Implementation of electronic health records (EHRs) is a driver for the improvement of health care and the reduction of health care costs. Developing countries face substantial challenges in adopting EHRs. The complex adaptive system conceptual framework was used to guide this single case study to explore strategies that health care leaders used to successfully implement the EHR system. Data were collected from 6 health care leaders from an island in the Caribbean using a semistructured interview technique. Data were analyzed using the Bengtsson's 4-stage data analysis process, which includes decontextualization, recontextualization, categorization, and compilation. The results of the study yielded 5 main themes: training, increased staffing, monitoring, identifying organizational gaps, and time. The implications of the study for positive social change include the potential to improve the standards of care provided to promote improved patient outcomes by using the strategies identified in this study to successfully implement the EHR system.

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<p>This study proposes that poor understanding of the structures, processes and outcomes of organisations seriously hampers collaboration between professional groups in care organisations. Three care settings were investigated: follow-up of patients with heart disease, an intensive care unit and care services for older people.</p><p>The overall aim was to investigate how people understand structures, processes and outcomes in care organisations. The participants were patients, patient representatives, healthcare professionals, managers and politicians.</p><p>A qualitative approach was used. Thematic analysis and grounded theory were employed in analysing the data.</p><p>Despite considerable efforts, no major changes took place over a 7-year period as to how cardiac follow-up services were understood. The system of cardiac follow-up services was found fragmented in its organisation and in the way individuals understood it. The results indicate that care professionals, patients and leaders have dissimilar understandings. The data suggest that care is organised from a professional-centred perspective rather than from a holistic worldview of the patients’ total context. Leaders in intensive care perceive their organisation as a learning organisation. However, in daily work healthcare tends to function to what can be described as a mass production approach to care. This state of conflict caused confusion and chaos among the leaders. The municipal elderly care services and the county council’s geriatric organisation had difficulties in co-ordination. Older people were perceived as passive recipients of healthcare, rather than as consumers whose well being and outcome were a reflection to the quality of the service.</p><p>The study concludes that despite the major changes that have taken place in the Swedish health and elderly care organisations over the past years, healthcare professionals’ understanding of their work has gone largely unchanged. Their understanding of care structures and processes did not change despite outside pressures. Lack of understanding of what others understand hampers development with the result that care organisations risk stagnation.</p>

<p>The present thesis follows an intensive care unit during four year of hard work and demanding organisational changes (1998-2001). The changes were mainly initiated by diminishing resources and a legislative claim to pay regard to the quality aspect of health care service. The process of implementing a quality system was the main focus for the thesis. Triangulation was used aiming at explore the process from different views. Two interviews studies were conducted one with the staff and another with the leadership. Both interviews were analysed thematically combined with a phenomenographic technique (e.g. using the how, and what aspect). A longitudinal quasi experimental time-series study was also accomplished. The correlation between staff variables and workload were measured once a year. The result show a 20 % increase in workload per staff and year. The staff judged the organisational climate for innovativeness stable over the period. Sick leave increased, and more so, than the general trend in the society. In spite of this increase the prevalence of stress related symptoms was the same. Two different systems emerged, a complex adaptive system and a mechanical system. The two systems exist and functions intertwined. Because of the construction of the patient register it is possible to see that the situation around a patients being admitted ≥ 5 days functions according to the complex systems character while the situation around the acute patients functions according to a mechanical system. Sick leave correlated with number of patient admitted ≥ 5 days (P=,000). It seemed the problem found had its root in the unawareness of the existing of a complex system. The result has implications for a need of increased awareness about how to manage the situation when the ICU is functioning according to the complex adaptive system.</p>

This study proposes that poor understanding of the structures, processes and outcomes of organisations seriously hampers collaboration between professional groups in care organisations. Three care settings were investigated: follow-up of patients with heart disease, an intensive care unit and care services for older people. The overall aim was to investigate how people understand structures, processes and outcomes in care organisations. The participants were patients, patient representatives, healthcare professionals, managers and politicians. A qualitative approach was used. Thematic analysis and grounded theory were employed in analysing the data. Despite considerable efforts, no major changes took place over a 7-year period as to how cardiac follow-up services were understood. The system of cardiac follow-up services was found fragmented in its organisation and in the way individuals understood it. The results indicate that care professionals, patients and leaders have dissimilar understandings. The data suggest that care is organised from a professional-centred perspective rather than from a holistic worldview of the patients’ total context. Leaders in intensive care perceive their organisation as a learning organisation. However, in daily work healthcare tends to function to what can be described as a mass production approach to care. This state of conflict caused confusion and chaos among the leaders. The municipal elderly care services and the county council’s geriatric organisation had difficulties in co-ordination. Older people were perceived as passive recipients of healthcare, rather than as consumers whose well being and outcome were a reflection to the quality of the service. The study concludes that despite the major changes that have taken place in the Swedish health and elderly care organisations over the past years, healthcare professionals’ understanding of their work has gone largely unchanged. Their understanding of care structures and processes did not change despite outside pressures. Lack of understanding of what others understand hampers development with the result that care organisations risk stagnation.

