Utilizing the Cynefin Framework Within a Healthcare Setting

The healthcare field is something I’ve been interested in since I was a little girl. When I first started thinking about what I wanted to be when I grew up, I told everyone I was going to be a pediatric oncologist. I wanted to work with children and I wanted a complex working environment, never wanted to settle for anything dull or monotonous in day-to-day activities.

As I grew up, that dream evolved into nursing school, and now into healthcare administration. One thing that hasn’t changed is my need to work in an environment that isn’t monotonous. I’ve just learned to utilize my skills in a different way, and I know that I enjoy taking disorder and turning it into a functional system.

One of the more unique ways I’ve found to create boundaries and take the everyday disorder of healthcare and produce as clearly defined roles as possible is through the Cynefin Framework, pictured below.

Used with permission from Dave Snowden of Cognitive Edge
  • *It’s important to note that this method can be used for any problem within any specialty, but for the purposes of this blog, we are using the healthcare setting.

As you can see from the image, the Cynefin Framework splits into four parts, Complex, Complicated, Chaotic, and Obvious. We will break each of these down and explain how they can apply within the healthcare setting and broken down even further to accommodate a specific unit within a hospital or clinic.

Obvious

The obvious is something that is very blatant and simple to fix. For example, if someone comes into the emergency room with a broken arm, it’s simple to analyze and fix the problem at hand. A simple fracture doesn’t have many complications, and there is one specific way to approach and fix the problem.

In an administration setting, one may be faced with the problem of approving timecards. This is done every two weeks and requires administration to log in to the appropriate applications and review and approve timecards for those who work in their department. Simple problem, simple solution.

Complex

While complicated and complex are very similar in nature, complex evolves over time and requires probing to figure out the base of a problem. One way to illustrate this is with diabetes. While those who are diabetic have a management plan for treating their day-to-day symptoms, the burden of maintaining healthy levels falls on the individual. A care plan can be written, but following it is up to the patient.

Additionally, general practitioners approach almost every patient with a complex mindset. They have to attempt to get to the root of problems, but they cannot order blood tests for everything and much of the treatment plans at home rely on the patient to follow instructions. This creates a complex back-and-forth of trying to find solutions to create a “better” outcome, but may never achieve a perfect one.

Complicated

Those who work as a specialist often work in a complicated environment that involves research and development of a plan. It’s’ an ongoing progress to find a best-options outcome, but has an obvious, up-front issue.

A complicated issue within the healthcare system may look like someone being diagnosed with cancer and seeking treatment. This patient requires expert analysis and knowledge in order to diagnose and create a plan of care.

Chaos

Finally, there’s chaos. One of the best examples of chaos in the healthcare system has been illustrated throughout the COVID-19 pandemic. Emergency plans are in place for situations such as this, but they do not adequately predict what healthcare workers may face once the situation arises.

Frontline workers had to be determine need for those who required life-saving oxygen and ventilators, nurses and doctors were without PPE, staffing was low, administration was struggling to keep everyone supplied with what they needed, and patients were flooding in the doors and required triaging by those who were receiving and treating them.

Chaos is unpredictable, but prevention can be in place. However, even with the best plans in place, it may not cover all situations that may arise. Thinking about it as a trauma situation works best: attend to those who are dying first and then move down the line until you reach those with minor bumps, bruises, and scrapes. Peace and ease will be restored, but it may take time and *will* take teamwork.

While there are several other methods to acknowledge and solve the complications that arise within a healthcare environment, the Cynefin Framework can be used by those in administration within a healthcare system to take apart difficult decisions and solve them by analyzing the problem from various angles and perspectives. Healthcare is full of ever-changing situations, and the Cynefin Framework defines the boundaries between simple, chaotic, complex, and complicated and prepares administration for all scenarios.

By applying the Cynefin Framework to specific departments within healthcare, it allows for simplicity in addressing concerns and knowing the best steps to take moving forward to stabilize incoming concerns, and The Cynefin Framework gives an appropriate method to use in the appropriate situation at the appropriate time on a day-to-day basis in healthcare administration.

Resources:

Gray, B. (2017, December 20). The Cynefin Framework: Applying an Understanding of Complexity to Medicine. Journal of Primary Healthcare, 9(4), 258–261. https://doi.org/10.1071/HC17002

Van Beurden, E. K., Kia, A. M., Zask, A., Dietrich, U., & Rose, L. (2011, November 29). Making sense in a complex landscape: how the Cynefin Framework from Complex Adaptive Systems Theory can inform health promotion practice. Health Promotion International, 28(1), 73–83. https://doi.org/10.1093/heapro/dar089

Married mother of three girls working towards finding solutions and strategies to apply to healthcare administration while pursuing my MBA.

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