5 Embracing complexity, advancing medical practice, and the need for wicked teams

Physicians work in complex adaptive systems. For complex medical problems, physicians are often quick to seek solutions before understanding the problems before them. This is due to engrained mental models of hierarchies of evidence that often fail to recognize the practical difficulties in translating evidence into changes in medical practice. There is a need to understand complexity and implications for implementation, spread and scale, evaluation, and knowledge translation. This workshop is designed to give participants a more nuanced understanding of solving complex problems in medicine and a heuristic framework to advance medical practice. The workshop will be interactive as participants learn and create their own hypothetical strategy to identify a problem, conduct research, and translate evidence into practice. This interactive workshop will give participants the opportunity to: 1) learn the Edmonton Physician Learning Program approach to mobilize the power of a Wicked Team to understand complex medical problems and create elegant solutions; 2) understand how to use the theory and frameworks to make sense of problems, support behaviour change, and optimize implementation; and 3) begin to harness the power of adaptive skill building to support communication, team effectiveness, and getting the job done. Participants will be presented with a Quality Improvement research problem that we at the Edmonton Physician Learning Program have recently completed as a project. The problem, identified in collaboration with antimicrobial stewardship leaders in Edmonton, was that cefazolin--the antibiotic of choice for all patients undergoing surgery, including those with a beta-lactam allergy--is under-administered within surgical procedures. Cefazolin is structurally different from all other beta-lactam antibiotics and therefore does not cross-react with any other beta-lactam. This was identified as ideal for Quality Improvement research because cefazolin is highly effective, safe, and can reduce the likelihood of surgical site infections by upwards of 50%. Participants will be guided through the workshop to design their own research and team approach to address this problem, beginning with the question: why does this problem matter? Participants will proceed to organize a hypothetical research team, research design, and implementation strategies to advance physician practice. At the end, participants will learn how the Edmonton Physician Learning Program solved this problem.