Danielle Vossebeld, Nicholas Spencer, Remko van der Lugt, Joris Jaspers, Christine De Lille
This article examines processes of technological innovation and implementation in a large academic hospital in the Netherlands to discuss the interconnectedness, interdependency, and dynamics of complex systems. The preliminary goal in this extensive case study at this hospital was to design better (medical) devices for nurses. However, while focussing on eliciting needs and better technological development and implementation, we recognised the interdependencies in the hospital between people, technology, processes, and contexts. We saw how choices in design and implementation caused ripple effects through the systems, influencing nurses’ technology use. Even if specific technology was unaltered, we observed how its effectiveness and user satisfaction were changed by events in the system.
Through direct interpretation, we identified patterns of complex systems in the innovation and implementation processes. In earlier work, we presented two technology implementation processes. This work revisits the materials collected from the extensive case study and its case examples and applies the complex systems theory as a lens to describe the underlying dynamics. We relate the observed hospital technologies and processes, demonstrating how influences on them precipitate expected and unintended consequences. We use the timelines of various implementation processes in mapping dependencies and ripple effects and deploy the literature on complex systems to demonstrate which system properties strengthen or dampen these rippling effects.
Moreover, examples of the partial unravelling of the interrelated elements demonstrate the multitude of influences that can cause (unintended) consequences in systems. Identifying these dynamics is relevant for hospital innovation processes. It also demonstrates how expected events can negatively impacts nurses’ work processes.
In systemic design it is essential to understand the effects of events and the consequential dynamics in systems. The presented examples of the dynamics and interdependencies support the comprehension of complex systems theory. Furthermore, understanding these smaller and more defined systems facilitates recognising the characteristics and patterns of larger complex systems.
Keywords: sociotechnical system, system dynamics, ripple effect, systems thinking, health technology