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Table 1 Complexity Analysis Framework for QI in Health Care

From: Make it complicated: a qualitative study utilizing a complexity framework to explain improvement in health care

SituationProblem definitionResponsePrimary locus of responsibility for the workKind of workDecision-making process
SimpleClear
Ordered universe with clear causality
Clear
Answers are self-evident, undisputed, and can be determined based on facts and evidence
ManagerTechnical
Often a question of solution implementation
Sense
Categorize
Respond
Responses are developed through the categorization of existing facts
ComplicatedClear
Ordered universe with clear causality, though not perceived by everyone
Requires learning
May contain multiple correct answers; involves analysis, expert consultations, and the creation of working groups. Requires coordination and collaboration, time consuming, often with a tradeoff between the “best” answer and making a decision, but complete data becomes available … eventually
Manager and staffTechnical and adaptive
Often a question of solution implementation and evolution of new responses through experimentation and discovery
Sense
Analyze
Respond
Responses are developed based on analyzing several options
ComplexRequires learning Unordered universe without clear causalityRequires learning
No right answers exist – decisions often based on incomplete data
Staff > managerAdaptive
Often a question of evolution of new responses through experimentation and discovery
Probe
Sense
Respond
Responses are developed by letting them emerge by testing different ideas
ChaoticRequires action to create stability in an unordered universeRequires action to stabilize in order to gain perspective and enable diagnosis – no point to search for right answersManagerTechnicalAct
Sense
Respond
By first acting, order can be established so that a response can be developed