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Reorganizing medical care for older persons in times of scarcity: A cybernetics analysis of work pressure and organizational change

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  • Schuurmans, J.J.
  • Felder, M.
  • Bal, R.
  • Wallenburg, I.

Abstract

Capacity problems in healthcare lead organizations to seek new and fluid ways of organizing care to safeguard access to services. Task reallocation, triage and stepped care models are increasingly foregrounded as promising interventions that enhance the capacity, efficiency, and resilience of medical services and through which access can be maintained for a growing client base. In this paper, we argue that interventions meant to enhance capacity and increase efficiency have their limits in a system that is already under strain. We draw on the cybernetics of Gregory Bateson and his concept of ‘budgets of flexibility’ to understand how stress accrues in systems and depletes their capacity for adaptive change. We analyze a case in which regional evening, weekend and night shifts (EWNs) were organized for nursing homes, which included the implementation of a new triage system and task reallocation between various professionals. We show how this initiative rerouted and reprocessed information pathways between professionals, and how this rewiring resulted in a buildup of stress and concomitant emotions of frustration, anxiety, fear and disempowerment through four different mechanisms: (1) fragmentation of information flows; (2) accumulation of information; (3) a loss of richness of information, and (4) slow-moving information flows. The accrual of stress depleted the overall capacity for adaptive change in the system and eventually culminated in a partial breakdown of the new medical service.

Suggested Citation

  • Schuurmans, J.J. & Felder, M. & Bal, R. & Wallenburg, I., 2025. "Reorganizing medical care for older persons in times of scarcity: A cybernetics analysis of work pressure and organizational change," Social Science & Medicine, Elsevier, vol. 366(C).
    • Handle: RePEc:eee:socmed:v:366:y:2025:i:c:s0277953624010888
    DOI: 10.1016/j.socscimed.2024.117634
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    1. Marten Scheffer & Steve Carpenter & Jonathan A. Foley & Carl Folke & Brian Walker, 2001. "Catastrophic shifts in ecosystems," Nature, Nature, vol. 413(6856), pages 591-596, October.
    2. Sherman, Melina & Klinenberg, Eric, 2024. "Beyond burnout: Moral suffering among healthcare workers in the first COVID-19 surge," Social Science & Medicine, Elsevier, vol. 340(C).
    3. Martin Kornberger & Stephan Leixnering & Renate E. Meyer, 2019. "The logic of tact : How decisions happen in situations of crisis," Post-Print hal-02312257, HAL.
    4. van de Bovenkamp, Hester & van Pijkeren, Nienke & Ree, Eline & Aase, Ingunn & Johannessen, Terese & Vollaard, Hans & Wallenburg, Iris & Bal, Roland & Wiig, Siri, 2023. "Creativity at the margins: A cross-country case study on how Dutch and Norwegian peripheries address challenges to quality work in care for older persons," Health Policy, Elsevier, vol. 127(C), pages 66-73.
    5. Keshavarz, Nastaran & Nutbeam, Don & Rowling, Louise & Khavarpour, Freidoon, 2010. "Schools as social complex adaptive systems: A new way to understand the challenges of introducing the health promoting schools concept," Social Science & Medicine, Elsevier, vol. 70(10), pages 1467-1474, May.
    6. Rodriquez, Jason, 2023. "Reconfiguring the social organization of work in the intensive care unit: Changed relationships and new roles during COVID-19," Social Science & Medicine, Elsevier, vol. 317(C).
    7. Gilson, Lucy & Ellokor, Soraya & Lehmann, Uta & Brady, Leanne, 2020. "Organizational change and everyday health system resilience: Lessons from Cape Town, South Africa," Social Science & Medicine, Elsevier, vol. 266(C).
    8. Shuster, Stef M. & Lubben, Noah, 2022. "The uneven consequences of rapid organizational change: COVID-19 and healthcare workers," Social Science & Medicine, Elsevier, vol. 315(C).
    9. Trondsen, Marianne V. & Tjora, Aksel & Broom, Alex & Scambler, Graham, 2018. "The symbolic affordances of a video-mediated gaze in emergency psychiatry," Social Science & Medicine, Elsevier, vol. 197(C), pages 87-94.
    10. Hannigan, Ben, 2013. "Connections and consequences in complex systems: Insights from a case study of the emergence and local impact of crisis resolution and home treatment services," Social Science & Medicine, Elsevier, vol. 93(C), pages 212-219.
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