Understanding clinical complexity in organ and organizational systems: Challenges local and global

J Eval Clin Pract. 2024 Mar;30(2):316-329. doi: 10.1111/jep.13886. Epub 2023 Jun 19.

Abstract

Introduction: Complexity in healthcare systems has been arbitrarily defined as tasks or systems ranging from complicated to intractable, with a general view of these not being 'simple'. Complexity in healthcare systems in first-world countries has been well elucidated, however, data from third-world countries is still scant. MATERIALS AND METHODS: We present four cases each from three different organ systems-chronic kidney disease, alcohol use disorder, and heart failure-in the backdrop of our healthcare organization. We present our analysis of the complexities faced clinically and, in our local healthcare system which led to these events.

Results: Analysis of these cases showed that patients with chronic kidney disease had vertebral-spinal pathologies due to poor infection control measures during haemodialysis. All these patients were young with a long history of secondary hypertension. In patients with alcohol use disorder, a common theme of how government regulations and peer pressure promote alcohol use is analysed. In the four patients with unexplained heart failure, vascular health is viewed as a fractal dimension and the various factors affecting vascular health are elaborated.

Conclusion: Complexities exist clinically in making a diagnosis, and organizationally, in the variables and nodes dictating patient outcomes. Clinical complexities cannot be simplified but have to be navigated in an optimized way to improve clinical outcomes.

Keywords: alcohol use disorder; chronic kidney disease and heart failure; clinical complexity; healthcare systems; neural network; spondylodiscitis.

MeSH terms

  • Alcoholism*
  • Delivery of Health Care
  • Heart Failure*
  • Humans
  • Renal Dialysis
  • Renal Insufficiency, Chronic*