presentation given by Tim Holt on complexity and diabetes given at the December 2004 Plexus Conference - Improving Health of the Chronicially Ill: Insights From Complexity Science..
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Do What You Can, With What You Have, Where You Are: A Quest to Eliminate MRSA at the VA Pittsburgh Healthcare System
Article/Report
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.
The authors of this story, one in a new series of Plexus publications called Deeper Learning, are the distinguished communications scholar Arvind Singhal, PhD, Samuel Shirley and Edna Holt Marston Professor, University of Texas El Paso, Karen Greiner, a PhD student at Ohio University, and Prucia Buscell, Plexus Publications Editor. .
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Dynamic Patterns: The Self-Organization of Brain and Behavior
Book
While contemporary neurophysiology and molecular biology tends to look at brain activity as the action of individual neurons and chemical neurotransmitters, Dr. Kelso's book looks at brain activity as the coordinated behavior and interactions of all components that make up the brain. The renowned scientist Hermann Haken calls the book a fascinating work filled with Dr. Kelso's ingeniously designed experiments and the application of the concepts of synergetics, a field of interdisciplinary research that Haken himself founded and developed. .
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Dynamical" Vs. "Genetic" Disease: What Do Complex Rhythms Reveal About Pathophysiology
Other audio/visual
A Powerpoint presentation prepared by Leon Glass for use in conjunction with his PlexusCalls..
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Edgeplace
Website
Edgeplace.com is a site designed to acquaint healthcare leaders with complexity concepts and leadership principles, resources, and examples of the ideas in practice. Much of the content of Edgeplace.com is contained in the book Edgeware: Insights From Complexity Science for Health Care Leaders written by Brenda Zimmerman, Curt Lindberg and Paul Plsek. Copies of the book can be ordered by going to this URL click here
Volume discounts and orders by bookstores can be secured by contacting Curt Lindberg at Curt@PlexusInstitute.org..
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Edgeware: Lessons From Complexity Science for Health Care Leaders
Book
Annotation by Tom Petzinger – "At last. Authors who reveal the clarity in complexity. As a journalist and business author myself, I've read virtually every book seeking to apply complexity science to strategy, work, and economics. None, I assure you, comes close to EDGEWARE in terms of sheer clarity and utility. Though solid on the theory of complexity, this book's real breakthrough in its tremendous practicality for leaders. The pages are brimming with case after case--episodes of complexity in action that inspire as well as inform. For leaders (in hospitals and anywhere else) who ask, 'What do I do on Monday morning?' EDGEWARE provides literally dozens of suggestions. Don't get me wrong. Applying complexity is hard work. No book will ever make it easy to abandon command-and-control leadership or to let organizations 'play' their way into the future. But with EDGEWARE as your guide, the work will be joyous.".
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Ending the End-of-Life Communication Impasse: A Dialogic Intervention
Article/Report
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..
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Enhancing the Informal Curriculum of a Medical School: A Case Study in Organizational Change-For Baltimore Conference Attendees
Article/Report
The Indiana University School of Medicine initiated a school-wide culture change project usingan alternative, participatory approach built oninterets, strengths, and values of individuals and microsystems. Student satisfaction with their educational experience rose sharply a nd reflective narratives describe changes in their work and learning environment..
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Fifth Wave: Psychotherapy and Complexity, The
Article/Report
If you are interested in the link between complexity science and recent developments in psychotherapy, check out this article by psychologist Barrie Evans..
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Fractal Physiology
Book
One of the first books to explore the implications of fractal patterns and dynamics for understanding human physiology. Written by pioneers in the field of nonlinear dynamics and complexity science..
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Fractal Response of Physiological Signals to Stress Conditions, Environmental Changes, and Neurodegenerative Diseases
Article/Report
In the last two decades, the biomedical community has witnessed the development of nonlinear and fractal physiology. The application of nonlinear system theory to the analysis of biomedical time series and the development of nonlinear dynamic model have been useful in understanding how biological systems respond to peculiar altered conditions caused by internal; stress, environmental stress and disease. .
