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Health Care Analysis

Open Access 19-01-2024 | Original Article

The Lifeworld of the Complex Care Hospital Doctor: A Complex Adaptive Phenomenological Study

Authors: Felice Borghmans, Stella Laletas, Harvey Newnham, Venesser Fernandes

Published in: Health Care Analysis

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Abstract

The ever-increasing prevalence of chronic conditions over the last half century has gradually altered the demographic of patients admitted to acute care settings; environments traditionally associated with episodic care rather than chronic and complex healthcare. In consequence, the lifeworld of the hospital medical doctor often entails healthcare for a complex, multi-morbid, patient cohort. This paper examines the experience of providing complex healthcare in the pressurised and fast-paced acute care setting. Four medical doctors from two metropolitan health services were interviewed and their data were analysed using a combinatorial framework of phenomenology and complexity theory. The horizon of complex care revealed itself as dynamic, expansive, immersive, and relational, entailing a specialised kind of practice that is now common in acute care settings. Yet this practice has made inroads largely without heralding the unique nature and potential of its ground. Herein lies opportunity for complex care clinicians to expand notions of health and illness, and to shape research, practice, and system design, for a future in which care for health complexity is optimised, irrespective of care settings.
Literature
1.
Weatherall, D., Greenwood, B., Chee, H. L., & Wasi, P., et al. (2006). Science and technology for disease control: Past, present, and future. In D. T. Jamison, J. G. Breman, A. R. Measham, G. Alleyne, M. Claeson, & D. B. Evans (Eds.), Disease control priorities in developing countries (pp. 119–137). Oxford University Press.
2.
Huber, M., Knottnerus, J. A., Green, L., van der Horst, H., Jadad, A. R., Kromhout, D., et al. (2011). How should we define health? BMJ, 343, d4163.PubMedCrossRef
3.
Reeve, J., Blakeman, T., Freeman, G. K., Green, L. A., James, P. A., Lucassen, P., et al. (2013). Generalist solutions to complex problems: Generating practice-based evidence—The example of managing multi-morbidity. BMC Family Practice, 14(112), 112.PubMedPubMedCentralCrossRef
4.
Australian Institute of Health and Welfare. (2022). National strategic framework for chronic conditions, reporting framework: Indicator results. Canberra: AIHW.
5.
Australian Institute of Health and Welfare. (2022). Chronic conditions and multimorbidity.
6.
Ham, C., Imison, C., & Jennings, M. (2010). Avoiding hospital admissions: Lessons from the evidence. The king’s fund.
7.
Mazza, D., Pearce, C., Joe, A., Turner, L. R., Brijnath, B., Browning, C., et al. (2018). Emergency department utilisation by older people in metropolitan Melbourne, 2008–12: Findings from the reducing older patient’s avoidable presentations for emergency care treatment (REDIRECT) study. Australian Health Review, 42(2), 181–188.PubMedCrossRef
8.
The Economist Intelligence Unit. (2012). Never too early: Takling chronic disease to extend healthy life years.
9.
Oliver, D. (2019). David Oliver: Is hospital avoidance an elusive holy grail? BMJ: British Medical Journal, 364, l746.PubMedCrossRef
10.
Wallace, E., Smith, S. M., Fahey, T., & Roland, M. (2016). Reducing emergency admissions through community based interventions. BMJ, 352, h6817.PubMedCrossRef
11.
Australian Institute of Health and Welfare. (2022). Admitted patient care 2021–2016 Costs and funding. Canberra: AIHW.
12.
Newnham, H. H. (2022). Acting on better data for general medical care will help solve our acute hospital access crisis. Medical Journal of Australia, 216(3), 116–118.PubMedCrossRef
13.
Department of Health and Aged Care. (2021). National Health Reform Agreement (NHRA)—Long-term health reforms roadmap.
14.
Laitinen, H., Kaunonen, M., & Åstedt-Kurki, P. (2011). When time matters: The reality of patient care in acute care settings. International Journal of Nursing Practice, 17(4), 388–395.PubMedCrossRef
15.
