Analyzing katana referral hospital as a complex adaptive system: Agents, interactions and adaptation to a changing environment

Abstract

This study deals with the adaptation of Katana referral hospital in Eastern Democratic Republic of Congo in changing environment that is affected for more than a decade by intermittent armed conflicts. His objective is t generate theoretical proposals for addressing differently the analysis of hospitals governance in the aims to asses their performance and how to improve that performance. The methodology applied approach uses a case stud using mixed methods ( qualitative and quantitative) for data collection. It uses (1) hospital data to measure th output of hospitals, (2) literature review to identify among others, events and interventions recorded in the histor of hospital during the study period and (3) information from individual interviews to validate the interpretation o the results of the previous two sources of data and understand the responsiveness of management team referra hospital during times of change. The study brings four theoretical propositions: (1) Interaction between key agent is a positive force driving adaptation if the actors share a same vision, (2) The strength of the interaction betwee agents is largely based on the nature of institutional arrangements, which in turn are shaped by the actor themselves, (3) The owner and the management team play a decisive role in the implementation of effectiv institutional arrangements and establishment of positive interactions between agents, (4) The analysis of recipien population's perception of health services provided allow to better tailor and adapt the health services offer to th population's needs and expectations. Research shows that it isn't enough just to provide support (financial an technical), to manage a hospital for operate and adapt to a changing environment but must still animate considering that it is a complex adaptive system and that this animation is nothing other than the induction of positive interaction between agents.