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Fractal Variability Versus Pathologic Periodicity: Complexity Loss and Stereotypy In Disease
Article/Report
This comprehensive article proffers new complexity-based definitions of health and disease. Goldberger develops the case that healthy physiologic systems are characterized by fractal complexity, while unhealthy systems are marked by highly periodic (regular) dynamics and a concomitant loss of adaptability. A must read for anyone interested in complexity and human health..
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From Invisible to Visible: Learning to See and Stop MRSA at Billings Clinic
Article/Report
In two and a half years, Billings Clinic, a 272-bed hospital in Billings, Montana, was able to reduce healthcare associated MRSA infections by 84 percent. This story tells how the whole Billings Clinic community collaborated in fighting infection. It’s also an inspiring example of how the behavioral change process Positive Deviance helped dedicated healthcare providers transform their culture.
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Health Care Organizations as Complex Adaptive Systems
Article/Report
The authors introduce complexity science concepts and suggest its value in understanding and leading healthcare organizations. .
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Healthcare and Open Space Technology
Article/Report
OST inspires creative self-organization and new solutions in healthcare organizations. .
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High-performing and low-performing nursing homes: A view from complexity science
Article/Report
This article examines performance of two low-performing and two high-performing nursing homes, using complexity science principles to add "richness" to the analysis. It provides a well-devloped overview of the complexity science framework used in the research and focuses on the degree of connectivity, information flow and cognitive diversity found in the nursing home. Thoughtful implications for practice are then explored..
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How Improving Practice Relationships Among Clinicians and Nonclinicians Can Improve Quality in Primary Care
Article/Report
Quality is explored as an emergent property arising from relationships within healthcare organiztions. .
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Hyperstructures and the Biology of Interpersonal Dependence
Article/Report
This articles explores brain activity associated with attachment and separation behaviors, and thus patterns of interdependency among people. As such, Smith and Stevens explore connections between behavior at several levels - the neurological, the psychological and the sociological..
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Insights from Complexity Science for the Practice of Medicine
Speech/presentation
An introduction for clinicians to complexity science and its relevance to medicine and understanding of human physiology. Explores heart rate variability in some depth, referencing the extensive medical literature and demonstrating its value as a powerful diagnostic marker and connection to morbidity and mortality..
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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 jocket and amateur jazz historian, he applies his understanding of jazz improv to the esdsentials of the doctor-patient encounter. .
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John Stelling Presentation on Antimicrobial Resistance
Article/Report
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Latest Advances in Complexity Science
Speech/presentation
Presentation made by Bruce West, Chief Scientist Mathematics, US Army Research Office, at Plexus conference, On the Edge: Nursing in the Age of Complexity, July 2009.
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Lessons From the Field: How to Successfully Coach a Positive Deviance Initiative
Speech/presentation
These authors, who are familiar with the social change process Positive Deviance and have worked with PD in a successful initiative to engage hospital communitites in the effort to prevent healthcare-associated MRSA infections, describe how to help people use PD to discover how infection control can be practiced consistently by everyone. .
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Letting Go, Gaining Control: Positive Deviance and MRSA Prevention
Article/Report
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..
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Life at the Edge of Chaos - Health Care Applications of Complexity Science
Article/Report
This article seeks to introduce health care practitioners tot he science of complexity and show how it can be helpful in dealing with both medical and health care organizational issues.
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Limits of Reductionism in Medicine: Could Systems Biology Offer an Alternative?, The
Article/Report
A thoughtful article which compares alternative approaches to medicine - reductionism and systems biology. It contrasts current practices in medical science - focus on a singular dominant factor, emphasize homeostasis, inexact risk modification, and additive treatments - with the orientation of systems biology - robustness, dynamic stability, and variability.
Munessh Tewari, one of the coauthors, is a member of the Science Advisory Board of Plexus Institute..
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Linearity, Complexity and Well-being
Article/Report
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..
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Loss of 'Complexity' and Aging: Potential Applications of Fractals and Chaos Theory to Senescence
Article/Report
New views of the aging by two leading researchers suggest that it is related to the loss of complex patterns in physiologic systems..
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Managing for Success in Health Care Delivery
Speech/presentation
Take a look at powerpoint slides used by Ruth Anderson in her presentation at the December 2004 Plexus Conference, Improving Health of the Chronically Ill: Insights From Complexity Science. Her remarks focused on complexity science informed management practices in health care and their impact on patient outcomes..
