{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T17:30:06Z","timestamp":1787592606928,"version":"build-2736575974"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,12,27]],"date-time":"2017-12-27T00:00:00Z","timestamp":1514332800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The specialty of emergency medicine is experiencing the convergence of a number of transformational forces in the United States, including health care reform, technological advancements, and societal shifts. These bring both opportunity and uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>21st Century Challenges<\/jats:title>\n                    <jats:p>Persistent challenges such as the opioid epidemic, rising health care costs, misaligned incentives, patients with multiple chronic diseases, and emergency department crowding continue to plague the acute, unscheduled care system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reductionism and Complex Systems Thinking<\/jats:title>\n                    <jats:p>The traditional approach to health care practice and improvement\u2013reductionism\u2013is not adequate for the complexity of the twenty\u2010first century. Reductionist thinking will likely continue to produce unintended consequences and suboptimal outcomes. Complex systems thinking provides a perspective and set of tools better suited for the challenges and opportunities facing public health in general, and emergency medicine more specifically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for Emergency Medicine<\/jats:title>\n                    <jats:p>This article introduces complex systems thinking and argues for its application in the context of emergency medicine by drawing on the history of the circumstances surrounding the formation of the specialty and by providing examples of its application to several practice challenges.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.12862","type":"journal-article","created":{"date-parts":[[2017,12,27]],"date-time":"2017-12-27T04:13:28Z","timestamp":1514348008000},"page":"629-634","source":"Crossref","is-referenced-by-count":34,"title":["Complex systems thinking in emergency medicine: A novel paradigm for a rapidly changing and interconnected health care landscape"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5232-5080","authenticated-orcid":false,"given":"Matthew A.","family":"Widmer","sequence":"first","affiliation":[{"name":"Romney Institute of Public Management Brigham Young University  Provo UT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5078-8401","authenticated-orcid":false,"given":"R. Chad","family":"Swanson","sequence":"additional","affiliation":[{"name":"Arizona State University School for the Science of Healthcare Delivery  Tempe AZ USA"},{"name":"Department of Emergency Medicine Intermountain Healthcare  Provo UT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian J.","family":"Zink","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Alpert Medical School of Brown University  Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse M.","family":"Pines","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Health Policy and Management, and the Center for Healthcare Innovation and Policy Research the George Washington University  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,12,27]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Centers for Medicare and Medicaid Services. MACRA: MIPS & APMs.CMS.govCenters for Medicare & Medicaid Services. Available at:https:\/\/www.cms.gov\/medicare\/quality-initiatives-patient-assessment-instruments\/value-based-programs\/macra-mips-and-apms\/macra-mips-and-apms.html. Published May 5 2017. Accessed May 26 2017."},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2016.05.029"},{"key":"e_1_2_7_4_1","volume-title":"Hospital Statistics","author":"American Hospital Association","year":"2013"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2009.0748"},{"issue":"6","key":"e_1_2_7_6_1","first-page":"101","article-title":"Trends in Aging\u2014United States and worldwide","volume":"52","author":"Centers for Disease Control and Prevention","year":"2003","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12072"},{"key":"e_1_2_7_8_1","volume-title":"The Fifth Discipline","author":"Senge P","year":"1990"},{"key":"e_1_2_7_9_1","unstructured":"Plsek P.(2001)Appendix B. Redesigning health\u2010care with insights from the science of complex adaptive systems. In IOM Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health Care System for the 21st Century pp. 309\u2013322."},{"key":"e_1_2_7_10_1","unstructured":"BernsteinM LinskyM.Leading change through adaptive design. Stanford Social Innovation Review. Winter2016."},{"key":"e_1_2_7_11_1","unstructured":"National Cancer Institute.Greater than the Sum: Systems Thinking in Tobacco Control. Tobacco Control Monograph No. 18.Bethesda MD:U.S. Department of Health and Human Services National Institutes of Health National Cancer Institute. NIH Pub. No. 06\u20106085 April (2007)."},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2014.3.21578"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czs090"},{"key":"e_1_2_7_14_1","unstructured":"The IHITriple Aim. Institute for Healthcare Improvement.http:\/\/www.ihi.org\/Engage\/Initiatives\/TripleAim\/Pages\/default.aspx. Accessed May 27 2017."},{"key":"e_1_2_7_15_1","unstructured":"Concepts: Emergence.Concepts: emergence | NECSI.http:\/\/necsi.edu\/guide\/concepts\/emergence.html. Accessed May 27 2017."},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2012.11.12171"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2011.11.046"},{"key":"e_1_2_7_18_1","doi-asserted-by":"crossref","unstructured":"Bernstein SL D'OnofrioG RosnerJ et al. \u201cSuccessful tobacco dependence treatment in low\u2010income emergency department patients: a randomized trial\u201d. Annals of emergency medicine 66.2 (2015): 140\u2010147.","DOI":"10.1016\/j.annemergmed.2015.03.030"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2013-203502"},{"key":"e_1_2_7_20_1","volume-title":"The Social Transformation of American Medicine","author":"Starr P","year":"1982"},{"key":"e_1_2_7_21_1","volume-title":"American Medicine and the Public Interest: A History of Specialization","author":"Stevens R","year":"1998"},{"key":"e_1_2_7_22_1","unstructured":"American Hospital Association:Emergency services: the hospital emergency department in an emergency care system Chicago 1972 American Hospital Association."},{"key":"e_1_2_7_23_1","volume-title":"Health Care USA: Understanding its Organization and Delivery","author":"Sultz H","year":"2014"},{"key":"e_1_2_7_24_1","volume-title":"Anyone, Anything, Anytime: A History of Emergency Medicine","author":"Zink BJ","year":"2006"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-197907000-00001"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfami.9.1.40"},{"key":"e_1_2_7_27_1","unstructured":"LaPietraA.St. Joseph's Regional Medical Center aims to avoid opioid use in emergency department.http:\/\/www.acepnow.com\/article\/st-josephs-regional-medical-center-aims-avoid-opioid-use-emergency-department\/. Published August 16 2016. Accessed May 27 2017."},{"key":"e_1_2_7_28_1","unstructured":"Prescription Drug Monitoring Programs (PDMPs).Centers for Disease Control and Prevention.https:\/\/www.cdc.gov\/drugoverdose\/pdmp\/. Published March 21 2017. Accessed May 27 2017."},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-4998-0_40"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu565"},{"key":"e_1_2_7_31_1","unstructured":"Fact sheets. American College of Emergency Physicians | News Room.http:\/\/newsroom.acep.org\/fact_sheets?item=29928. Accessed May 27 2017."},{"key":"e_1_2_7_32_1","unstructured":"HenryG.PA training and oversight: a model worth copying? Emergency physicians monthly.http:\/\/epmonthly.com\/article\/pa-training-oversight-model-worth-copying\/. Published February 23 2016. Accessed May 27 2017."}],"container-title":["Journal of Evaluation in Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjep.12862","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.12862","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T12:08:08Z","timestamp":1695470888000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jep.12862"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,27]]},"references-count":31,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1111\/jep.12862"],"URL":"https:\/\/doi.org\/10.1111\/jep.12862","archive":["Portico"],"relation":{},"ISSN":["1356-1294","1365-2753"],"issn-type":[{"value":"1356-1294","type":"print"},{"value":"1365-2753","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,27]]}}}