From leadership research to district action: A Complex Adaptive Systems Approach to Health Professions Education Transformation: The Case of the University of Missouri-Columbia School of Medicine and an Integrated Quality Improvement-Interprofessional Collaborative Practice Curriculum

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

OBJECTIVES In 2003, the University of Missouri-Columbia School of Medicine (MU SOM) initiated an integrated quality improvement-interprofessional collaborative practice (QI-ICP) curriculum as part of a larger curriculum renewal process. While exploring a different case study focused on the content of the curriculum, investigators became intrigued by MU SOM's approach to change, specifically, how complex adaptive systems (CAS) thinking may have supported sustained transformational change in curriculum across multiple health professions programs. The primary aim of this study was to elucidate the aspects of MU's experience with transformation that were grounded in CAS. A secondary aim was to explore the usefulness of a CAS-based management framework for organizational transformation using the case of curricular transformation in health professions education at MU. METHODS Data collection involved interviews, with twelve faculty from a variety of programs, and document analysis, including previously published papers and gray literature (websites, organizational charts and planning documents, and faculty development materials). RESULTS Using abductive analysis, we found that leadership in the health professions programs at MU, informed by earlier learning about organizational sensemaking and CAS theory, addressed all 9 of the characteristics of CAS presented in the initial framework. Additionally, systematic combining revealed the need to adjust the framework to ensure applicability to health professions education. The analysis of MU's experience also offered key insights into how that transformation happened in practice. The CAS framework adjustments make explicit the importance of common purpose and the concept of leadership as an emergent event and make it easier to apply the framework to a broader set of organizational contexts, including health professions education. CONCLUSION The use of the adjusted framework, informed by insights from this specific case, may help health professions education programs evaluate past change efforts or plan for future change.

Study methods

This research study formed part of the first author's doctoral dissertation. Due to life circumstances impacting KS, including sequential and multiple parental and bereavement leaves, there was a 10-year delay between data collection and final analysis and reporting. It is important to note that literature reviews were completed at intervals during the delay, and these reviews affirmed the continued relevance of the study. Ethical approval was maintained throughout this entire period.

Limitations

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A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Pilot a structured team debrief in one voluntary staff team. Invite dissent, record a specific improvement action and assign responsibility without collecting identifiable criticism. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Compare participation distribution, action completion, near-miss reporting and a consistent voluntary team-climate measure. Increased reporting may reflect greater openness rather than more errors. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Katherine Stevenson; Marcel D’Eon; Linda Headrick; Boel Andersson Gäre. A Complex Adaptive Systems Approach to Health Professions Education Transformation: The Case of the University of Missouri-Columbia School of Medicine and an Integrated Quality Improvement-Interprofessional Collaborative Practice Curriculum. Journal of Medical Education and Curricular Development (2025-01-01). https://doi.org/10.1177/23821205251315624

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.