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Managing Health Care Organizations: Where Professionalism Meets Complexity Science
Article/Report
This araticle provides an introduction to complexity science, suggests some management implications of the science, and recommends that healthcare organizations be viewed as complex adaptive systems. .
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Mergers versus Emergers: Structural Change in Health Care Systems
Resource within a website
Structural changes are commonplace in modern health care systems. Mergers, alliances, networks and other forms of structural change are being undertaken to reduce costs, improve utilization and service breadth, and reduce variation in demand. While some of these changes have provided benefits to both the health care provider and consumers, many have failed to reach their full potential, or worse. In this paper we propose that mergers and other structural changes are a rational response to market pressures, under the assumptions of the currently dominant, mechanistic business model of health care. Most mergers are primarily aimed at exploiting existing knowledge and capability. Synergy is thought of only as a deterministic phenomenon, something that can be created and managed. We next present a biologically based model using complexity science that illustrates the broader, explorative role that mergers based on the principles of self-organization could have. First, these self-organizing mergers-we call them emergers-could focus on much broader objectives than merely reducing costs. Second, emergers could be used to innovate radically different configurations of our health care system. Building on the first two roles, we see a third role that challenges the fundamental assumptions of what health care is, what it could be and how it could be delivered..
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Merging, De-merging, and Emerging at Deaconess Billings Clinic
Article/Report
This is an encouraging story about an emergent approach to health care system creation, involving the merger of the Deaconess Medical Center and the Billings Clinic. From the abstract: "By squarely surfacing the distinct cultures of the organizations through abundant interaction, relationship building and information flow, differences can be creatively transformed, resulting in deep-seated change and the emergence of a genuine, shared health care system culture.".
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More We Than Me: How the Fight Against MRSA Led to a New Way of Collaborating at Albert Einstein Medical Center
Article/Report
Hundreds of people at the Albert Einstein Medical Center in Philadelphia are using the social change process Positive Deviance to fight Methicillin Resistant Staphylococcus Aureus (MRSA). Their work has forged new relationships, expanded adherance to infection control ptorocol, and encouraging results in declining infection rates.
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MRSA Issue of emerging
Article/Report
Every year, two million patients acquire infections while being treated in US hospitals, and a growing number of the infection-causing microbes are resistant to antibiotics. In this special issue of emerging read about MRSA, the cause of 126,000 hospitalizations and thousands of deaths every year, and what a pioneering group of hospitals is doing, using the social change process Positive Deviance, to prevent the spread of MRSA..
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Multifractality in human heartbeat dynamics
Article/Report
The article by a world-wide team of scientists in the internationally respected science journal presents evidence of the fractal nature of healthy human heart rate dynamics. This is contrasted with the discovery of the loss of fractality in the life-threatening condition, congestive heart failure. The following statement is presented in the closing paragraph of the article - "the detection of robust multi-fractal scaling in the heart-rate dynamics is of interest because it indicates that the control mechanisms regulating the heartbeat might interact as part of a coupled cascade of feedback loops in a system operating far from equilibrium.".
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Multiple organ dysfunction syndrome: Exploring the paradigm of complex nonlinear systems
Article/Report
This article proposes that the paradigm of complex nonlinear systems be used in critical care research regarding the systemic host response and multiple organ dysfunction syndrome (MODS). It is suggested that "understanding the host response as a complex nonlinear system offers innovative means of studying critical care patients, specifically by suggesting a greater focus on systemic properties. We hypothesize that analysis of variability and connectivity of individual variables offer a novel means of evaluating and differentiating the systemic properties of complex nonlinear systems.".
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New Theoretical Foundation for Relationship-centered Care, A
Article/Report
Read about the new theory of complex responsive processes of relating written by a Anthony Suchman, a leader in the clinical philosophy of relationship-centered (health) care..
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Nonlinear Conversations
Article/Report
Complex interactions through nonlinear conversations. The author, a physician, proposes an alternative to the traditional medical interview..
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Non-linear dynamics for clinicians: chaos theory, fractals, and complexity at the bedside
Article/Report
A wonderful introductory article for medical personnel by a physician who has delved deeply into human health and physiology from the complexity and chaos perspectives. Suggests new definitions for health and ill-health, and new diagnostic and therapeutic approaches. Contains comprehensive reference list of other medically related articles.
