Complex systems

Complex Systems and Implementation Science

The Complex Systems and Implementation Science Research Stream is part of the Centre for Healthcare Resilience and Implementation Science at the Australian Institute of Health Innovation.

Healthcare is increasingly recognised as a complex adaptive system, comprised of multiple levels of interacting agents, including diverse organisations (e.g., hospitals, not-for-profits, governments, professional bodies), groups (e.g., medical teams, online patient communities) and individuals (e.g., doctor, nurse, patient, carer, pharmacist). All of this interconnection leads to nonlinearity, making understanding, influencing and improving the healthcare system a challenge of the greatest magnitude. For example, complexity science highlights the importance of local context, such that an intervention that works in one hospital might show little improvement or might not even be adopted in another. Furthermore, feedback loops within complex systems mean that changes may not be sustained, as their effects become self-correcting (negative feedback); alternatively, a small perturbation in one part of system, for example a doctor failing to wash their hands, may have repercussion across the entire network, such as causing frustration among their team, patient infection, culminating in a national scandal.

While such complexity belies easy prediction, our research focuses on ways to understand this complex system, with the goal of improving healthcare. We look at the links and disconnects of agents in a complex system through social network analysis which can highlight common phenomena such as silos. We also find ways to make sense of this complexity through qualitative methods, such as observation, ethnography, and quantitative analysis, in particular utilising “Big Data”. In addition, we are interested in understanding and making use of feedback for the purposes of healthcare improvement.

Publications of note

Braithwaite, J., Dammery, G., Spanos, S., Smith, C.L., Ellis, L.A., Churruca, K., Fisher, G., Zurynski, Y. Learning health systems 2.0: Future-proofing healthcare against pandemics and climate change. A White Paper. Australian Institute of Health Innovation, Macquarie University: Sydney, Australia, 2023. ISBN: 9781741385014.

Franklin, M, Townsend J, Lewis S, Boyle F, Warren, M, Ernst K, Gibson A, Rapport F, Braithwaite J, Smith AL. (2022) The role and value of metastatic breast care nurses: Supporting women and their families to live well with metastatic breast cancer. Australian Institute of Health Innovation, Macquarie University: Sydney.

Long, J. C., Best, S., Hatem, S., Theodorou, T., Catton, T., Murray, S., Braithwaite, J., & Christodoulou, J. (2021). The long and winding road: perspectives of people and parents of children with mitochondrial conditions negotiating management after diagnosis. Orphanet Journal of Rare Diseases, 16(1), 1-12. [310]. https://doi.org/10.1186/s13023-021-01939-6

Ellis, L. A., Churruca, K., Tran, Y., Long, J. C., Pomare, C. & Braithwaite, J. (2020). An empirical application of “Broken Windows” and related theories in healthcare: Examining disorder, patient safety, staff outcomes, and collective efficacy in hospitals. BMC Health Services Research, 20, 1123 (2020). doi: 10.1186/s12913-020-05974-0

Long, J.C., Gul, H., McPherson, E., Best, S., Augustsson, H., Churruca, K., Ellis, L. A. & Braithwaite, J.  (2021). A dynamic systems view of clinical genomics: a rich picture of the landscape in Australia using a complexity science lens. BMC Medical Genomics. 14, 63. https://doi.org/10.1186/s12920-021-00910-5

Ludlow, K., Churruca, K., Ellis, L. A., Mumford, V., & Braithwaite, J. (2021). Decisions and Dilemmas: The Context of Prioritization Dilemmas and Influences on Staff Members’ Prioritization Decisions in Residential Aged Care. Qualitative Health Research. doi: 10.1177/1049732321998294

Pomare, C., Churruca, K., Ellis, L. A., Long, J. C., & Braithwaite, J. (2019). A revised model of uncertainty in complex healthcare settings: a scoping review. Journal of Evaluation in Clinical Practice, 25(2), 176-182. https://doi.org/10.1111/jep.13079

Zurynski, Y., Smith, C. L., Vedovi, A., Ellis, L. A., Knaggs, G., Meulenbroeks, I., Warwick, M., Gul, H., Pomare, C., & Braithwaite, J. (2020). Mapping the learning health system: a scoping review of current evidence. A white paper. Australian Institute of Health Innovation, Macquarie University.

Pomare, C., Mahmoud, Z., Vedovi, A., Ellis, L. A., Knaggs, G., Smith, C. L., Zurynski, Y., & Braithwaite, J. (2021). Learning health systems: a review of key topic areas and bibliometric trends. Learning Health Systems, [e10265]. https://doi.org/10.1002/lrh2.10265

Complexity Science in Healthcare – Aspirations, Approaches, Applications and Accomplishments: A White Paper

Navigating the healthcare maze: a new model of care for epilepsy The Health Advocate AHHA Issue 52/February 2019

Braithwaite, J., Churruca, K., Long, J. C., Ellis, L. A., & Herkes, J. (2018). When complexity science meets implementation science: a theoretical and empirical analysis of systems change. BMC Medicine, 16(1), 1-14. [63]. https://doi.org/10.1186/s12916-018-1057-z

Churruca, K., Ludlow, K., Taylor, N., Long, J. C., Best, S., & Braithwaite, J. (2019). The time has come: embedded implementation research for health care improvement. Journal of Evaluation in Clinical Practice, 25(3), 373-380. https://doi.org/10.1111/jep.13100

Churruca, K., Pomare, C., Ellis, L. A., Long, J. C., & Braithwaite, J. (2019). The influence of complexity: a bibliometric analysis of complexity science in healthcare. BMJ Open, 9(3), 1-10. [027308]. https://doi.org/10.1136/bmjopen-2018-027308

CHRIS WORKING PAPER #102  Leveraging complexity features in Genomic Implementation

CHRIS WORKING PAPER #106 Where the Rubber Meets the Road: A Learning Health Care System for Australia: A Working Paper Providing a Synthesis of Ideas Drawn from Selected Literature Braithwaite J, Boyling C, Warwick M, Smith K-L, Zurynski Y, Hibbert P

More Complexity Science and Implementation Science papers by Professor Braithwaite.

Presentation

"Implementing Genomics into Clinical Care"—Presentation by Professor Jeffrey Braithwaite to The Genomics in Australian Healthcare: Foundations to Future Conference. 5 September 2019

Selected stream projects

Rare Disease Awareness, Education, Support and Training (RArEST) Project

Genomics in primary care

Observatory on the Future of Healthcare

The National Paediatric Applied Research Translation Initiative (N-PARTI)

'Broken Hospital Windows'

Communities of practice and social professional networks

Developing an implementation strategy for enhancing the detection and management of familial hypercholesterolaemia in Australia

Genomics translational activities

Implementation of genomic medicine into clinical practice

Implementation and Complexity Science in Mental Health - various projects

Implementation Science Interest Group

Implementing and scaling an evidence-informed model for hip fracture management

Keeping Australians out of hospital

Mackenzie's Mission

Melanoma Centre of Research Excellence

Mitochondrial Guidelines

NHMRC Centre of Research Excellence in Implementation Science in Oncology

Rouse Hill Hospital  Development Project

Centres related to this research

Centre for Healthcare Resilience and Implementation Science