The extended care team for people with multimorbidity as a complex adaptive system: How to raise the adaptability of your own team.
Authors: Boeckxstaens Pauline 
Published: January 2024

1.Short summary: Rapid changes in healthcare structure and demands require continuous adaptability of healthcare teams. This workshop will describe a case vignette of a patient with multimorbidity to start a theoretically underpinned reflection on how teams can be supported to adapt to changing contexts.

2.Why: Traditionally healthcare delivery has been structured based on disease-specific guidelines, procedures and teams in which effectiveness and quality of interventions is  often measured by means of disease specific clinical outcome indicators defined in disease-specific randomized clinical trials. However, for people with a combination of disorders or with a complex context, outcomes are often a lot more uncertain. In addition, patients with multimorbidity are often followed by different professionals in different healthcare and welfare services, each with their own perspective and priorities. Therefore, interprofessional healthcare teams often operate in complex situations. Moreover, they tend to operate in fragmented order throughout different primary and secondary healthcare and welfare services. Complexity science has been introduced in healthcare as a theoretical framework to better understand complex situations. Interdisciplinary healthcare teams can be viewed as Complex Adaptive Systems (CAS) by focusing more on the team members' interactions than on the characteristics of individual team members. Viewing teams in this way can provide us with insights into the origins of team behavior. Insights that can be supportive to improved team functioning and improved integrated care.

3.Audience: Clinicians, teamleaders, managers

Structure (90')

Introduction (10') on changes in population needs (e.g. multimorbidity) and healthcare delivery (e.g. interprofessional collaboration) including the related challenges. The need for optimizing the adaptability of clinical teams towards this changing working context will be emphasized as focus of the workshop. Theoretical background on complexity science as a lens to better understand working in VUCA (volatile, uncertain, complex, ambiguous) conditions

Group work (30') A case vignette will be provided of a patient with multimorbidity taken care of by a multiprofessional team. Based on the case vignette participants will fill in the CAL questionnaire (Complex Adaptive Leadership Organisational Capability Questionnaire). Group discussion on the meaning of the scores will be guided by the moderators

Theory (10')The constructs of the Questionnaire will be explained and the use of the questionnaire as a monitoring tool during team transitions will be discussed

Group work (10') discuss/brainstorm about strategies to influence the topics defined in the different questions of the questionnaire.

Reporting back (20') small groups will report back about the strategies they have defined for each question.

Wrap up and key messages (10') Two minutes of repetition of the theoretical principles of complexity science in healthcare by the moderators. Group formulation of preferred strategies defined during the workshop to optimize the adaptability of clinical teams in working with complex patients

5.How to engage

Small group discussions – plenary discussions

Case vignette – clinical reflection – brainstorm

Dscussion on transferability of ideas to real world situation

6.Take home messages?

Partly by moderators, partly by participants

One pager with theoretical underpinning + further reading suggestions will be provided