Widmer Matthew A, Swanson R Chad, Zink Brian J, Pines Jesse M
Romney Institute of Public Management, Brigham Young University, Provo, UT, USA.
Arizona State University, School for the Science of Healthcare Delivery, Tempe, AZ, USA.
J Eval Clin Pract. 2018 Jun;24(3):629-634. doi: 10.1111/jep.12862. Epub 2017 Dec 27.
The specialty of emergency medicine is experiencing the convergence of a number of transformational forces in the United States, including health care reform, technological advancements, and societal shifts. These bring both opportunity and uncertainty. 21ST CENTURY CHALLENGES: Persistent challenges such as the opioid epidemic, rising health care costs, misaligned incentives, patients with multiple chronic diseases, and emergency department crowding continue to plague the acute, unscheduled care system.
The traditional approach to health care practice and improvement-reductionism-is not adequate for the complexity of the twenty-first century. Reductionist thinking will likely continue to produce unintended consequences and suboptimal outcomes. Complex systems thinking provides a perspective and set of tools better suited for the challenges and opportunities facing public health in general, and emergency medicine more specifically.
This article introduces complex systems thinking and argues for its application in the context of emergency medicine by drawing on the history of the circumstances surrounding the formation of the specialty and by providing examples of its application to several practice challenges.
在美国，急诊医学专业正经历着多种变革力量的汇聚，包括医疗保健改革、技术进步和社会变迁。这些既带来了机遇，也带来了不确定性。
21世纪的挑战：诸如阿片类药物流行、医疗保健成本上升、激励措施失调、患有多种慢性病的患者以及急诊科拥挤等持续存在的挑战，继续困扰着急性非预约护理系统。
传统的医疗保健实践与改进方法——还原论——不足以应对21世纪的复杂性。还原论思维可能会继续产生意想不到的后果和次优结果。复杂系统思维提供了一种视角和一套工具，更适合于一般公共卫生尤其是急诊医学所面临的挑战和机遇。
本文介绍了复杂系统思维，并通过借鉴该专业形成时的历史背景情况以及提供其在几个实践挑战中的应用示例，论证了其在急诊医学背景下的应用。
