Teach EBP?

An introduction to Complexity theory!

Mechanistic / Cause and effect view of life

• I lead – you follow• I say – you do• I manage – you do• I teach – you learn• You teach – I pass

Complex systems

• Complex systems consist of a large number of elements

• These interact in a dynamic way• Each element influences the

others and is influenced in turn• Most interactions are short range• But complex systems do interact

with their environment

Complex systems contd• There are loops in the interactions

which can have a +ve or –ve effect• Complex systems are not in

equilibrium – only survive through a constant flow of energy

• Present and future behaviour partly determined by past

• Elements in the system react to local info and are ignorant of behaviour of system as a whole

agreement

low

high

certainty lowhigh

(After Stacey, Stephenson & Greenhalgh)

agreement

low

high

certainty lowhigh

agreement

low

high

certainty lowhigh

environment

taskcomplexity

order

chaos

agreement

low

high

certainty lowhigh

environment

task

Zone of complexity

Competence

Don’t go here!

Capability

Competence- what individuals know or are able to do in terms of knowledge, skills and attitude.

Capability- extent to which individuals can adapt to change, generate new knowledge and continue to improve their performance

Complexity systems and education

• The system and its environment is never constant

• Individuals are independent and creative decision makers

• Uncertainty and paradox are inherent within the system

• Problems that can’t be solved can nevertheless be moved forward

Complexity systems and education contd

• Effective solutions can emerge from minimum specification

• Small changes can have big effects

• Behaviour exhibits patterns • Change is more easily adopted

when it taps into these patterns

Problem based learner

RCA Problem cases

Narrative based

EBPAudit Ethics

Change Management

“Process based learning”?

Process based learning

Learning driven by needs

Characterised by –

•Dynamic and emergent PLP with explicit goals

•Protected time

•Mentoring and peer support

•Written log or record

References

“The challenge of complexity in health care”

Plesk and Greenhalgh - BMJ 2001; 323: 625-8

“Coping with complexity: educating for capability”

Fraser and Greenhalgh - BMJ 2001; 323: 799-803

“Complexity and clinical governance:using the insights to develop the strategy”

Sweeney and Mannion - BJGP; 52(suppl): S4-S9