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We discuss the impact of complexity science on the design and management of health care organizations over the past decade. We provide an overview of complexity science issues and their impact on thinking about health care systems, particularly with the rising importance of information systems. We also present a complexity science perspective on current issues in today’s health care organizations and suggest ways that this perspective might help in approaching these issues.

We review selected research, focusing on work in which we participated, to identify specific examples of applications of complexity science. We then take a look at information systems in health care organizations from a complexity viewpoint.

Complexity science is a fundamentally different way of understanding nature and has influenced the thinking of scholars and practitioners as they have attempted to understand health care organizations. Many scholars study health care organizations as complex adaptive systems and through this perspective develop new management strategies. Most important, perhaps, is the understanding that attention to relationships and interdependencies is critical for developing effective management strategies.

Increased understanding of complexity science can enhance the ability of researchers and practitioners to develop new ways of understanding and improving health care organizations.

This analysis opens new vistas for scholars and practitioners attempting to understand health care organizations as complex adaptive systems. The analysis holds value for those already familiar with this approach as well as those who may not be as familiar.

This study aims to explore the structural aspects (roles, responsibilities and reporting) of dyad leadership in one health-care organization (HCO).

The perceptions of 32 leaders (17 physician leaders and 15 dyad co-leaders) in formal leadership positions (six first-level with formal authority limited to teams or divisions, 23 middle-level with wider departmental or program responsibility and three senior-level with institution-wide authority) were obtained through focus groups and surveys. In addition, five senior leaders were interviewed. Descriptive statistics was used for quantitative data, and qualitative data were analyzed for themes by coding and categorization.

There are a large number of shared responsibilities in the hybrid model, as most activities in HCOs bridge administrative and professional spheres. These span the leadership (e.g. global performance and quality improvement) and management (e.g. human resources, budgets and education delivery) domains. The individual responsibilities, except for staff and physician engagement are in the management domain (e.g. operations and patient care). Both partners are responsible for joint decision-making, projecting a united front and joint reporting through a quadrat format. The mutual relationship and joint accountability are key characteristics and are critical to addressing potential conflicts and contradictions and achieving coherence.

Clarity of role will assist development of standardized job descriptions and required competencies, recruitment and leadership development.

This is an original empirical study presenting an integrated view of dyad leaders and senior leadership, meaningful expansion of shared responsibilities including academic functions and developing mutual relationship and emphasizing the central role of stability generating management functions.

The purpose of this paper is to discuss the value of post‐modern psychosocial approaches to studying knowledge and practice construction in health care organizations and settings (HCO&S) and the increasing ability of qualitative research to furnish a deeper, more ecological, and more usable understanding of the social construction of health knowledge and practices.

The argument proposed in the paper is based on a critical literature review conducted on the Psychinfo, Scopus, PubMed and Web of Science databases.

Recent years have seen cultural changes in the values and goals of healthcare interventions that are deeply reconfiguring HCO&S. These changes are reframing HCO&S action and are highlighting the importance of understanding and managing not only the “expert context” but also the “lay contexts” of healthcare interventions. In an attempt to deal with these emergent changes (and challenges), HCO&S are taking advantage of new insights matured in the post‐modern turn of organizational analysis. In this frame, qualitative research proves suitable for connecting HCO&S needs and priorities with the new post‐modern paradigm of knowledge‐ and practice‐sharing in organizations.

The paper demonstrates the value of qualitative research in the analysis of HCO&S and casts light on the new research trends and new technical‐methodological options arising in this field.

The relentless onslaught of computers and communications technologies has recently descended on the healthcare industry. Fortunately, however, the utilization of technologies in healthcare delivery and administration could not be timelier because of the need to control escalating health costs. While the proliferation of information and communication technologies in healthcare, referred to as health management information systems (HMIS), is certainly long overdue in healthcare organizations (HCOs), it is important to recognize and be prepared for the vulnerabilities of these technologies to natural, technological, and man‐made disasters. This paper describes how HCOs have justifiably become dependent on HMIS and how these organizations may proactively plan for disasters which can impact on HMIS. A phased approach, referred to as the disaster recovery and business continuity (DRBC) planning model, is presented in the paper as an approach to develop and implement business continuity plans in HCOs.

The aim of this paper is to investigate the role that halal certification organisations (HCOs) play in the UK in assuring quality in halal cosmetics.

The study evaluates whether halal certification assures the quality of halal cosmetic products. This research evaluated the quality assurance systems of major UK HCOs, using a hypothetical product as a test vehicle. The investigation considered whether these organisations differ in their definition of “halal” and “halal cosmetics” and also considered how effectively their certification signals quality assurance.

