If Gaming is the Problem, Is “Complexity Thinking” the Answer? A Response to the Recent Commentaries

Document Type: Correspondence

Authors

1 School of Population Health, University of Auckland, Auckland, New Zealand

2 Auckland District Health Board, University of Auckland, Auckland, New Zealand

3 Wintec, Hamilton, New Zealand

Keywords


 

We would like to thank the authors of each of the three commentaries1-3 for their very useful and thought-provoking comments on our article on the gaming of New Zealand’s emergency department (ED) target.4 We were heartened by Lisa M Lines’ comment that ‘performance measure developers, healthcare providers and administrators, policy-makers, and researchers in the field would do well to be both humbled and encouraged by this research.’3 ... (Read more...)

  1. Chen J. Improve the design and implementation of metrics from the perspective of complexity science; comment on “gaming New Zealand’s emergency department target: how and why did it vary over time and between organisations?” Int J Health Policy Manag. 2020; In Press. doi:10.34172/ijhpm.2020.47
  2. Hamblin R, Shuker C. Beyond targets: measuring better and rebuilding trust; comment on “gaming New Zealand’s emergency department target: how and why did it vary over time and between organisations?” Int J Health Policy Manag. 2020; In Press. doi:10.34172/ijhpm.2020.38
  3. Lines LM. Games people play: lessons on performance measure gaming from New Zealand; comment on “gaming New Zealand’s emergency department target: how and why did it vary over time and between organisations?” Int J Health Policy Manag. 2020; In Press. doi:10.34172/ijhpm.2020.41
  4. Tenbensel T, Jones P, Chalmers LM, Ameratunga S, Carswell P. Gaming New Zealand's emergency department target: how and why did it vary over time and between organisations? Int J Health Policy Manag. 2020;9(4):152-162. doi:10.15171/ijhpm.2019.98
  5. Tenbensel T, Chalmers L, Jones P, Appleton-Dyer S, Walton L, Ameratunga S. New Zealand's emergency department target - did it reduce ED length of stay, and if so, how and when? BMC Health Serv Res. 2017;17(1):678. doi:10.1186/s12913-017-2617-1
  6. Tenbensel T, Chalmers L, Willing E. Comparing the implementation consequences of the immunisation and emergency department health targets in New Zealand. J Health Organ Manag. 2016;30(6):1009-1024. doi:10.1108/jhom-08-2015-0126
  7. Jones P, Chalmers L, Wells S, et al. Implementing performance improvement in New Zealand emergency departments: the six hour time target policy national research project protocol. BMC Health Serv Res. 2012;12:45. doi:10.1186/1472-6963-12-45
  8. Jones P, Wells S, Harper A, et al. Impact of a national time target for ED length of stay on patient outcomes. N Z Med J. 2017;130(1455):15-34.
  9. Jones P, Sopina E, Ashton T. Resource implications of a national health target: the New Zealand experience of a Shorter Stays in Emergency Departments target. Emerg Med Australas. 2014;26(6):579-584. doi:10.1111/1742-6723.12312
  10. Best A, Berland A, Herbert C, et al. Using systems thinking to support clinical system transformation. J Health Organ Manag. 2016;30(3):302-323. doi:10.1108/jhom-12-2014-0206
  11. McDaniel RR Jr, Lanham HJ, Anderson RA. Implications of complex adaptive systems theory for the design of research on health care organizations. Health Care Manage Rev. 2009;34(2):191-199. doi:10.1097/HMR.0b013e31819c8b38
  12. Van Dooren W, Hoffmann C. Performance management in Europe: an idea whose time has come and gone? In: Ongaro E, Van Thiel S, eds. The Palgrave Handbook of Public Administration and Management in Europe. London: Palgrave Macmillan; 2018:207-225.
  13. Grudniewicz A, Tenbensel T, Evans JM, Steele Gray C, Baker GR, Wodchis WP. 'Complexity-compatible' policy for integrated care? lessons from the implementation of Ontario's Health Links. Soc Sci Med. 2018;198:95-102. doi:10.1016/j.socscimed.2017.12.029
  14. Tenbensel T. Complexity and health policy. In: Geyer R, Cairney P, ed. Handbook on Complexity and Public Policy. Cheltenham: Edward Elgar Publishing; 2015.
  15. Kreindler SA. The stipulation-stimulation spiral: a model of system change. Int J Health Plann Manage. 2019;34(4):e1464-e1477. doi:10.1002/hpm.2811