A Complex Adaptive Systems Approach to Health Professions Education Transformation: The Case of the University of Missouri-Columbia School of Medicine and an Integrated Quality Improvement-Interprofessional Collaborative Practice Curriculum.

Objectives: In 2003, the University of Missouri-Columbia School of Medicine (MU SOM) initiated an integrated quality improvement-interprofessional collaborative practice (QI-ICP) curriculum as part of a larger curriculum renewal process. While exploring a different case study focused on the content of the curriculum, investigators became intrigued by MU SOM's approach to change, specifically, how complex adaptive systems (CAS) thinking may have supported sustained transformational change in curriculum across multiple health professions programs. The primary aim of this study was to elucidate the aspects of MU's experience with transformation that were grounded in CAS. A secondary aim was to explore the usefulness of a CAS-based management framework for organizational transformation using the case of curricular transformation in health professions education at MU.

Methods: Data collection involved interviews, with twelve faculty from a variety of programs, and document analysis, including previously published papers and gray literature (websites, organizational charts and planning documents, and faculty development materials).

Results: Using abductive analysis, we found that leadership in the health professions programs at MU, informed by earlier learning about organizational sensemaking and CAS theory, addressed all 9 of the characteristics of CAS presented in the initial framework. Additionally, systematic combining revealed the need to adjust the framework to ensure applicability to health professions education. The analysis of MU's experience also offered key insights into how that transformation happened in practice. The CAS framework adjustments make explicit the importance of common purpose and the concept of leadership as an emergent event and make it easier to apply the framework to a broader set of organizational contexts, including health professions education.

Conclusion: The use of the adjusted framework, informed by insights from this specific case, may help health professions education programs evaluate past change efforts or plan for future change.