A Brief Introduction to Systems

Abstract

The VA began nationwide conversion to a medical home system called Patient Aligned Care Teams (PACTs) in 2010. Primary care clinics were tasked with improving access, implementing team-based practice redesign, and improving clinical outcomes. For many clinics, these concepts represented a huge shift from their current practice culture. In addition, the resources promised for the conversion were slow in coming, while the improvement expectations were nearly immediate. In 2011, the complexity of interprofessional education was added, threatening to require overwhelming cultural change. And yet in many ways the Boise VA Center of Excellence succeeded. The VA is now trying to understand what factors explain the wide range of success with PACT adoption across their systems. In this book, we are proposing that a systems viewpoint—and a complex adaptive systems approach in particular—can be helpful for aligning expectations between stakeholders, understanding outcomes, facilitating change, and explaining the performance variability between clinics.