The present thesis follows an intensive care unit during four year of hard work and demanding organisational changes (1998-2001). The changes were mainly initiated by diminishing resources and a legislative claim to pay regard to the quality aspect of health care service. The process of implementing a quality system was the main focus for the thesis. Triangulation was used aiming at explore the process from different views. Two interviews studies were conducted one with the staff and another with the leadership. Both interviews were analysed thematically combined with a phenomenographic technique (e.g. using the how, and what aspect). A longitudinal quasi experimental time-series study was also accomplished. The correlation between staff variables and workload were measured once a year. The result show a 20 % increase in workload per staff and year. The staff judged the organisational climate for innovativeness stable over the period. Sick leave increased, and more so, than the general trend in the society. In spite of this increase the prevalence of stress related symptoms was the same. Two different systems emerged, a complex adaptive system and a mechanical system. The two systems exist and functions intertwined. Because of the construction of the patient register it is possible to see that the situation around a patients being admitted ≥ 5 days functions according to the complex systems character while the situation around the acute patients functions according to a mechanical system. Sick leave correlated with number of patient admitted ≥ 5 days (P=,000). It seemed the problem found had its root in the unawareness of the existing of a complex system. The result has implications for a need of increased awareness about how to manage the situation when the ICU is functioning according to the complex adaptive system.

La communication humaine vise principalement à transmettre de l'information par le biais de l'utilisation de langues. Plusieurs chercheurs ont soutenu l'hypothèse selon laquelle les limites de la capacité du canal de transmission amènent les locuteurs de chaque langue à encoder l'information de manière à obtenir une répartition uniforme de l'information entre les unités linguistiques utilisées. Dans nos recherches, la stratégie d'encodage de l'information en communication parlée est connue comme résultant de l'interaction complexe de facteurs neuro-cognitifs, linguistiques, et sociolinguistiques et nos travaux s'inscrivent donc dans le cadre des systèmes adaptatifs complexes. Plus précisément, cette thèse vise à mettre en évidence les tendances générales, translinguistiques, guidant l'encodage de l'information en tenant compte de la structure des langues à trois niveaux d'analyse (macrosystémique, mésosystémique, et microsystémique). Notre étude s'appuie ainsi sur des corpus oraux et textuels multilingues dans une double perspective quantitative et typologique. Dans cette recherche, la langue est définie comme un système adaptatif complexe, régulé par le phénomène d'auto-organisation, qui motive une première question de recherche : "Comment les langues présentant des débits de parole et des densités d'information variés transmettent-elles les informations en moyenne ?". L'hypothèse défendue propose que la densité moyenne d'information par unité linguistique varie au cours de la communication, mais est compensée par le débit moyen de la parole. Plusieurs notions issues de la théorie de l'information ont inspiré notre manière de quantifier le contenu de l'information et le résultat de la première étude montre que le débit moyen d'information (i.e. la quantité moyenne d'information transmise par seconde) est relativement stable dans une fourchette limitée de variation parmi les 18 langues étudiées. Alors que la première étude propose une analyse de l'auto-organisation au niveau macro- systémique, la deuxième étude porte sur des sous-systèmes linguistiques tels que la phonologie et la morphologie : elle relève donc d'une analyse au niveau mésosystémique. Elle porte sur les interactions entre les modules morphologique et phonologique en utilisant les mesures de la complexité linguistique de ces modules. L'objectif est de tester l'hypothèse d'uniformité de la complexité globale au niveau mésosystémique. Les résultats révèlent une corrélation négative entre la complexité morphologique et la complexité phonologique dans les 14 langues et vont dans le sens de l'hypothèse de l'uniformité de la complexité globale d'un point de vue