The Hospital: A Complex Adaptive System

Abstract

Introduction: Numerous contemporary authors have described modern sanitary organisations as complex adaptive systems. Therefore, the behaviours and response patterns of their services and units are hardly intelligible if analysed by rationalist or Cartesian points of view. Methodology: The information used in this study’s process was extracted from Medline and LILACS databases, using the key words “Hospital”, “Health Care Economics and Organizations”, “Complexity Analysis”, and “Healthcare Systems”. No selection or exclusion criteria were used, due to the fact that the opinion developed in this article is based in the authors’ personal experience and not in a structured revision methodology. Results and Discussion: Hospitals are complex medical services companies due to many factors which alter their behaviour and work environment. They are governed by paradigms of complexity, and their structure, which needs to be particularly designed for the institution’s purpose, is also complex. Medical care is provided within an interdisciplinary matrix, in which agency relationships are not always translated into coherent diagnosis and therapy plans. Furthermore, these relationships usually increase, or do not modify, the gap between effectiveness and efficiency. Hospitals are open systems, and work dynamically, out of equilibrium. Therefore, contradictory or unpredictable agent’s behaviours are often seen affecting not only the organisation as a whole, but also the environment with which it interacts. Hospitals’ limits are diffuse and flexible, and their results are greater than the sum of its parts. Conclusion: The mentioned factors, among others, allow us to define a hospital as a complex adaptive system, which demands a new analytical approach, and the abolition of reductionist thinking. In this context, hospitals’ leaders will have to know the institution’s values, and simultaneously be used to working with tense flow logistics.