Complex Adaptive Chronic Care Standardized Chronic Care Model
Core Values and Agency
Focus on individual health and local systems Bottom up improvement with local and central accountability Key agents: individual patients and clinicians, self-organizing healthcare networks and partnerships Core value is individualized patient care and community health Focus on “control” of individual disease Top down improvement with protocols and incentives Key agents: policy makers, data analyzers, funders, administrators, providers Core value is evidence-based disease management
Structure and Processes
Complex dynamic multi-layered systems Bottom up: self-organization of interacting agents forming evolving structures shaped by internal levers or constraints, or local contextual interactions Discreet intervention protocols, best practices, static notions of quality Top down: policy leverage and financial incentives used to manage system performance around external system levers and constraints. Linear structures and processes may or may not adjust for local context and systems
Outcomes
Empowerment emerges from complex environments Adaptability, self-organization, and empowerment enable the emergence of improved health outcomes Success comes from clarity of accountability, “obsessive” tracking and action on key performance indicators, and process-based teamwork