typologique holistique. La troisième étude analyse l'organisation interne des sous-systèmes phonologiques au moyen de la notion de charge fonctionnelle (FL) au niveau microsystémique. Les contributions relatives des sous-systèmes phonologiques (segments, accents, et tons) sont évaluées quantitativement en estimant leur rôle dans les stratégies lexicales. Elles sont aussi comparées entre 2 langues tonales et 7 langues non-tonales. En outre, la distribution interne de la charge fonctionnelle à travers les sous-systèmes vocaliques et consonantiques est analysée de façon translinguistique dans les 9 langues. Les résultats soulignent l'importance du système tonal dans les distinctions lexicales et indiquent que seuls quelques contrastes dotés d'une charge fonctionnelle élevée sont observés dans les distributions inégales de charge fonctionnelle des sous-systèmes dans les 9 langues. Cette thèse présente donc des études empiriques et quantitatives réalisées à trois niveaux d'analyse, qui permettent de décrire des tendances générales parmi les langues et apportent des éclaircissements sur le phénomène d'auto-organisation. / The main goal of using language is to transmit information. One of the fundamental questions in linguistics concerns the way how information is conveyed by means of language in human communication. So far many researchers have supported the uniform information density (UID) hypothesis asserting that due to channel capacity, speakers tend to encode information strategically in order to achieve uniform rate of information conveyed per linguistic unit. In this study, it is assumed that the encoding strategy of information during speech communication results from complex interaction among neurocognitive, linguistic, and sociolinguistic factors in the framework of complex adaptive system. In particular, this thesis aims to find general cross-language tendencies of information encoding and language structure at three different levels of analysis (i.e. macrosystemic, mesosystemic, and microsystemic levels), by using multilingual parallel oral and text corpora from a quantitative and typological perspective. In this study, language is defined as a complex adaptive system which is regulated by the phenomenon of self-organization, where the first research question comes from : "How do languages exhibiting various speech rates and information density transmit information on average ?". It is assumed that the average information density per linguistic unit varies during communication but would be compensated by the average speech rate. Several notions of the Information theory are used as measures for quantifying information content and the result of the first study shows that the average information rate (i.e. the average amount of information conveyed per second) is relatively stable within a limited range of variation among the 18 languages studied. While the first study corresponds to an analysis of self-organization at the macrosystemic level, the second study deals with linguistic subsystems such as phonology and morphology and thus, covers an analysis at the mesosystemic level. It investigates interactions between phonological and morphological modules by means of the measures of linguistic complexity of these modules. The goal is to examine whether the equal complexity hypothesis holds true at the mesosystemic level. The result exhibits a negative correlation between morphological and phonological complexity in the 14 languages and supports the equal complexity hypothesis from a holistic typological perspective. The third study investigates the internal organization of phonological subsystems by means of functional load (FL) at the microsystemic level. The relative contributions of phonological subsystems (segments, stress, and tones) are quantitatively computed by estimating their role of lexical strategies and are compared in 2 tonal and 7 non-tonal languages. Furthermore, the internal FL distribution of vocalic and consonantal subsystems is analyzed cross-linguistically in the 9 languages. The result highlights the importance of tone system in lexical distinctions and indicates that only a few salient high-FL contrasts are observed in the uneven FL distributions of subsystems in the 9 languages. This thesis therefore attempts to provide empirical and quantitative studies at the three different levels of analysis, which exhibit general tendencies among languages and provide insight into the phenomenon of self-organization.

