Nordic School of Public Health, Göteborg, Sweden.
Int J Integr Care. 2008;8:e68. Epub 2008 Oct 23.
Organizations can be regarded as systems. The traditional model of systems views them as machines. This seems to be insufficient when it comes to understanding and organizing complex tasks. To better understand integrated care we should approach organizations as constantly changing living organisms, where many agents are interconnected in so-called Complex Adaptive Systems (CAS).
The term "complex" emphasizes that the necessary competence to perform a task is not owned by any one part, but comes as a result of co-operation within the system. "Adaptive" means that system change occurs through successive adaptations. A CAS consists of several subsystems called agents, which act in dependence of one another. Examples would be the ant-hill, the human immune defence, the financial market and the surgical operating theatre team. Studying a CAS, the focus is on the interaction and communication between agents. Although these thoughts are not new, the CAS-approach has not yet been widely applied to the management of integrated care. This helps the management to understand why the traditional top down way of managing, following the machine model thinking, may meet with problems in interdependent organizations with complex tasks.
When we perceive health and social services as CASs we should gain more insight into the processes that go on within and between organizations and how top management, for example within a hospital, in fact executes its steering function.
组织可以被视为系统。传统的系统模型将它们视为机器。但当涉及到理解和组织复杂任务时，这似乎还不够。为了更好地理解综合护理，我们应该将组织视为不断变化的生物体，其中许多代理在所谓的复杂适应系统 (CAS) 中相互连接。
“复杂”一词强调，执行任务所需的必要能力不是由任何一个部分拥有的，而是来自系统内部的合作。“适应”意味着系统通过连续的适应而发生变化。一个 CAS 由几个称为代理的子系统组成，它们相互依存地运作。例如蚁丘、人体免疫系统、金融市场和外科手术室团队。研究 CAS 时，重点是代理之间的交互和通信。尽管这些思想并不新鲜，但 CAS 方法尚未广泛应用于综合护理的管理。这有助于管理层理解为什么传统的自上而下的管理方式，遵循机器模型思维，在具有复杂任务的相互依存的组织中可能会遇到问题。
当我们将卫生和社会服务视为 CAS 时，我们应该更深入地了解组织内部和组织之间发生的过程，以及例如医院内的高层管理人员如何实际执行其指导职能。
