Understanding Change in Primary Care Practice Using Complexity Theory

摘要: Background Understanding the organization of primary care practices is essential for implementing changes related to delivery preventive or other health services. A theoretical model derived from complexity theory provides a framework understanding practice change. Methods Data were reviewed brief participant observation fieldnotes collected in 84 Direct Observation Primary Care (DOPC) study and 27 three similar studies investigating services delivery. These data synthesized with information an extensive search social science, nursing, literature concerning organization, on fields mathematics, physics, biology, management, medicine, family systems, create practice. Results are understood as complex adaptive systems consisting agents, such patients, office staff, physicians, who enact internal models income generation, patient care, organizational operations. interact dynamically each unique The particular shape determined by its goals. suggests strategies promoting change practitioner behavior: joining, transforming, learning. Conclusions This has important implications Practices much more than present assume. identified why some work others do not.