Lapao, L. V. (2016). The importance of time in developing a boundaryless hospital: An example from Norther Portugal. In H. Albach, H. Meffert, A. Pinkwart, R. Reichwald, & W. Von Eiff (Eds.), Boundaryless hospital: Rethink and redefine health care management (pp. 81–101). Heidelberg: Springer.CrossRef
16.
Bleakley, A., & Bligh, J. (2009). Who can resist Foucault? Journal of Medicine and Philosophy, 34(4), 368–383.PubMedCrossRef
17.
18.
Manning, E., & Gagnon, M. (2017). The complex patient: A concept clarification. Nursing Health Sciences, 19(1), 13–21.PubMedCrossRef
19.
Webster, F., Rice, K., Bhattacharyya, O., Katz, J., Oosenbrug, E., & Upshur, R. (2019). The mismeasurement of complexity: Provider narratives of patients with complex needs in primary care settings. International Journal of Equity Health, 18(1), 1–8.CrossRef
20.
Pagone, T., & Briggs, L. (2019). Royal commission into aged care quality and safety. Canberra.
21.
Searle, J. R. (1998). Mind, language, and society: Philosophy in the real world. Basic Books.
22.
Sturmberg, J. P., & Miles, A. (2013). The complex nature of knowledge. In J. Sturmberg & C. M. Martin (Eds.), Handbook of systems and complexity in health. Springer.CrossRef
23.
Heath, I. (2013). Complexity, uncertainty, and mess as the links between science and the humanities in health care. In J. Sturmberg & C. M. Martin (Eds.), Handbook of systems and complexity in health (pp. 19–24). Springer.CrossRef
24.
Coyle, F. J. (2009). ‘It just doesn’t seem to fit’. Environmental illness, corporeal chaos and the body as a complex system. Journal of Evaluation in Clinical Practice, 15(4), 770–775.PubMedCrossRef
25.
Borghmans, F. (2021). The radical and requisite openness of viable systems: Implications for healthcare strategy and practice. Journal of Evaluation in Clinical Practice, 28(2), 324–331.PubMedCrossRef
26.
Martin, C. M., Vogel, C., Grady, D., Zarabzadeh, A., Hederman, L., Kellett, J., et al. (2012). Implementation of complex adaptive chronic care: The patient journey record system (PaJR). Journal of Evaluation in Clinical Practice, 18(6), 1226–1234.PubMedCrossRef
27.
Sturmberg, J. P., Getz, L. O., Stange, K. C., Upshur, R. E. G., & Mercer, S. W. (2021). Beyond multimorbidity: What can we learn from complexity science? Journal of Evaluation in Clinical Practice, 27(5), 1187–1193.PubMedCrossRef
28.
Ljungholm, L., Klinga, C., Edin-Liljegren, A., & Ekstedt, M. (2022). What matters in care continuity on the chronic care trajectory for patients and family carers? A conceptual model. Journal of Clinical Nursing, 31(9–10), 1327–1338.PubMedCrossRef
29.
Hall, J. (2015). Australian health care: The challenge of reform in a fragmented system. The New England Journal of Medicine, 373(6), 493–497.PubMedCrossRef
30.
Bird, S., Kurowski, W., & Dickman, G. (2005). Evaluating a model of service integration for older people with complex health needs. Evaluation Journal of Australasi, 4(1–2), 34–41.CrossRef
31.
Bell, S. P., & Saraf, A. (2014). Risk stratification in very old adults: How to best gauge risk as the basis of management choices for patients aged over 80. Progress in cardiovascular diseases, 57(2), 197–203.PubMedPubMedCentralCrossRef
32.
Scambler, G. (2009). Health-related stigma. Sociol Health and Illness, 31(3), 441–455.CrossRef
33.
Moran, D. (2002). Editor’s introduction. In D. Moran & T. Mooney (Eds.), The Phenomenology Reader (pp. 1–26). Routledge.
34.
Husserl, E. (1931). Ideas: General introduction to pure phenomenology. George Allen and Unwin Ltd.
35.
Heidegger, M. (1962). Being and time. Harper & row.
36.
Landes, D. A. (2012). Translator’s introduction. In D. A. Landes (Ed.), Phenomenology of perception. p. xxx-li: Oxon.
37.
Smith, D. W. (2018). Phenomenology. In E. N. Zalta (Ed.), The stanford encyclopedia of philosophy. Metaphysics Research Lab, Stanford University.
