Analysis: Using Simplified Chaos Theory to Manage Nursing Services

In her article for the Journal of Nursing Management, Carol A. Haigh asserts that "the study of nonlinear dynamics, in which seemingly random events are actually predictable from simple deterministic equations" can and should be applied to predict patient service outcomes (Rouse, 2009). Haigh states repeatedly in this piece that for the chaos theory to apply, the system being analyzed must be evolving. Yet, by the author's own admission, the fact that the health care system is always in flux due to a number of factors including changes and retention of nursing staff, changes in seasons, and our recent change in national health care policy often negate predictions made using this theory (Haigh, 2008, p. 300).

Haigh maintains this theory needs to be applied to the field of nursing because it is a method of effectively managing the dwindling resources of staff and time. To prove her point, she cites a 1997 study where McDaniel applied the theory to nursing management. According to Haigh, "He speculated that the isolation of top management from the environmental turbulence in which organizations function means that front-line managers are better placed to direct service through flexible, porous and adaptive responses" (Haigh, 2008, p. 300). McDaniel concluded his findings by arguing for localized control over healthcare emphasizing that those who know an area best are the ones best suited to adjust to its specific needs (Haigh, 2008, p. 300).

In addition to being evolving, a system must be identifiable as one of three types of attractors. The two periodic attractors, the fixed-point attractor, and the limit cycle attractor are both examples of "manifestations of periodic stable systems", which means each of these can be mapped in geometric shapes, making forecasting future results possible (Haigh, 2008, p. 299). The third type, an "aperiodic equilibrium" known as a chaos attractor, cannot be identified or mapped because it has no unique shape and its mathematical path is too haphazard for forecasting (Haigh, 2008, p. 299). Therefore, only systems that fall into the category of periodic attractors can be analyzed using the mathematical calculations that are the basis of chaos theory.

Haigh's study (2008) focused on the assessment of staff and patient interaction in one acute pain clinic. Researchers used a modified version of the Malthusian healthcare delivery model to account for population growth and hence, to predict future patient load increases (301). After reviewing how many patients were being seen at the clinic on a yearly basis, researchers found the nursing service was growing at an unsustainable rate of 20% per year" (Haigh, 2008, p. 302). Haigh and her team concluded that if this growth rate continued, seeing patients would take up all of the service providers' available time. The author points out that while the conclusion is not a happy one for the clinic, the use of chaos theory worked in this case because they now know what they are up against and can plan by either hiring more staff or not taking on more patients in the future" (Haigh, 2008, p. 302). Haigh makes it clear that the prediction of this study is based on variables. The researchers cannot know if the practice will continue to exist or if patient satisfaction will remain high and sustain the current rising demand for services (2008, p. 302).

Like any other service industry, health care continues to change. We see changes in the patient population based on the seasons. For example, typically there are fewer hospital admissions in the summer and more in the winter. Technology continues to advance at a rapid rate, changing the way we do our daily tasks such as dispensing medications to our patients. In this country, the recent passage of the Affordable Care Act is sure to bring sweeping changes to the health care industry. We work in a system that is ever-changing.

Haigh's study showed that chaos theory has some applications in health care management. If you can isolate a trend by charting significant growth or decreases in a specific area, it would be unwise not to plan for it. However, the systemic state of flux in the health care industry means that the application of chaos theory is limited.

References

Haigh, C. A. (2008). Using simplified chaos theory to manage nursing services. Journal of Nursing Management, 16, 298–304. doi: 10.1111/j.1365-2834.2007.00833.x

Rouse, M. (2009). Definition of chaos theory. Retrieved from http://whatis.techtarget.com/definition/chaos-theory