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Notes & Reflections on Positive Deviance Informed Prevention Effort at Hospital El Tunal, Bogota, Colombia
Article/Report
Physicians, nurses, and other staff members work together on infection prevention, remind each other to wash their hands, and sanitary hand gel is called "holy water". .
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Notes & Reflections on Positive Deviance Informed Prevention Effort at Hospital El Tunal, Bogota, Colombia
Article/Report
Physicians, nurses, and other staff members work together on infection prevention, remind each other to wash their hands, and sanitary hand gel is called "holy water". .
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Nursing Homes as Complex Adaptive Systems
Article/Report
Improving quality is an important challenge in nursing homes. This article reports on the results of a study designed to test the hypothesis that management practices consistent with complexity science (open communication, participation in decision-making, relationship-oriented leadership...) improve resident outcomes. The hypothesis was supported, suggesting that traditional nursing home leadership pracitces need rethinking and that complexity-inspired practices should be adopted as a key strategy for enhancing the care of patients..
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On the Edge: Nursing in the Age of Complexity
Book
This book, the first to address complexity science and nursing, is a product of the Plexus Institute science and nursing communities. It addresses the broad implications of the science for nursing practice, research, policy making and leadership. .
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Organizations as Machines, Organizations as Conversations: Two Core Metaphors and their Consequences
Article/Report
The way an organization is envisioned, as machine or conversation, has powerful impact on what happens. .
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Origin of Disease and Health, Heart Waves: The Single Solution to Heart Rate Variability and Ischemic PreconditioningThe Origin of Disease and Health, Heart Waves: The Single Solution to Heart Rate Variability and Ischemic Preconditioning, The
Article/Report
This provocative article explores the concepts of the heart waves and heart rate variability as indicators of health and disease and proposes a route to increase the fractal complexity, and hence health, of human physiologic systems through a novel approach to physical activity and exercise. Don't miss this one..
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Pathways to Prevention
Article/Report
Certain patterns of human relationship emerge in tandem with successful infection control. .
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Physicians and Decisions: A Simple Rule for Increasing Connections in Hospitals
Article/Report
A gem of an article, which explores a simple rule for hospitals: let doctors and nurses help decide key strategic issues. It documents the benefits of increased connections among key stakeholders - improved financial performance and more adaptable strategies..
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Physionet
Website
Physionet is a public service of the Research Resource for Complex Physiologic Signals, funded by the National Center for Research Resources of the National Institutes of Health. It offers free access via the web to large collections of recorded physiologic signals and related open-source software..
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PlexusCalls: A Community Tackles Youth Violence & Drug Use
Speech/presentation
Join this provocative discussion to learn how members of a community can combine their differing knowledge and resources to change the conditions that perpetuate youth violence.
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PlexusCalls: Alzheimer's, Dementia, Complexity
Speech/presentation
Susan D. Gilster, PhD, is founder and executive director of the Alois Alzheimer Center, a pioneering free-standing facility dedicated exclusively to individuals with Alzheimer's disease and dementia..
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PlexusCalls: Communication, Medicine, Jazz
Speech/presentation
"Man you don't have to play a whole lot of notes. You just have to play the pretty notes". Trumpeter Miles Davis.
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PlexusCalls: Community approach to preventing AIDS
Speech/presentation
Helen Epstein is the author of The Invisible Cure: Africa, the West and the Fight Against AIDS. This groundbreaking new book argues that the very institutions designed to lead the global response to HIV/AIDS may in fact be undermining community responses to the epidemic..
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PlexusCalls:"Too Beautiful" – Our Father's Last Days
Speech/presentation
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, and David Introcaso, PhD..
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Positive Deviance: Useful Methodology to Prevent Hospital Acquired Infections
Speech/presentation
Hospital El Tunal, Bogota, Colombia, has been employing Positive Deviance (PD) process to stem the transmission of MRSA. The hospital shared their experience with the process with other hospitals in Colombia and staff from El Tunal during a May 2009 workshop..