38.
Manson, S. M. (2001). Simplifying complexity: A review of complexity theory. Geoforum, 32(3), 405–414.CrossRef
39.
Ashby, W., & Goldstein, J. (2011). Variety, constraint, and the law of requisite variety. Emergence: Complexity and Organization, 13(1/2), 190–207.
40.
Beer, S. (1984). The viable system model: Its provenance, development, methodology, and pathology. The Journal of the Operational Research Society, 35(1), 7–25.CrossRef
41.
Byrne, D. S., & Callaghan, G. (2014). Complexity theory and the social sciences: The state of the art. First edition G. Callaghan (Ed.), Routledge.
42.
Cilliers, P. (2013). Understanding complex systems. In J. P. Sturmberg & C. M. Martin (Eds.), Handbook of systems and complexity in health (pp. 27–38). Springer.CrossRef
43.
Petrick, E. R. (2020). Building the black box: Cyberneticians and complex systems. Science, Technology, & Human Values, 45(4), 575–595.CrossRef
44.
Morçöl, G. (2005). Phenomenology of complexity theory and cognitive science: Implications for developing an embodied knowledge of public administration and policy. Administrative theory and praxis, 27(1), 1–23.CrossRef
45.
Dávila, X. Y., & Romesín, H. M. (2013). Systemic and meta-systemic laws. Interactions, 20(3), 76.CrossRef
46.
Maturana, H., Dávila Yáñez, X., & Ramírez, M. S. (2015). Cultural-biology: Systemic consequences of our evolutionary natural drift as molecular autopoietic systems. Foundations of Science, 21(4), 631–678.CrossRef
47.
Varela, F. J., Thompson, E., & Rosch, E. (2017). The embodied mind, Revised Edition: Cognitive science and human experience. 2nd ed. MIT Press.
48.
Kincheloe, J. L. (2001). Describing the bricolage: Conceptualizing a new rigor in qualitative research. Qualitative inquiry, 7(6), 679–692.CrossRef
49.
Vagle, M. (2018). Crafting phenomenological research 2ed (pp. 1–180). Routledge.CrossRef
50.
Vandermause, R. K., & Fleming, S. E. (2011). Philosophical hermeneutic interviewing. International Journal of Qualitative Methods, 10(4), 367–377.CrossRef
51.
Silverman, D. (2010). Doing qualitative research: A practical handbook (3rd ed.). SAGE.
52.
Van Manen, M. (2016). Researching lived experience: Human science for an action sensitive pedagogy. Second edition. Routledge.
53.
Levinas, E. (1969). Totality and infinity. Duquesne University Press.
54.
Mugerauer, R. (2010). Anatomy of life and well-being: A framework for the contributions of phenomenology and complexity theory. International Journal of Qualitative Studies on Health and Well-being, 5(2), 5097–5112.CrossRef
55.
Gergel, T. L. (2012). Medicine and the individual: Is phenomenology the answer? Journal of Evaluation in Clinical Practice, 18(5), 1102–1109.PubMedCrossRef
56.
Buja, L. M. (2019). Medical education today: All that glitters is not gold. BMC Medical Education, 19(1), 1–11.CrossRef
57.
Engel, G. L. (1982). The biopsychosocial model and medical education: Who are to be the teachers? New England Journal of Medicine, 306(13), 802–805.PubMedCrossRef
58.
Tretter, F., & Löffler-Stastka, H. (2019). Medical knowledge integration and “systems medicine”: Needs, ambitions, limitations and options. Medical Hypotheses, 133, 109386.PubMedCrossRef
59.
Sturmberg, J. P. (2019). Evidence-based medicine: Not a panacea for the problems of a complex adaptive world. Journal of Evaluation in Clinical Practice, 25(5), 706–716.PubMedCrossRef
60.
Engel, G. L. (1982). Sounding board. The biopsychosocial model and medical education. Who are to be the teachers? The New England Journal of Medicine, 306(13), 802–805.PubMedCrossRef
61.
Baker, R., Freeman, G. K., Freeman, G. K., Bankart, M. J., & Nockels, K. H. (2020). Primary medical care continuity and patient mortality: A systematic review. British Journal of General Practice, 70(698), E600–E611.CrossRef
62.
