PDF(Pubmed)
Abstract：
BACKGROUND: Primary care is often described as slow to change. But conceptualized through complexity theory, primary care is continually changing in unpredictable, non-linear ways through self-organization processes. Self-organization has proven hard to study directly. We aimed to develop a methodology to study self-organization and describe how a primary care clinic self-organizes over time.
METHODS: We completed a virtual case study of an urban primary care clinic from May-Nov 2021, applying methodological insights from actor-network theory to examine the complexity theory concept of self-organization. We chose to focus our attention on self-organization activities that alter organizational routines. Data included fieldnotes of observed team meetings, document collection, interviews with clinic members, and notes from brief weekly discussions to detect actions to change clinical and administrative routines. Adapting schema analysis, we described changes to different organizational routines chronologically, then explored intersecting changes. We sought feedback on results from the participating clinic.
RESULTS: Re-establishing equilibrium remained challenging well into the COVID-19 pandemic. The primary care clinic continued to self-organize in response to changing health policies, unintended consequences of earlier adaptations, staff changes, and clinical care initiatives. Physical space, technologies, external and internal policies, guidelines, and clinic members all influenced self-organization. Changing one created ripple effects, sometimes generating new, unanticipated problems. Member checking confirmed we captured most of the changes to organizational routines during the case study period.
CONCLUSIONS: Through insights from actor-network theory, applied to studying actions taken that alter organizational routines, it is possible to operationalize the theoretical construct of self-organization. Our methodology illuminates the primary care clinic as a continually changing entity with co-existing and intersecting processes of self-organization in response to varied change pressures.
METHODS: We completed a virtual case study of an urban primary care clinic from May-Nov 2021, applying methodological insights from actor-network theory to examine the complexity theory concept of self-organization. We chose to focus our attention on self-organization activities that alter organizational routines. Data included fieldnotes of observed team meetings, document collection, interviews with clinic members, and notes from brief weekly discussions to detect actions to change clinical and administrative routines. Adapting schema analysis, we described changes to different organizational routines chronologically, then explored intersecting changes. We sought feedback on results from the participating clinic.
RESULTS: Re-establishing equilibrium remained challenging well into the COVID-19 pandemic. The primary care clinic continued to self-organize in response to changing health policies, unintended consequences of earlier adaptations, staff changes, and clinical care initiatives. Physical space, technologies, external and internal policies, guidelines, and clinic members all influenced self-organization. Changing one created ripple effects, sometimes generating new, unanticipated problems. Member checking confirmed we captured most of the changes to organizational routines during the case study period.
CONCLUSIONS: Through insights from actor-network theory, applied to studying actions taken that alter organizational routines, it is possible to operationalize the theoretical construct of self-organization. Our methodology illuminates the primary care clinic as a continually changing entity with co-existing and intersecting processes of self-organization in response to varied change pressures.
摘要：
背景：初级保健通常被描述为变化缓慢。但是通过复杂性理论概念化，初级保健在不可预测的情况下不断变化，通过自组织过程的非线性方式。事实证明，自组织很难直接研究。我们旨在开发一种方法来研究自组织，并描述初级保健诊所如何随着时间的推移自我组织。
方法：我们从2021年5月至11月完成了一个城市初级保健诊所的虚拟案例研究，应用参与者网络理论的方法论见解来研究自组织的复杂性理论概念。我们选择将注意力集中在改变组织惯例的自组织活动上。数据包括观察到的团队会议的现场笔记，文档集合,采访诊所成员，以及每周简短讨论的笔记，以检测改变临床和管理程序的措施。适应模式分析，我们按时间顺序描述了不同组织例程的变化，然后探索交叉变化。我们从参与的诊所寻求对结果的反馈。
结果：在COVID-19大流行中，重新建立平衡仍然具有挑战性。初级保健诊所继续自我组织，以应对不断变化的卫生政策，早期适应的意外后果，工作人员变动,和临床护理计划。物理空间,技术,外部和内部政策，指导方针,和诊所成员都影响了自我组织。改变一个创造的涟漪效果，有时会产生新的，意想不到的问题。成员检查证实，在案例研究期间，我们捕获了组织例程的大部分更改。
结论：通过参与者网络理论的见解，适用于研究改变组织惯例所采取的行动，有可能将自组织的理论建构付诸实施。我们的方法阐明了初级保健诊所作为一个不断变化的实体，具有共存和交叉的自组织过程，以应对变化的压力。
方法：我们从2021年5月至11月完成了一个城市初级保健诊所的虚拟案例研究，应用参与者网络理论的方法论见解来研究自组织的复杂性理论概念。我们选择将注意力集中在改变组织惯例的自组织活动上。数据包括观察到的团队会议的现场笔记，文档集合,采访诊所成员，以及每周简短讨论的笔记，以检测改变临床和管理程序的措施。适应模式分析，我们按时间顺序描述了不同组织例程的变化，然后探索交叉变化。我们从参与的诊所寻求对结果的反馈。
结果：在COVID-19大流行中，重新建立平衡仍然具有挑战性。初级保健诊所继续自我组织，以应对不断变化的卫生政策，早期适应的意外后果，工作人员变动,和临床护理计划。物理空间,技术,外部和内部政策，指导方针,和诊所成员都影响了自我组织。改变一个创造的涟漪效果，有时会产生新的，意想不到的问题。成员检查证实，在案例研究期间，我们捕获了组织例程的大部分更改。
结论：通过参与者网络理论的见解，适用于研究改变组织惯例所采取的行动，有可能将自组织的理论建构付诸实施。我们的方法阐明了初级保健诊所作为一个不断变化的实体，具有共存和交叉的自组织过程，以应对变化的压力。
