Les théories de la complexité et la systémique en gouvernance clinique: le cas des soins intensifs chirurgicaux
In Health Technology Assessment and Management, Evidence-Based Medicine and many tools available for clinical assessment reflect a positivistic and mechanistic approach to Health Care Organizations and scientific knowledge.    We argue that the Complexity Theories and the Systemic decision-making process give a different insight on those two aspects of Clinical Governance in a Surgical Intensive Care Unit (SICU).  In a case-study, we describe the nature of critically ill and unstable patients and the organizational structure of a SICU in a university based hospital.  We demonstrate all the characteristics of complexity in that setting, through the use of many examples and micro-situational analysis.  After an epistemological critical appraisal of EBM, we suggest that if a SICU is conceptualized as a dynamic non-linear adaptative system, then clinical knowledge and scientific thought processes must include hermeneutical, systemic and  abductive  types of reasoning.  Finally, we draw upon Karl Weick’s work and suggest that a SICU must be considered as a High Reliability Organization in order to aim for improving patient care and create better conditions for quality and performance in this complex environment.
Non-Linear Dynamic System Health Technology Assessment Health Care Management Medical Epistemology EBM High Reliability Organization Surgical Critical Care ICU Complexity Theory Systemic Thought Process