Many of the technological and social systems our society has come to depend on can be classified as complex adaptive systems (CAS). These systems are made of many individual parts that self-organize to respond and adapt to changing outside and inside influences affecting the system and its actors. These CAS can be placed on a spectrum ranging from loosely- to tightly-coupled, depending on the degree of interrelatedness and interdependence between system components. This research has explored how the process of collaboration occurs in both a loosely- and tightly-coupled setting using one exemplar of each system. The loosely-coupled exemplar related to disaster risk reduction in two Canadian communities while the tightly-coupled one involved the implementation of a surgical information management system in a Canadian hospital. A list of core elements of collaboration that should be considered essential to the success of all collaborative endeavours was developed as a result: Engagement, Communication, Leadership, Role Clarity, Awareness, Time, and Technical Skills and Knowledge. Based on observing how the core elements of collaboration interacted with one another within each of these example systems, two models were created to represent their relationships. A list of considerations that collaborative tool designers should consider was also developed and the implications of these considerations were discussed. As businesses and other organizations increasingly incorporate team-based work models, they will come to depend more heavily on technology-based solutions to support collaboration. By incorporating collaborative technologies that properly support the activity of these teams—based on the specific type of complex adaptive system in which their organization exists—organizations can avoid wasting time and resources developing tools that hinder collaboration.

[pt] O objetivo da dissertação é analisar a dinâmica de aprendizagem organizacional (AO) relativa ao processo de elaboração da Norma Internacional de Responsabilidade Social (ISO 26000), segundo a perspectiva da complexidade social. No contexto da normalização internacional e à luz dos desafios estratégicos enfrentados pela ISO referentes à governança global, parte-se do pressuposto de que a abordagem da complexidade social de AO pode contribuir para uma melhor compreensão do papel da aprendizagem na formação de consenso em dois níveis: entre as diversas categorias de stakeholders e entre países. A metodologia de pesquisa compreende: (i) revisão bibliográfica e documental sobre normalização internacional; sistemas adaptativos complexos; e aprendizagem organizacional, com especial atenção para abordagens integradoras; (ii) descrição do processo de desenvolvimento da norma internacional ISO 26000; (iii) proposição de modelo conceitual que integra normalização internacional e aprendizagem organizacional, segundo a perspectiva da complexidade social; (iv) pesquisa survey junto a especialistas do Grupo de Trabalho ISO-TMB-WG SR e de seu comitê espelho brasileiro; e (v) estudo de caso de AO no processo de elaboração da Norma Internacional ISO 26000, com resultados da pesquisa survey. Esses resultados incluem: (i) a análise da dinâmica de AO relativa ao processo de elaboração da norma ISO 26000; (ii) relação dos principais fatores facilitadores de AO neste caso, considerando os dois níveis de análise; e (iii) recomendações endereçadas à ISO e à ABNT para futuros desenvolvimentos de normas internacionais em ambientes sociais complexos. / [en] The main objective of this dissertation is to analyze the learning dynamics and the specific learning mechanisms experimented by the different groups during the development process of ISO 26000 standard, through the lens of the social complexity perspective of organizational learning (OL). In the context of ISO 26000’s learning process, it was assumed that the social complexity perspective of organizational learning (OL) could be especially useful as it can improve the understanding of the role of learning in a double level of consensus – amongst stakeholders and across countries – in the light of the strategic challenges faced by ISO within the global governance arena. The research methodology comprises: (i) bibliographical and documental review on international standardization; social complex adaptive systems; organizational learning, with special attention to integrative approaches; (ii) review of the development process of ISO 26000 standard; (iii) design of a conceptual model that integrates the international standardization and organizational learning, through the lens of the social complexity perspective; (iv) development and application of a survey questionnaire to representatives of ISO-TMB-WG SR, including its Brazilian Mirror Committee; and (v) description of ISO 26000 study case. The main results can be summarized as follows: (i) learning dynamics analysis of the development process of ISO 26000 standard; (ii) list of main facilitating and constraining factors for OL in this case; and (iii) recommendations addressed to ISO regarding future international standardization processes in social complex environments.

