Objective: To practice identifying dynamic complexity.Instructions:

Describe how the following example illustrates one or more of the system characteristics that contribute to dynamic complexity.

Example: Medical Associates is a for-profit medical group of 40 physicians that operates two facilities and offers services in several medical specialties, including cardiology; ear, nose, and throat; family medicine; gastroenterology; general surgery; pediatrics; and obstetrics and gynecology. Medical Associates is open six days a week in each location from 8:00 am until 6:00 pm. Plans are being developed to extend its hours to 9:00 pm two days a week. For several years, Medical Associates discounted its listed fees by 3 percent to 5 percent for its managed care contracts, but a few years ago, it had to accept larger discounts to remain in the networks of health plans. Lower reimbursements led.

Medical Associates to change its staffing from relying solely on registered nurses (RNs) to hiring medical assistants (MAs) as well. Currently, all physicians assigned to primary care service are assigned one RN or MA to assist with patient care. Physicians assigned to surgery are assigned one RN for every two physicians. As RNs retire or reassign, they have been replaced with MAs. On five recent occasions, when an RN assigned to a senior physician resigned, the senior physician demanded that the RN assigned to a junior physician be reassigned to him and that a new MA is hired to fill the vacancy with the junior physician. This ad hoc system of job switching has caused internal turmoil between the senior and junior physicians and has led to the subsequent resignation of two RNs who did not want to be reassigned. . . . Confusion exists around staff reporting relationships and who has the authority to change job assignments.