Practice jazz: Understanding variation in family practices using complexity science

Much variation exists in family practices. There is also much that is const ant and deeply resistant to change. In this paper we present the current st ate of an ongoing 4-year process of applying the concepts of complexity sci ence to help interpret the results of 3 studies of the content and process of family practice. We use 2 case studies from these data sets to illustrat e the application of complexity science to understanding Variation and the process of change in generalist practice. Our emerging understanding conceptualizes family practices as local profess ional complex adaptive systems. These systems exist for the purpose of seei ng patients for everyday health concerns and assisting them in getting on w ith their daily lives. Each family practice is unique because of history an d initial conditions, particular agents (eg, physicians, staff, patients, s ystems), nonlinear interactions among agents, the local ecology, and region al and global influences. How all these factors manifest in a particular pr actice can be understood using 3 complexity science properties: self-organi zation, emergence, and co-evolution. The concepts of sense-making and impro visation can he used to understand how practices deal with variation. We conclude that complexity science concepts can provide a useful framework for understanding variation and change in family practices. The challenge is to differentiate error from relational variation and to improve practice s' sense-making and improvisational skills. Future efforts to improve pract ice should focus on optimizing a practice's care as a whole and enhancing r eflective practice and relationship-centered care.