The business model concept was first introduced in the early 1990s alongside the boom of the Internet. Although the Internet bubble has burst, the popularity of the business model concept continues to increase. It is being used more and more often by not just people in business management, but also the general population, as people, for example, talk about a successful start-up. Although it has become part of the vernacular today, the business model concept itself is lacking in theoretical roots. Thus, a gap exists regarding the business model concept. Its usefulness in practice has been proven in numerous business cases, yet academia remains divided on the definition and appropriate means to use the concept. A thorough literature review reveals that the concept of a business model has been framed in various ways, ranging from the strategic logic of a company to the activities a company performs. This misalignment creates barriers for the advancement of this body of knowledge in both research and practice. Researchers have thus called for a clearer and more operational definition of the concept.<br> With this goal in mind, this qualitative study sought to advance business model understanding by proposing a business model conceptualization that: <br> 1) Is robust in its theoretical roots and informs the critical characteristics of a business model, <br> 2) Highlights potential means to resolve the debate over the definition of a business model through examination of its broad range of conceptualizations and uses, and,<br> 3) Guides business model design through a robust exploration of design options for users interested in business model development. <br> To achieve this goal, a three-stream study was conducted.<br> The first stream focused on creating a business model construct that is rooted in advanced system theory and on proposing a related business model framework. This objective was achieved through a combination of scholarship of integration and thematic analysis. A resilient complex adaptive system (RCAS) perspective was taken to proactively construct a business model conceptualization. To fully understand an RCAS, a literature review was carried out on the notion of systems. Theories from general system theory (GST) to an RCAS were examined to form a full understanding of these foundational concepts. The resulting construct was employed as the underlying structure of a business model framework. To create a set of functions that a business model should include, an extensive literature review was conducted on 150 business model research articles. Thematic analysis was employed to analyze words and phrases used by authors to describe the critical components of a business model, and then aggregate these views into a set of mutually supportive functions that represent the essence of a business model. Eight functions, termed “elemental functions”, centered on value were defined. These elemental functions are able to capture all components identified in the studied literature and collectively display required RCAS characteristics. This RCAS business model framework lays the foundation for a unified landscape of business model conceptualization and acts as a potential universal language in this body of knowledge. The developed framework also serves as the basis for the subsequent lines of work detailed below, and grounds both further research and application.<br> The second stream is based on the RCAS framework and draws on its ability to facilitate abstraction. The work stream focuses on outlining a knowledge space for business models utilizing three variables that are closely tied to abstraction in the business model context, namely: elemental functions, purposes, and levels of abstraction. These variables were identified as critical factors influencing business model variation from both a literature perspective and observations. A thematic analysis was conducted on the same 150 articles as in the first stream to extract the potential states of these variables. Eleven purposes and five levels of abstraction were identified; and these two variables act as the axes of the knowledge space. Elemental functions were incorporated in the knowledge space to illustrate the frequency with which each elemental function is used for specific purposes and specific levels of abstraction. This knowledge space, herein termed the business model knowledge map, can be used to position existing work and identify future opportunities for research. The 150 articles were positioned in this space to outline a grander picture of the business model concept. It highlights that previous authors in the business model area have worked on abstractions of the same concept. This stream is another step towards a universal landscape of business model conceptualization that could help unify previously diverse views of business models.<br> The last work stream contributes to the design of business models – one of the key purposes for which business model constructs are employed as highlighted in the knowledge map described above. Specifically, this work stream puts forward a system-inspired business model design method. Building directly on the RCAS framework, this stream employs combinatorial design thinking from engineering and design to create a design method. One of the most critical aspects of this design method is its emphasis on creating a complete, to the extent possible, set of design options for each elemental function that composes a business model. To achieve this, an extensive review of over 200 company annual reports was conducted to generate design options for each elemental function. This design method focuses on raising awareness of one’s design options thereby enhancing the potential for business model innovation.<br> Collectively, this study advances the business model body of knowledge in both research and practice. The study is unique in its proactive employment of the RCAS construct to define a business model, its focus on abstraction to form a theoretically robust and potentially universal landscape for knowledge and research on business models, and its proposition of a structured approach to complete business model design. It is hoped that the developments outlined herein help pave a path to a more unified view of business model concepts that can foster connections between the work of researchers who employ business model constructs and further advance the state of knowledge in this arena.<br><br>