If you have no background in maths or data management, chaos theory and complexity theory may well be new concepts to you. They are increasingly important in healthcare, however, with applications at the policy-making level and in the day-to-day treatment of patients on the ward. If you have leadership ambitions or if you simply want to improve what you do and help your colleagues to do likewise, this article provides a useful starting point for learning about the role that they play and how you can find out more about them.
How do chaos and complexity theory apply to healthcare?
Aspects of chaos theory have been used in healthcare since as long ago as 1990, but it wasn’t until the beginning of this millennium that chaos and complexity theory came to be widely recognized as a useful starting point for modeling processes within the sector, with multiple applications. It hinges on the fact that healthcare is intrinsically a nonlinear dynamic system (with multiple smaller nonlinear dynamic systems operating within it), so reductionist methods can never be applied to it with sufficient reliability to achieve consistent success. At ground level, healthcare also involves a lot of mixing (where two different variable move in different directions over time), while at the managerial level, all the way up to the development of corporate, state and federal policies, the changing material circumstances of patients are making it an increasingly complex field. Chaos and complexity theory enable more effective modeling which facilitates more effective practise at every level.
Health, society and economics
Applying chaos and complexity theory makes it possible to model the intersections of other large scale factors which influence healthcare requirements and the most efficient means of fulfilling them. It allows us to explore the way in which health outcomes are impacted by social status using complex demographic models which allow for the tracking of specific variables such as addiction or experience of exclusion. It also enables investigation of the relationship between poverty and health, and it can be plugged into geographic models to track the influence of local or regional factors such as the availability of good quality housing to people on low incomes. This kind of overview is useful in long term planning, both within the health sector itself and in other sectors where there is a desire to avoid or minimize negative health outcomes. It’s also useful for rapid response planning such as the identification and management of infectious disease outbreaks – indeed, epidemiology was one of the first areas of healthcare in which this type of modeling took off.
Climate change impacts on health
Being able to develop and use models like these is all the more important today because of the ways in which health outcomes are being affected by climate change. Some individual aspects of this can be tracked in linear fashion, such as the encroachment of specific tropical diseases into more northerly regions, but when assessing developing healthcare needs it’s really useful to be able to more accurately map the intersection of multiple factors, especially when they move in different directions – for instance, an increase in directly heat-related deaths in areas of dense urban housing coupled with a reduction in deaths from fungal pathogens which thrive more effectively in colder environments. This is not only about establishing healthcare needs in the immediate term – it’s about predicting likely developing needs across the next few years and decades.
Developing adaptive and resilient systems
In light of these challenges, as well as those posed by the aging population, the impact of mass migration induced by climate change, and the probability of further emerging pandemics, it’s really important to be able to identify means through which to improve the adaptability and resilience of healthcare systems. This applies within individual healthcare institutions as well as at a national level. Crucially, complexity theory makes it possible to identify the point at which adding resources ceases to result in appreciable gain, so that planners can effectively resist pressure to try to solve problems by throwing money at them, and thereby preserve funding which might be spent more usefully in other areas. It makes it easier to establish the optimal level of redundancy in any given system, so that, for instance, a hospital ward can run smoothly without being severely impacted when individual absences occur due to illness.
Accessing the big picture through statistics
When a system is too big and complex to be analyzed in a straightforward way, statistics come to the rescue. Recent improvements in computing technology mean that it’s now possible to process bigger data sets than ever before, and doing so makes it much easier to spot patterns even in highly complex systems. The results are not always intuitive, however, so it’s important to have an understanding of the principles involved in order to know when you can be confident in acting on evidence derived in this manner. It’s also important to be able to distinguish a significant pattern from an incidental one, and, of course, to be able to ask the right questions in the first place. Although information can be extrapolated from one situation and applied to another, the very nature of complex systems means that it’s better to use situation specific data wherever possible.
Recognizing holistic health challenges
Although the language used in talking about complexity theory may at first seem alien and off-putting to many healthcare workers, the underlying principles are actually very close to those which have been at the core of nursing throughout its professional history: to wit, that healthcare needs to be approached with a view to overall wellness rather than through a narrow focus on treating individual causes of disease. The recognition that maintaining health, whether in an individual patient or across a population, requires acknowledging the interplay of multiple factors is fundamental to nursing, and this means that nurses tend to adapt to integrating complexity theory into their work much more quickly than their colleagues in adjacent professions. The advantage which it brings lies in putting nurses intuitive understanding on an evidenced basis, making it easier to explain to those other professionals, as well as providing a means of filling in gaps when a particular situation is simply too complex to be resolved using intuition.
Feedback and adjustment
Another intersecting principle in nursing is the value of feedback. Nurses and proponents of chaos and complexity theory are on the same page when it comes to recognizing the importance of seeking feedback and integrating it into care models. The latter advocate for a systemic approach which involves continually responding to feedback and then seeking more, so that with each step the system moves closer to an optimal approach. Like most of the other matters discussed in this article, this is an approach which scales very effectively, so it can be used in healthcare policy or in the treatment of an individual patient.
Tackling multi-system disorders
At the patient level, an integrated approach which makes use of complexity theory can be particularly effective in the treatment of multi-system disorders or cases involving multiple co-morbidities. In practice, such patients often struggle to access effective treatment because the traditional medical approach tries to tackle their different problems separately instead of recognizing the ways in which they intersect – and the ways in which treatments for one might be ineffective or even harmful in light of another. Psychiatric factors can also be taken into account in this way, increasing the odds of patient compliance with prescribed treatment regimes and decreasing the risk of mental health crises developing as a consequence of the treatment of physical illness. Furthermore, drawing on complexity theory, especially where individual patient observations are integrated into big data sets for analysis, means that relationships can sometimes be identified between symptoms which appeared to be unrelated, opening up opportunities for further improvements in treatment.
Ongoing education
In order for medical institutions and policy making bodies to take proper advantage of the opportunities offered by chaos and complexity theory, it is vital that individuals working there properly understand systemic instability. Here, again, nursing has an advantage over some other healthcare professions in that it is already geared toward lifelong learning. There’s no Gre required to study for a post-master’s DNP at Walsh University, and you can do so online in as little as five semesters. Chaos and complexity theory is built into the foundations of this course so it will put you in a position to play a key role in helping your organization to improve and move forward – as well as putting you in a strong position to find work elsewhere, if that’s your preferred option.
As the systems within which we all work grow ever larger and more complex, acknowledging the chaos inherent within them is vital. Developing a good working understanding of chaos and complexity theory can help you and your organization to avoid becoming overwhelmed and to find new ways forward in the ongoing effort to optimize patient care.
