WONCA Special Interest Group:Complexities in Health

Complexities in Health

The fascination of complexity: dealing with individuals in a field of uncertainty, the theme of the 2009 WONCA Europe conference in Basel, introduced complexity sciences to the field of general practice.

A group of complexity researchers in primary care – Carmel Martin, Jim Price, Bruno Kissling, Stefan Topolski and Joachim Sturmberg – formed the nidus for a complexity Special Interest Group (SIG), formally agreed to, by WONCA Executive, in March 2010. This newly-formed SIG is co-convened by Joachim Sturmberg from Australia, Carmel Martin from Ireland and Jim Price from the United Kingdom.

We are an active group, currently we are looking to expand our social networking and research collaborations to promote the application of complexity theory/science to clinical, organizational issues and biopsychosocial, knowledge and philosophical understandings of primary care.

Contact the convenor, A/Prof Achim Sturmberg, if you are interested in joining.

Convenor / Chair

A/Prof Joachim Sturmberg

Joachim P Sturmberg MBBS, DRACOG, MFM, FRACGP, PhD is A/Prof of General Practice at the Departments of General Practice of Monash University, Melbourne and the Newcastle University, Newcastle, Australia.

Joachim has been a practice principal at Wamberal Primary Care, Wamberal, Australia for over 20 years. He is a general practice educator and researcher, with a main focus on the foundations of primary care, continuity of care and health systems reform. He is a member of the New South Wales Health Council on Primary Care.

He has a longstanding interest in the application of systems and complexity principles to health care delivery, education and health systems organisation. He is co-editor-in-chief of the forum on systems and complexity in health, published in the Journal of Evaluation in Clinical Practice.

Co-Convenor or other office bearers

Co-convenor: Prof Carmel M Martin

Carmel Martin MBBS, MSc, PhD, MRCGP, FRACGP, FAFPHM is currently working in a mixture of roles related to general practice in Ireland. She works half time as visiting professor at the National Digital Research Centre, in Dublin; does general practice one and one half days per week with Kildare and County West Wicklow Doctors on Call; and is a visiting academic for one day per week at Department of Public Health and Primary Care, Trinity College Dublin, Ireland. She is also currently Associate Professor of Family Medicine, Northern Ontario School of Medicine, Canada.

Carmel currently has two major streams of interest in complex non-linear systems. One is the theory and methods of research and evaluation that inform the practice and policy of general practice. The other interest is the operationalising of chronic illness care around trajectories of illness and wellness using complex systems theory and IT systems. For more information about Carmel academic interests and achievements see:

http://tcd.academia.edu/CarmelMartin

Co-convenor: Dr Jim Price

Jim Price MA FRCP FRCGP FAcadMEd is Deputy Head of School, Principal Lecturer in Medical Education and Programme Leader for Professional Development at the Institute of Postgraduate Medicine (IPGM), Brighton & Sussex Medical School and the University of Brighton.

Jim has been a general practice principal in West Sussex for over 20 years, with experience as a GP Trainer, postgraduate GP tutor and, since 2001, as an academic at Brighton and Sussex Medical School. He was involved in the development of the new undergraduate medical school’s clinical curriculum, and has developed and led several masters programmes at postgraduate level.

He has a longstanding interest in the application of complexity theory / science to medical and health education, in particular as it relates to leadership and how it might inform teaching and educational research. He holds a Masters in Applied Professional Research, a Diploma in Health Care Management (Keele) and is a Fellow of the Academy of Medical Educators.

Executive Members

  • David Katterndahl, USA
  • Bruno Kissling, Switzerland
  • Diane O’Halloran, Australia
  • Stefan Topolski, USA

Membership Open?

Vision and Mission of WONCA SIG on Complexities in Health

Objectives of the WONCA SIG on Complexities in Health

The Complexity SIG wants to be a meeting place for all those who are interested in exploring the new concepts of systems and complexity, and to allow the exchange of research ideas and encourage the presentation of complexity based research at all WONCA meetings.

The Complexity SIG will run introductory workshops at all future WONCA meetings, so watch out and come along and get hooked!

The longer term aim of this SIG will be to promulgate systems and complexity sciences within WONCA, to offer workshops in systems and complexity methodologies, and to become an expert body to advise on research and policy issues within general practice/ family medicine.

Why we need a SIG on Systems and Complexity in Health

Since its inception, WONCA has led the way in addressing, both the pressing issues and the emerging challenges, of general practice and family medicine around the globe.

The next big challenge for the discipline arises in that the familiar patterns of investigating problems no longer provides answers that fit our daily experiences – we have reached the limits of the ‘reductionist research paradigm’.

