Utilizing Complexity Science to Drive Practice Change Through Patient- and Family-Centered Care

Healthcare is rapidly changing and complex. In the chaotic environment of daily clinical practice, decisions are made that have tremendous impact on patient care. Since the Institute of Medicine (IOM) landmark report, Crossing the Quality Chasm, experts have revisited the progress of change. The Agency for Research and Quality annually reports on progress for improving healthcare as mandated by the US Congress. In 2009, it was reported that ‘‘quality is improving at a slow pace’’ with a median rate of change of 2.3% per year.’’ Leape and others noted that the progress of change is slow and many patients ‘‘fear they may be harmed when they enter a hospital.’’ A contributing factor to the lack of progress is the predominance of hierarchical structures and silos in healthcare organizations inhibiting significant performance improvement. Achieving high reliability or ‘‘consistent performance over time’’ has been difficult, resulting in ‘‘pockets of excellence’’ rather than generalized, sustained patient care improvement. Although leaders hold practice improvement as an undeniable goal, the complex healthcare environment presents formidable challenges as transformation in care processes are designed and implemented.