physical features of the environment where people live and work, which could reduce opportunities and prevent patients from thinking about new solutions to problems. Some of these structures relate to mental processes that are consequences of one’s culture, group, and inquiry skills. Making correct inferences about the dynamics of complex nonlinear systems might prove a challenging task for leaders in almost any type of business (Sterman, 1994). Effective management is difficult in a world of high dynamic complexity for modern health care managers. Management decisions may create unanticipated side effects and delayed consequences. Attempts to stabilize a system may destabilize the operation. Decisions may provoke reactions by other professionals seeking to restore the balance that was upset. Decisions may move the system into a new realm of behavior where unexpected and unfamiliar dynamics arise because the dominant feedback loops have changed (Forrester, 1972). Defining the various sets of elements within a complex adaptive system and documenting the level of interactions within the system present enormous challenges for health care managers (Paina & Peters, 2012). Adaptability is a function of transformation of each element within the system to a coherent whole. Stacy (2011) explained the health
14 care industry is a complex adaptive system. The business contains different sets of interdependencies and emerging behaviors, which are revolutionary in nature. Such interdependencies within the complex adaptive system depend on a set of rules that require revisions because of changes that occur within the internal and external health care environment. Burns et al. (2012) correlated a system integration model between physicians and patients within a larger construct regulated by the industry. The health care system is highly complex and the rules that govern the system change on a reoccurring basis in the United States (Bourtani et al., 2010). The myriad of interrelated activities require control, regulation, guidance, and compromise based on conditions that may affect the health care environment and the community. Physicians and medical practitioners are part of the health care system; both controlled by internal and external factors. Guided by the Patient Protection and Affordable Care Act (2010), practitioners must comply with legislation, which regulates the interactions and treatment of the people (Kaspar, 2012). Health care organizations are part of an interconnected adaptive system, one that is vibrant, erratic, and distinctive in nature and forms the baseline conceptual framework for the telemedicine exploration (Greenfield, Nugus, Fairbrother, Milne, & Debono, 2011). The government mandates regulations for the betterment of citizens, such as groups of interrelated individuals including patients, providers, and different policy makers. Paina and Peters (2012) asserted that the application of a complex adaptive system theory in health care organizations is valuable in assisting policy evaluators and
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