The study indicated that there is a failure to adopt holistic halal terminology which implies that within the UK halal cosmetics industry, manufacturers may not be working within agreed standards for halal product integrity.

This study focussed on UK certification for halal cosmetics by three HCOs and disregarded other forms of halal businesses. The literature review is based solely on literature available in the English language. The study lacks generalisability, as only one hypothetical product was tested; therefore, it was not possible to reach an understanding of all the costs involved in UK HCO certification.

This study undertook a comprehensive literature review on halal certification to produce a comparison of halal sanctioning laws, certification processes and the level of supply chain verification by UK HCOs.

This study adds value to the knowledge on UK halal certification.

Annual influenza epidemics cause great losses in both human and financial terms. The purpose of this paper is to propose a model for optimizing a large-scale influenza vaccination program (VP). The goal is to minimize the total cost of the vaccination supply chain while guaranteeing a sufficiently high level of population protection. From a practical point of view, the analysis returns the number of shipments and the quantity of vaccines in each periodic shipment that should be delivered from the manufacturers to the distribution center (DC), from the DC to the clinics, and from the clinics to each sub-group of customers during the vaccination season.

A mixed-integer programming optimization model is developed to describe the problem for a supply chain consisting of vaccine manufacturers, the healthcare organization (HCO) (comprising the DC and clinics), and the population being vaccinated (customers). The model suggests a VP that implemented by a nation-wide HCO.

The benefits of the proposed approach are shown to be particularly salient in cases of limited resources, as the model distributes demand backlogs in an efficient manner, prioritizing high-risk sub-groups of the population over lower-risk sub-groups. In particular, the authors show a reduction in direct medical burden of consumers, such as the need for doctors, hospitalization resources, and reduction of indirect, non-medical burden, such as loss of workdays.

Drawing from the extended enterprise paradigm, and, in particular, taking consumer benefits into account, the authors suggest an operational-strategic model that creates impressive added value in a highly constrained supply chain. The model constitutes a powerful decision tool for the deployment of large-scale seasonal products, and its implementation can yield multiple benefits for various consumer segments.

The model proposed herein constitutes a decision support tool comprising operational-tactical and tactical-strategic perspectives, which logistics managers can utilize to create an enterprise-oriented plan that takes into account medical and non-medical costs.

The primary objective of this article is to explore what senior managers think they should be doing to improve communication in their organization, what they actually do in communication terms, and the high work load which senior managers undertake.

This understanding is advanced by using the results of a communication audit which was conducted in a major European health‐care organization (HCO) undergoing significant internal re‐organization. A communication audit can be defined as: “a comprehensive and thorough study of communication philosophy, concepts, structure, flow and practice within an organisation”. It assists managers by “providing an objective picture of what is happening compared with what senior executives think (or have been told) is happening”.

First, senior managers who over‐work are even less likely to have the time for reflection, followed by behaviour change. Second, the absence of adequate upward communication may blind managers to the full nature of their problems, which in turn guides the search for solutions.

Clearly there is a need to examine other types of organizations to establish the universality of the communication issues and problems that were found in a large HCO in Europe, using both quantitative and qualitative methodologies.

The data suggest that attempting to cover up communication weaknesses by managers working even longer hours only has the effect of further disempowering people, and so accentuating rather than alleviating the underlying difficulty.

The article has value to fellow academics and managers in practice and contributes to the debate on upward communication and the workload of managers.

The chemical analysis of wells in the Ardabil area, Ardabil Province NW of Iran, was evaluated to determine the hydrogeochemical processes and ion concentration background in the region. The purpose of this study is to analyze the hydrochemical quality of groundwater in Ardabil aquifer in order to assess the suitability of the waters for different uses.

The chemical analysis of 75 water wells in the Ardabil area, was evaluated. Over the entire area, the dominated hydrochemical types are: Na-Cl, Na-HCO3-Cl-Mg, Ca-SO4, Ca-Mg-SO4-Cl and Ca-Mg-HCO3. The abundance of the major ions is as follows: Na⁺>Ca²⁺>Mg²⁺>K⁺ and SO₄^2–> Cl^–>HCO₃^– and major ion concentrations are below the acceptable level for drinking water. Most of groundwater samples fell in the soft water category. All of groundwaters belong to the excellent category and can be used safely for irrigation.