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Power of Positive Deviance, The
Article/Report
This issue of emerging explores positive deviance, a new approach to social and behavioral change pioneered by Jerry and Monique Sternin. The process was created by the Sternins in their work in developing countries on such intractable issues as childhood malnutrtion in Vietnam, neonatal mortablity in the mountainous regions of Pakistan, and female genital cutting in Egypt. .
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Power of Relationships for High-Quality Long-Term Care, The
Article/Report
Ruth Anderson and her colleagues examine quality and complexity science in long term care. .
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Practice of Medicine is in the Interactions- A Day with Robert A. Lindberg, MD, The
Article/Report
Dr. Arvind Singhal, the noted communications scholar and member of the Plexus Institute Science Board 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..
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Primary Care Practice: Uncertainty & Surprise
Speech/presentation
Take a peak at some fascinating material on primary care practices as complex systems shared by Dr. Benjamin Crabtree at a recent conference..
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Rey Laboratory for Nonlinear Dynamics in Medicine
Website
Rey Laboratory for Nonlinear Dynamics in Medicine is the only laboratory in the world devoted to exploring complex, nonlinear behavior in human physiological systems. It is led by Ary Goldberger, M.D., a cardiologist at Beth Israel Deaconness Medical Center and Havard Medical School, who has devoted his career to seeking to new understandings of the nonlinear mechanisms and patterns of health and disease..
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RN Participation in Organizational Decision Making and Improvements in Resident Outcomes
Article/Report
Results from a research study reported in this article show that nursing homes that had higher levels of RN participation in decision making had greater improvements in outcomes for patients.
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Role of conversation in health care interventions, The: enabling sensemaking and learning
Article/Report
The authors argue that some unanticipated variation in healthcare interventions arise because unexpected conversations emerge during the intervention attempts. The role of conversation ininterventionis discusse, drawing upon literaeture from sociolinguistics and complex adaptive system theory to create an interpretive framework. .
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Role of conversation in health care interventions, The: enabling sensemaking and learning
Book
The authors argue that some unanticipated variation in healthcare interventions arise because unexpected conversations emerge during the intervention attempts. The role of conversation ininterventionis discusse, drawing upon literaeture from sociolinguistics and complex adaptive system theory to create an interpretive framework. .
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RWJF Final Report on PD MRSA Prevention Partnership
Article/Report
This report was submitted to The Robert Wood Johnson Foundation and presents a summary of the accomplishments and lessons from the PD MRSA Prevention Partnership. This partnership was dedicated to pilot testing the social change process Positive Deviance in hospital efforts to reduce MRSA infections..
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School-Based Community Family Therapy for Adolescents at Risk
Article/Report
Read about the pioneering work of two family therapists who are bringing a complexity and relational orientation to family therpay and community work..
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Self-Organization and Emergence: A Complexity Science Foundation for the Saint Luke's Hospital Stroke Center
Speech/presentation
Take a look at the powerpoint presentation used by Marilyn Rymer, MD, at the December 2004 Plexus Conference - Improving Health of the Chronically Ill: Insights from Complexity Science..
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Staff-Driven Cultural Transformation Diminishes MRSA
Article/Report
This article tells the story of the work being done in six hospitals across the country to pioneer the use of Positive Deviance, a process that fosters behavioral and social change, on the prevention of MRSA (methicillin-resistant staphylococcus aureus), a deadly healthcare acquired infection..
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Survivor's Guide for Primary Care Physicians, A
Article/Report
Building Office Relationships and interacting with the local landscape are keys to resiliency. This article explores the ways to do both..
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Survivor's Guide for Primary Care Physicians, A
Book
Building Office Relationships and interacting with the local landscape are keys to resiliency. This article explores the ways to do both..
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Too Beautiful: Insights for the End-of-Life Process
Article/Report
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. This science highlights the inherent unpredictability of complex systems and offers new understanding of how patterns of behavior emerge from interactions within systems. The principles of complexity science helped family members let go of the unrealistic expectations that one can, if wise enough, predict how the dying process would unfold and provided guidance for acting in the face of this uncertainty. The parent, near the end, told the family, "I am leaving under the circumstances everyone wishes for....".
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TQM, Chaos and Complexity
Article/Report
A superb article which explores what chaos and complexity theory offer to traditional thinking about quality improvement. Includes a comprehensive set of references..
