RESUMEN
RATIONALE, AIMS AND OBJECTIVES: Person-centred health care is prominent in international health care reforms. A shift to understanding and improving personal care at the point of delivery has generated debates about the nature of the person-centred research agenda. This paper purviews research paradigms that influence current person-centred research approaches and traditions that influence knowledge foundations in the field. It presents a synthesis of the emergent approaches and methodologies and highlights gaps between static academic research and the increasing accessibility of evaluation, informatics and big data from health information systems. FINDINGS: Paradigms in health services research range from theoretical to atheoretical, including positivist, interpretive, postmodern and pragmatic. Interpretivist (subjective) and positivist (objectivist) paradigms have been historically polarized. Yet, integrative and pragmatic approaches have emerged. Nevertheless, there is a tendency to reductionism, and to reduce personal experiences to metrics in the positivist paradigm. Integrating personalized information into clinical systems is increasingly driven by the pervasive health information technology, which raises many issues about the asymmetry and uncertainty in the flow of information to support personal health journeys. The flux and uncertainty of knowledge between and within paradigmatic or pragmatic approaches highlights the uncertainty and the 'unorder and disorder' in what is known and what it means. Transdisciplinary, complex adaptive systems theory with multi-ontology sense making provides an overarching framework for making sense of the complex dynamics in research progress. CONCLUSION: A major challenge to current research paradigms is focus on the individualizing of care and enhancing experiences of persons in health settings. There is an urgent need for person-centred research to address this complex process. A transdisciplinary and complex systems approach provides a sense-making framework.
Asunto(s)
Investigación sobre Servicios de Salud/organización & administración , Atención Dirigida al Paciente/organización & administración , Medicina de Precisión/métodos , Teoría de Sistemas , Femenino , Predicción , Humanos , Masculino , Medicina de Precisión/tendenciasRESUMEN
OBJECTIVE: To demonstrate the usefulness of theoretical framework in the analysis of complex policy issues related to primary health care (PHC) workforce for informed policy decisions and planning. APPROACH: The study links complexity theories with political economy and connects them to theoretical work on structure and agency to guide the analysis of the PHC workforce issues and their related ramifications. This theoretical framework guides as well the literature review. With this approach, it is possible to ascertain and disturb the linear thinking which tends to surround questions or issues related to PHC human resources. CONCLUSION: Workforce changes occur in a multifaceted structure of norms and values as well as within the policies, regulations and traditions, the ruling relations² between professions, and between employers and employees. Similarly, changes in the population characteristics and in the political economy not only affect the demand for care but also have implications for the type of staff that can be hired.
Asunto(s)
Personal de Salud , Comunicación Interdisciplinaria , Política Organizacional , Atención Primaria de Salud , Humanos , Modelos Teóricos , Formulación de PolíticasRESUMEN
RATIONALE: The outputs from vastly expanding health research and knowledge industry with a broadening range of approaches to the synthesis of knowledge provide an impetus to develop complex science and theory-informed knowledge management in health care. Aims To stimulate debate in order to assist health care decision makers to move beyond framing certainty and evidence in purely reductionist terms. OBJECTIVES: To locate health, health care and health knowledge systems research using a complex adaptive systems theory framework. Methods An conceptual analysis of pervading methodologies and ways of knowing in health systems research to elucidate a framework in order to inform health care decision making. FINDINGS: A living Tree of (Research) Knowledge is proposed, with theoretic and operational frameworks. Branches of the tree are linked to differing evolutionary and developmental processes in order to assist researchers in the ongoing self-organizing of taxonomies, multiple methods and types of knowledge, recognizing the 'lived', developing and adaptive nature of our understandings. CONCLUSIONS: It is challenging to determine whither the directions 'knowledge' creation and management should take in complex health systems, beyond a total reliance on reductionism. Yet quality will wither, if knowledge does not pertain to real world contexts.
Asunto(s)
Atención a la Salud/organización & administración , Investigación sobre Servicios de Salud , Modelos TeóricosRESUMEN
OBJECTIVE: To disentangle the concepts of primary health care and primary care as well as their conceptual and empirical ramifications for progressive transformation. METHODS: over 400 international and interdisciplinary abstracts and papers with 96 annotated bibliography abstracts of literature across multiple dimensions relating to the knowledge base around mechanisms in PHC development were reviewed. The text is confronted with the reality, as it exists in the field and makes the case for complexity perspectives to assess this phenomenon in its context. CONCLUSION: PHC complexity is an important analytical tool to interrogate the ways in which this phenomenon is socially constructed as well as in the matrices in which it is embedded. It is also a potent analytical tool to assist in the deconstruction of prevalent linear thinking built around PHC as a whole.