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A 'systems thinking' conceptual framework to explore clinical practice.

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Abstract

Background/Purpose The nature of clinical practice is ever-changing, varies according to the attributes of those enacting it, and poses complex questions that must be considered within context. As such, healthcare professionals need the ability to understand and respond to the larger contexts of the healthcare system. Existing approaches to describing clinical practice may be limited in how they conceptualize such context and complexity. Methods We sought to evaluate how conceptualization of paramedic practice may be optimized using a systems approach. We examine the role of combining an adaptation of Ecological Systems Theory (EST) and complexity thinking as ways of describing paramedic practice. Results EST can be adapted to outline the elements of clinical practice. This obligates a focus on various healthcare system levels which are often missing from our descriptions of practice. Complexity thinking obligates a focus on the non-linear, unpredictable nature of relationships between these elements. When combined, these frameworks allow for identification of elements within the system that may have value in describing clinical practice. We illustrate how aspects of paramedic practice may be ignored until viewed from a merging of these approaches. Conclusion Merging EST with complexity thinking provides an opportunity to reflect the complex realities of clinical practice when attempting to describe it. This conceptual framework promotes a focus on factors from macro level to individual patient level, as well as on the relationships within the system. This can be used as a foundation to inform future efforts to represent clinical practice, such as in the development of competency frameworks.
A systems thinking approach may enable us to identify
contexts of practice, and may expose components and
relationships that further our understanding of clinical
practice when developing competency frameworks.
INTRODUCTION
The nature of clinical practice is ever-changing, varies
according to the attributes of those enacting it, and poses
complex questions that must be considered within
context. As such, healthcare professionals need the ability
to understand and respond to the larger contexts of the
healthcare system. Existing approaches to describing
clinical practice may be limited in how they conceptualize
such context and complexity.
METHODS
We sought to evaluate how conceptualization of
paramedic practice may be optimized using a systems
thinking approach. We examine the role of combining an
adaptation of Bronfenbrenner’s Ecological Systems
Theory (EST) and complexity thinking as ways of
describing paramedic practice.
RESULTS
EST can be adapted to outline the elements of clinical
practice (Figure 1). This obligates a focus on various
healthcare system levels which are often missing from
our descriptions of practice. Complexity thinking
obligates a focus on the non-linear, unpredictable nature
of relationships between these elements. When
combined, these frameworks allow for identification of
elements within the system that may have value in
describing clinical practice (Figure 2). We illustrate how
aspects of paramedic practice may be ignored until
viewed from a merging of these approaches.
CONCLUSIONS
Merging EST with complexity thinking provides an
opportunity to reflect the complex realities of clinical
practice when attempting to describe it. This conceptual
framework promotes a focus on factors from macro level
to individual patient level, as well as on the relationships
within the system. This can be used as a foundation to
inform future efforts to represent clinical practice, such
as when developing competency frameworks.
Alan M. Batt PhD(c)1-3, Brett Williams PhD1, Madison Brydges PhD(c)3,4,
Matthew Leyenaar PhD(c)3,4, Walter Tavares PhD3,5
1.Dept of Paramedicine, Monash University, Australia
2.Paramedic Programs, Fanshawe College, Canada
3.McNally Project for Paramedicine Research, Canada
4.McMaster University, Canada
5.The Wilson Centre, University of Toronto, Canada
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pre-print paper
A 'systems thinking' conceptual framework to explore clinical
practice.
Figure 2. The ‘real world’ interactions of paramedic practice, informed by EST and complexity thinking, and illustrated via a systems map. Note: (a) size of elements is irrelevant; (b)
overlaps do not illustrate significance but rather illustrate influence in an easier to understand form than influence diagrams; (c) colours of elements are informed by EST diagram; (d) model
is a partial representation. KSAOs = knowledge, skills, attitudes, other attributes (i.e. competencies)
Figure 1. The system of paramedic practice informed by EST.
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