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1.
The care of older people in Sweden has undergone several major reorganisations during the past decade. The healthcare organisation, governed by the county councils, previously had the responsibility of providing care services for elderly people. However, the local municipalities have taken over that duty since 1992. The obligation of the health services is now restricted solely to medical issues. The present study focused on the understanding that politicians and managers have about caring for older people. A section of Stockholm with a population of 320,000 inhabitants was studied. The authors hypothesised that differences in understanding might have an impact on the services of care which older people receive. Interviews were conducted with eight leading politicians and 12 managers responsible for elderly care services. The main focus of inquiry concerned the participants' understanding of caring for older people. The results indicate that politicians and managers in elderly care sometimes have divergent views on how the care should be developed and produced to best serve older people. Five themes of understanding elderly care services and eight contradictory statements among the respondents were identified. A follow-up group session with the respondents was conducted to discuss the results of the interviews. The different ways of understanding elderly care services showed a complex and fragmented organisation lacking clear goals, structures and leadership. However, the authors found a willingness among respondents to collaborate with one another, as well as indications of positive attitudes toward improving healthcare, domiciliary and nursing care of older people.  相似文献
2.

Introduction

Interactive workshops are often the default mechanism for sharing knowledge across professional and sector boundaries; yet we understand little about if, and how, they work. Between 2009 and 2011, the Research to Reality programme in North East England ran eight stand-alone facilitated multi-agency workshops focused on priority public health issues. Local authorities, the health service, and academe collaborated on the programme to share latest evidence and best practice

Methods

A realist evaluation asked the overarching question ‘what worked where, for whom, and under what conditions’ regarding the knowledge exchange (KE) mechanisms underpinning any changes. Data were collected from fifty-one interviews, six observations, and analysis of programme documentation.

Results

191 delegates attended (local authority 46%, NHS 24%, academia 22%, third sector 6%, other 2%). The programme theory was that awareness raising and critical discussion would facilitate ownership and evidence uptake. KE activity included: research digests, academic and senior practitioner presentations, and facilitated round-table discussions. Joint action planning was used to prompt informed follow-up action. Participants valued the digests, expert input, opportunities for discussion, networking and ‘space to think’. However, within a few months, sustainability was lost. There was no evidence of direct changes to practice. Multiple barriers to research utilization emerged.

Discussion

The findings suggest that in pressured contexts exacerbated by structural reform providing evidence summaries, input from academic and practice experts, conversational spaces and personal action planning are necessary to create enthusiasm on the day, but are insufficient to prompt practice change in the medium term. The findings question makes assumptions about the instrumental, linear use of knowledge and of change focused on individuals as a driver for organizational change. Delegates' views of ‘what would work’ are shared. Mechanisms that would enhance interactive formats are discussed.  相似文献
3.
目的:通过研究北京市医药分开试点方案对医生、病人和医院的影响,对病人就诊支出进行预测.方法:采用复杂适应系统仿真方法,构建病人单次和长期就诊支出的仿真模型.结果:病人就诊支出受自身经济能力、医生行为、自身行为和医院就诊人次四方面因素的影响.结论:新医改方案下,仿真为病人就诊支出的预测提供了一种便捷工具.  相似文献
4.
5.
Achieving system-wide implementation of health promotion programs in schools and sustaining both the program and its health related benefits have proved challenging. This paper reports on a qualitative study examining the implementation of health promoting schools programs in primary schools in Sydney, Australia. It draw upon insights from systems science to examine the relevance and usefulness of the concept of “complex adaptive systems” as a framework to better understand ways in which health promoting school interventions could be introduced and sustained. The primary data for the study were collected by semi-structured interviews with 26 school principals and teachers. Additional information was extracted from publicly available school management plans and annual reports. We examined the data from these sources to determine whether schools exhibit characteristics of complex adaptive systems. The results confirmed that schools do exhibit most, but not all of the characteristics of social complex adaptive systems, and exhibit significant differences with artificial and natural systems. Understanding schools as social complex adaptive systems may help to explain some of the challenges of introducing and sustaining change in schools. These insights may, in turn, lead us to adopt more sophisticated approaches to the diffusion of new programs in school systems that account for the diverse, complex and context specific nature of individual school systems.  相似文献
6.
引入复杂适应系统理论和基于Agent的建模方法探索固体废物管理系统的动态演化进程。给出了基于Agent的固体废物管理系统演化仿真模型,该模型能正确描述废物管理系统的演化与发展趋势,对模型中涉及的Agent及其交互关系进行了设计。  相似文献
7.
创新团队是一个独立、开放的复杂适应系统。复杂适应系统理论为认识、理解创新团队的内部运作机制提供了新的思路。本文从复杂适应系统理论的视角对创新团队内部的沟通与交流机制、竞争与协作机制、激励与约束机制、冲突管理机制进行了分析。  相似文献
8.
Emergency clinicians undertake boundary-work as they facilitate patient trajectories through the Emergency Department (ED). Emergency clinicians must manage the constantly-changing dynamics at the boundaries of the ED and other hospital departments and organizations whose services emergency clinicians seek to integrate. Integrating the care that differing clinical groups provide, the services EDs offer, and patients' needs across this journey is challenging. The journey is usually accounted for in a linear way - as a "continuity of care" problem. In this paper, we instead conceptualize integrated care in the ED using a complex adaptive systems (CAS) perspective. A CAS perspective accounts for the degree to which other departments and units outside of the ED are integrated, and appropriately described, using CAS concepts and language. One year of ethnographic research was conducted, combining observation and semi-structured interviews, in the EDs of two tertiary referral hospitals in Sydney, Australia. We found the CAS approach to be salient to analyzing integrated care in the ED because the processes of categorization, diagnosis and discharge are primarily about the linkages between services, and the communication and negotiation required to enact those linkages, however imperfectly they occur in practice. Emergency clinicians rapidly process large numbers of high-need patients, in a relatively efficient system of care inadequately explained by linear models. A CAS perspective exposes integrated care as management of the patient trajectory within porous, shifting and negotiable boundaries.  相似文献
9.