Bevan, H. (2012). A trilogy for healthcare improvement: Quality, productivity, and innovation. In P. Spurgeon, R. J. Bourke, & C. L. Cooper (Eds.), The innovation imperative in healthcare organizations (pp. 37–60). Northampton Edward Elgar Publishers Ltd.
63.
Chan, B., Hulen, E., Edwards, S., Mitchell, M., Nicolaidis, C., & Saha, S. (2019). “It’s like riding out the chaos”: Caring for socially complex patients in an ambulatory intensive care unit (A-ICU). Annals of Family Medicine, 17(6), 495–501.PubMedPubMedCentralCrossRef
64.
Byrne, A. L., Hegney, D., Harvey, C., Baldwin, A., Willis, E., Heard, D., et al. (2020). Exploring the nurse navigator role: A thematic analysis. Journal of Nursing Management, 28(4), 814–821.PubMedCrossRef
65.
Peteraf, M., Di Stefano, G., & Verona, G. (2013). The elephant in the room of dynamic capabilities: Bringing two diverging conversations together. Strategic Management Journal, 34(12), 1389–1410.CrossRef
66.
Nonaka, I., Toyama, R., & Konno, N. (2000). SECI, Ba and leadership: A unified model of dynamic knowledge creation. Long Range Planning, 33(1), 5–34.CrossRef
67.
Wainright, C. F., & Raffenaud, A. (2015). Communication. In M. D. Fottler, D. Malvey, & D. J. Slovensky (Eds.), Handbook of healthcare management. Edward Elgar Publishing Limited.
68.
69.
Coleman, K., Mattke, S., Perrault, P. J., & Wagner, E. H. (2009). Untangling practice redesign from disease management: How do we best care for the chronically ill? Annual Review of Public Health, 30(1), 385–408.PubMedCrossRef
70.
Howell, M. D., & Stevens, J. P. (2020). Understanding healthcare delivery science. McGraw-Hill Education.
71.
Foucault, M. (1994). The birth of the clinic. Vintage Books.
72.
The Royal Australian College of General Practitioners. (2012) . Position statement: Advance care planning should be incorporated into routine general practice [press release].
73.
Department of Health and Human Services. (2011). Hospital Admission Risk Program Monitoring and Evaluation Framework.
74.
75.
Australian Health Minister’s Advisory Council. (2020). National strategic framework for chronic conditions. Canberra
76.
Gaines, A. D. (2017). Sociocultural construction of medical knowledge. International Encyclopedia of Public Health. pp. 612–616.
77.
Majnarić, L. T., Babič, F., O’sullivan, S., & Holzinger, A. (2021). AI and big data in healthcare: Towards a more comprehensive research framework for multimorbidity. Journal of Clinical Medicine, 10(4), 1–23.CrossRef
78.
Bodeheimer, T., Wagner, E. H., & Grumbach, K. (2002). Improving primary care for patients with chronic illness. Journal of the American Medical Association, 288(14), 1775–1779.CrossRef
79.
Harrison, C., & Siriwardena, A. N. (2018). Multimorbidity. Australian Journal of General Practice, 47(1–2), 7.
80.
Petrillo, L. A., & Ritchie, C. S. (2016). The challenges of symptom management for patients with multimorbidity in research and practice: A thematic review. Progress in Palliative Care, 24(5), 262–267.PubMedPubMedCentralCrossRef
81.
Garcia-Goni, M., McKiernan, P., & Paolucci, F. (2016). Pathways towards health care systems with a chronic care focus: Beyond the 4 walls. In H. M. Albach, A. Pinkwart, & W. von Eiff (Eds.), Boundaryless hospital: Rethink and redefine health care management (pp. 59–80). Springer.CrossRef
82.
Harrison, S. L., Robertson, N., Apps, L. C., Steiner, M., Morgan, M. D., & Singh, S. J. (2015). “We are not worthy”: Understanding why patients decline pulmonary rehabilitation following an acute exacerbation of COPD. Disability and Rehabilitation, 37(9), 750–756.PubMedCrossRef
83.