As much as this research approach has provided us with great detail about the underlying mechanisms of many health problems, it has not been able to fully describe the occurrence of health and illness as a whole. Complexity Sciences provide a conceptual framework to gain the knowledge necessary to solve the many subtle and context-specific problems encountered in daily practice.

Systems and Complexity Sciences developed in the latter half of the 20th century in response to the realisation that the reductionist understanding of any discipline does not fully describe the whole field. In short, complex adaptive systems are characterised by a collection of individual agents, that act in an interconnected way through feedback loops. These interactions cannot be precisely predicted and outcomes emerge that may be unexpected and surprising.

Family medicine and primary care are practiced in complex systems. We work with complexity every day in clinical practice, yet, linear models and assumptions still dominate our research methods and approaches. It is clear that general practice/family medicine needs new ways to generate relevant knowledge in order to solve the problems encountered in daily practice. To paraphrase Einstein, the solutions that created today's crises are no longer suitable to solving them.

Fundamental to understanding complex adaptive systems is the notion of a core driver. This is the central point of orientation of a system. We believe that the patient’s experience of his / her health should be the core driver, in the presence (and in the absence) of discrete pathologies.

To secure sustainable and stable people-centred health systems for the next 50 years requires a coordinated and concerted effort by everyone; policy makers, educators, health and health services researchers, health care professionals and patients.

Activities

History

Relevant Resources

Journals

A forum on Systems and Complexity in Medicine and Healthcare, is now published in the Journal of Evaluation in Clinical Practice. We gratefully acknowledge Professor Andrew Miles, editor, for his encouragement and support in setting up the Forum.

http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291365-2753

Relevant Articles

Sturmberg, J. P. and Martin, C. M. Leadership and transitions: maintaining the science in complexity and complex systems. J Eval Clin Pract. 2012; 18: 186–189.

Martin CM, Grady D, Deaconking S, McMahon C, Zarabzadeh A, O'Shea B. Complex adaptive chronic care - typologies of patient journey: a case study. J Eval Clin Pract. 2011;17(3):520-4. Epub 2011/04/19

Félix-Bortolotti, M. Part 2 – primary health care workforce policy intricacies: multidisciplinary team case analysis. J Eval Clin Pract., 2011; 17: 400–404.

Boutellier, R. & Zoller, F. A. (2011) General practitioners are the future intermediaries. Journal of Evaluation in Clinical Practice, 2011; 17 (2), 405–409.

Martin CM, Sturmberg JP (eds) Forum on Systems and Complexity in medicine and health care. J Eval Clin Pract 2010;16(5).

Katerndahl D, Parchman M, Wood R. Trends in the perceived complexity of primary health care: a secondary analysis. J Eval Clin Pract. 2010;16(5):1002-8.

Thygeson M, Morrissey L, Ulstad V. Adaptive leadership and the practice of medicine: a complexity-based approach to reframing the doctor–patient relationship. J Eval Clin Pract. 2010;16(5):1009-15.

Katerndahl DA, Wood R, Jaen CR. A Method for Estimating Relative Complexity of Ambulatory Care. Ann Fam Med. 2010;8(4):341-7.

Martin CM. Complexity in dynamical health systems - transforming science and theory, and knowledge and practice. J Eval Clin Pract. 2010;16(1):209-10. Epub 2010/04/07.

Jordon M, Lanham HJ, Anderson RA, Jr RRM. Implications of complex adaptive systems theory for interpreting research about health care organizations. Forum on Systems and Complexity in Health Care in J Eval Clin Pract. 2010;16(1):228-31.

Martin CM, Kasperski J. Developing interdisciplinary maternity services policy in Canada. Evaluation of a consensus workshop. J Eval Clin Pract. 2010;16(1):238-45. Epub 2010/04/07.

Félix-Bortolotti M. Part 1 - Unravelling primary health care conceptual predicaments through the lenses of complexity: A position paper for progressive transformation. J Eval Clin Pract. 2009;15(5).

Relevant lectures

Joachim Sturmberg - An Introduction to Complexity in Health http://monash.academia.edu/JoachimSturmberg/Talks/20851/An_Introduction_to_Complexity_in_Health

Stefan Topolski - Clinical Applications of Chaos and Complexity http://umassmed.academia.edu/StefanTopolski/Talks/28948/Clinical_Applications_of_Chaos_and_Complexity

Family Medicine Digital Resource Library

http://www.fmdrl.org/index.cfm?event=c.beginBrowseD#Search+complexity

Publications