Background

There is still limited knowledge regarding the translation of early child development (ECD) knowledge into effective policies and large‐scale programmes. A variety of frameworks that outline the key steps in scaling up exist, but we argue that taking a complex adaptive systems (CAS) approach assists in understanding the complex, dynamic processes that result in programmes being taken to scale.

Objectives

The objective of this study is to examine the process of scaling up four major country‐level ECD programmes through the application of a CAS framework.

Methods

Nine key informants with a deep knowledge of how each ECD programme was established and brought to scale were interviewed via Skype or phone by using open‐ended interviews. The interviews were tape recorded and then transcribed verbatim for subsequent coding by using CAS domains. The coding and integration of the results to identify unique and common CAS scaling up features across the case studies involved an iterative process of reaching consensus.

Results

The scaling up of all four programmes behaved as a CAS including as follows: (i) positive feedback loops (five themes) and negative feedback loops (two themes); (ii) scale‐free networks (two themes); (iii) phase transitions (four themes); (iv) path dependence (two themes); and (v) emergent behaviour (six themes). Five additional themes were identified for sustainability, which was repeatedly mentioned as an important consideration when deciding how to scale up programmes.

Conclusions

CAS analysis is likely to improve our understanding of how effective ECD programmes become scaled up. Prospective CAS implementation research is needed to continue advancing the knowledge in the field.  相似文献
10.

Background

Chile Crece Contigo (ChCC) is defined as a comprehensive, intersectoral, and multicomponent policy that aims to help all children reach their full potential for development, regardless of their socio‐economic status.

Methods

This case study was developed on the basis of grey literature review and key informants' interviews.

Results

ChCC behaves as a complex adaptive system that combines universal and targeted benefits for the more vulnerable starting since gestation and until the children are 4 years old. Three key ministries are involved in ChCC management: health, education, and social development. Studies show adequate programme implementation and positive effects of ChCC on child development. In addition, it was found that the more families use ChCC benefits and the longer the subsystem has been operating in the commune, the greater the positive effects.

Conclusions

Strong political support based on principles of equity and child rights combined with strong evidence and funding commitment from government has been central to emergence, scaling up, and sustainability of ChCC. Further sustainability of ChCC will rely on firmly establishing a well‐trained and compensated cadre of early child development professionals and paraprofessionals as well as an improved management and evaluation decentralized system.  相似文献
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