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Understanding Change in Primary Care Practice Using Complexity Theory
Article/Report
From a significant study – The Direct Observation of Primary Care – the authors suggest that practices can be better understood by viewing them as complex adaptive systems. Such a view opens up new approaches to promoting and adapting to change.
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Understanding Healing Relationships in Primary Care
Article/Report
Clinicians often have an intuitive understanding of how their relationships with patients foster healing.Recent research shows clinicians practice three processes foster healing relationships: valuing thepatient, and beingnonjudgmental; using power in ways that benefit the patient, and being committed to the patient over time..
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When the Task is Accomplished, Can We Say We Did It Ourselves? A Quest to Eliminate MRSA at the Veterans Health Administration's Hopsitals in Pittsburgh
Article/Report
This story is about the quest at the VA Pittsburgh Healthcare System (VAPHS)to eliminate the transmission of deadly healthcare associated infections, specifically Methicillin-Resistant Staphylococcus Aureus or MRSA. Using the social and behavioral change process Positive Deviance, the facility was able to engage the innovativeness and energy of hundreds of hospital staff members - from environmental services staff to nurses, physical therapists, recreational therapists, unit secretaries, physicians, residents - and patients to uncover and create practices to prevent transmission of MRSA and to spread these practices to their colleagues. In so doing, a culture of engagement, participation and local action emerged.
VAPHS 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 PA MRSA Prevention Collaborative.
This story was written by noted communications scholar Arvind Singhal and Karen Greiner, a PhD student at Ohio University.
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Where Medicine Went Wrong: Rediscovering the Path to Complexity
Book
Bruce West, a highly regarded complexity scientist who introduced fractals and nonlinear dynamics to our understanding of human physiology, suggests in this book manuscript that many traditional measures of health - blood pressure, temperature, respiratory rate - are not good measures of how the body functions. New measures, which capture dynamics and the complexity of the human body and replace traditional understanding of human physiology, are needed he argues. The field of fractal physiology provides a path to such new indicators.
Trace the development of science and how it shapes our understanding of health and the practice of medicine. For a sense of this work, consider some of the chapter headings: Chance and Variation; Even Uncertainty has Laws; Fractal Physiology; and Disease as Complexity Loss..
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Which Nursing Home Would You Put Your Mother In?
Article/Report
Research suggests that the highest quality care in a long-term care institution is most dependent on the quality of the relationships among nursing home staff members. Quality of care outcomes in a nursing home need open, free-flowing, and meaningful conversations that occur between and among staff members. If the staff believes that their work and presence
matters, that their voices are important and are heard, it usually translates into better care for
patients. The two scholars who have led the charge in studying quality-of-care outcomes in U.S. nursing homes, and who - for over a decade - have questioned the use of conventional
management practices to manage health care organizations, are Reuben McDaniel, Jr. of the McCombs School of Business, University of Texas, Austin, and Ruth Anderson of Duke University's School of Nursing..
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WHO Global Strategy for Containment of Antimicrobial Resistance
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Executive summary: Deaths from accute respiratory infections, diarrheal diseases, measles, AIDS nmalaria, the TB account for more than 85% of the deaths frominfetionworkd wide. Resitance to the first-line drugs inmotofthepathogens that cause these diseases ranges from sero to nearly 100%. in someinstances resistance to second and third choice drugs is compromising treatment. Added to this problem is the growing incidence of hospital acquried infections, the emerging problems of antiviral resistance,and the increasing problem of drug resistance in parasitic diseases of poor and marginalized populations. .
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WHONET Survey of Laboratories and Publications - 2006
Article/Report
Laboratory figures represent the number of centers with data in WHONET, either at the local or national level. Publications include journal articles and reports. Several countries have not yet forwarded their publication list, and thus are not yet included in the below tallies..
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Women's Health and Complexity Science
Article/Report
This article explores how complexity science informs the development of an academic discipline in women's health. While obstetrics/gynecology was consistent with the prevailing scientific theory of the late 19th century, women's health can no longer be reduced to reproduction. A dynamic interaction between all disciplines will grow a new field. This new perspective will enable all types of clinicians to deliver care to the woman as a whole, based on the dynamic interaction of all her parts as she intereacts within the diverse contexts of her life..
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