The chemical analysis of 75 water wells in the Ardabil area, Ardabil Province NW of Iran, was evaluated to determine the hydrogeochemical processes and ion concentration background in the region. Over the entire area, the dominated hydrochemical types are: Na-Cl, Na-HCO3-Cl-Mg, Ca-SO4, Ca-Mg-SO4-Cl and Ca-Mg-HCO3. The abundance of the major ions is as follows: Na⁺>Ca²⁺>Mg²⁺>K⁺ and SO₄^2–> Cl^–>HCO₃^– and major ion concentrations are below the acceptable level for drinking water. Most of groundwater samples fell in the soft water category. All of groundwaters belong to the excellent category and can be used safely for irrigation.

The chemical analysis of 75 water wells in the Ardabil area, Ardabil Province NW of Iran, was evaluated to determine the hydrogeochemical processes and ion concentration background in the region. Over the entire area, the dominated hydrochemical types are: Na-Cl, Na-HCO3-Cl-Mg, Ca-SO4, Ca-Mg-SO4-Cl and Ca-Mg-HCO3. The abundance of the major ions is as follows: Na⁺>Ca²⁺>Mg²⁺>K⁺ and SO₄^2–> Cl^–>HCO₃^– and major ion concentrations are below the acceptable level for drinking water. Most of groundwater samples fell in the soft water category. All of groundwaters belong to the excellent category and can be used safely for irrigation.

The purpose of this paper is to develop a framework for the application of evidence-based management to chronic disease healthcare.

Chronic healthcare is specially characterized by recursive patient-physician interactions in which evidence-based medicine (EBM) is applied. However, implementing evidence-based solutions to improve healthcare quality requires managers to effect changes in many different areas: organizational structure, procedures, technology and in physician/provider behaviors. To complicate matters further, they must achieve these changes using the tools of resource allocation or incentives. The literature contains many systematic reviews evaluating the question of physician and patient behavior under various types and structures of incentives. Similarly, systematic reviews have also been done regarding specific changes to the healthcare process and their effectiveness in improving patient outcomes. Yet, these reviews uniformly lament a lack of appropriate data from well-organized studies on the question of “Why?” solutions may work in one instance while not in another. The authors present a new theoretical framework that aids in answering this question.

This paper presents a new theoretical framework (Influence Model of Chronic Healthcare) that identifies: the critical areas in which managers can effect changes that improve patient outcomes; the influence these areas can have on each other, as well as on patient and physician behavior; and the mechanisms by which these influences are exerted. For each, the authors draw upon, and present the evidence in the literature. Ultimately, the authors recognize that this is a complex question that has not yet been fully researched. The contribution of this model is twofold: first, the authors hope to focus future research efforts, and second, provide a useful heuristic to managers who must make decisions with only the lesser-quality evidence the literature contains today.

This model can be used by managers as a heuristic either ex ante or ex post to determine the effectiveness of their decisions and strategies in improving healthcare quality. In addition, it can be used to analyze why actions or decisions taken achieved a given outcome, and how best to proceed to effect further improvements on patient outcomes. Last, the model serves to focus attention on specific questions for further research.

The purpose of this paper is to reflect upon a workplace-based, interdisciplinary clinical leadership training programme (CLP) to increase willingness to take on leadership roles in a large regional health-care centre in Victoria, Australia. Strengthening the leadership capacity of clinical staff is an advocated strategy for improving patient safety and quality of care. An interdisciplinary approach to leadership is increasingly emphasised in the literature; however, externally sourced training programmes are expensive and tend to target a single discipline.

Appraisal of the first two years of CLP using multiple sourced feedback. A structured survey questionnaire with closed-ended questions graded using a five-point Likert scale was completed by participants of the 2012 programme. Participants from the 2011 programme were followed up for 18 months after completion of the programme to identify the uptake of new leadership roles. A reflective session was also completed by a senior executive staff that supported the implementation of the programme.

Workplace-based CLP is a low-cost and multidisciplinary alternative to externally sourced leadership courses. The CLP significantly increased willingness to take on leadership roles. Most participants (93 per cent) reported that they were more willing to take on a leadership role within their team. Fewer were willing to lead at the level of department (79 per cent) or organisation (64 per cent). Five of the 11 participants from the 2011 programme had taken on a new leadership role 18 months later. Senior executive feedback was positive especially around the engagement and building of staff confidence. They considered that the CLP had sufficient merit to support continuation for at least another two years.

Integrating health-care professionals into formal and informal leadership roles is essential to implement organisational change as part of the drive to improve the safety and quality of care for patients and service users. This is the first interdisciplinary, workplace-based leadership programme to be described in the literature, and demonstrates that it is possible to deliver low-cost, sustainable and productive training that increases the willingness to take on leadership roles.