Barreca, S., & Wilkins, S. (2008). Experiences of nurses working in a stroke rehabilitation unit. Journal of Advanced Nursing, 63(1), 36–44.PubMedCrossRef
84.
Oliver, D. (2008). ‘Acopia’ and ‘social admission’ are not diagnoses: Why older people deserve better. Journal of the Royal Society of Medicine, 101(4), 168–174.PubMedPubMedCentralCrossRef
85.
Ansari, Z., Haider, S. I., Ansari, H., de Gooyer, T., & Sindall, C. (2012). Patient characteristics associated with hospitalisations for ambulatory care sensitive conditions in Victoria, Australia. BMC Health Services Research, 12, 1–12.CrossRef
86.
Manderson, L., & Warren, N. (2016). “Just one thing after another”: Recursive cascades and chronic conditions. Medical Anthropology Quarterly, 30(4), 479–497.PubMedCrossRef
87.
Harvey, D. L., & Reed, M. H. (1994). The evolution of dissipative social systems. Journal of Social and Evolutionary Systems, 17(4), 371–411.CrossRef
88.
Pearl, R., & Madvig, P. (2020). Managing the most expensive patients. Harvard Business Review, 98(1), 68–75.
89.
Harrison, C., Henderson, J., Miller, G., & Britt, H. (2016). The prevalence of complex multimorbidity in Australia. Australian and New Zealand Journal of public health, 40(3), 239–244.PubMedCrossRef
90.
Juul-Larsen, H. G., Christensen, L. D., Bandholm, T., Andersen, O., Kallemose, T., Jørgensen, L. M., et al. (2020). Patterns of multimorbidity and differences in healthcare utilization and complexity among acutely hospitalized medical patients (≥ 65 years): A latent class approach. Clinical Epidemiology, 12, 245–259.PubMedPubMedCentralCrossRef
91.
Singer, M., Bulled, N., Ostrach, B., & Mendenhall, E. (2017). Syndemics and the biosocial conception of health. Lancet, 389(10072), 941–950.PubMedCrossRef
92.
Franklin, M., Lewis, S., Willis, K., Bourke-Taylor, H., & Smith, L. (2018). Patients’ and healthcare professionals’ perceptions of self-management support interactions: Systematic review and qualitative synthesis. Chronic Illness, 14(2), 79–103.PubMedCrossRef
93.
Hörberg, U., Galvin, K., Ekebergh, M., & Ozolins, L. L. (2019). Using lifeworld philosophy in education to intertwine caring and learning: An illustration of ways of learning how to care. Reflective Practice, 20(1), 56–69.CrossRef
94.
Weick, K. E., Sutcliffe, K. M., & Obstfeld, D. (2005). Organizing and the process of sensemaking. Organization Science, 16(4), 409–421.CrossRef
95.
Foucault, M. (1970). The Order of Things: An Archaeology of the human sciences .In: R. D. Laing (Ed.). Vintage Books.
96.
Rovesti, M., Fioranelli, M., Petrelli, P., Satolli, F., Roccia, M. G., Gianfaldoni, S., et al. (2018). Health and illness in history, science and society. Open Access Macedonian Journal of Medical Sciences, 6(1), 163–165.PubMedPubMedCentralCrossRef
97.
Barker, R. A. (2001). The nature of leadership. Human relations, 54(4), 469–494.CrossRef
98.
Dahlberg, H., & Dahlberg, K. (2003). To not make definite what is indefinite: A phenomenological analysis of perception and its epistemological consequences in human science research. The Humanistic Psychologist, 31(4), 34–50.CrossRef
99.
Pype, P., Mertens, F., Helewaut, F., & Krystallidou, D. (2018). Healthcare teams as complex adaptive systems: Understanding team behaviour through team members’ perception of interpersonal interaction. BMC Health Services Research, 18(1), 570.PubMedPubMedCentralCrossRef
Metadata
Title
The Lifeworld of the Complex Care Hospital Doctor: A Complex Adaptive Phenomenological Study
Authors
Felice Borghmans
Stella Laletas
Harvey Newnham
Venesser Fernandes
Publication date
19-01-2024
Publisher
Springer US
Published in
Health Care Analysis
Print ISSN: 1065-3058
Electronic ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-023-00474-8