The Nemesis Effect in Healthcare: Complexity, Artificial Intelligence and Patient Safety

Abstract

The Nemesis Effect occurs when a clinical intervention increases the likelihood of the adverse outcome it was intended to avoid, or has other perverse effects that vitiate its benefits. The effect arises from the natural tendency of a complex adaptive system (such as healthcare) toward increased ‘entropy’— that is, toward greater disorder — mediated through both the complex interconnectedness of its components and a relative inability of well-meaning human agents to see ‘the bigger picture’ when implementing powerful policies and technologies. To illustrate the concept, several examples are cited from modern medical practice: the rise of multidrug-resistant organisms, the unintended effects of the European Working Time Directive, and the deskilling impact of certain novel technologies in surgery and anaesthesia. The potential nemesis effects of artificial intelligence (AI) on clinical practice are then discussed, together with possible seeds of remedy through a human factors/ergonomics approach to healthcare governance and clinical training. Good clinical governance can be seen as a way of maintaining a state of ‘negative entropy’ needed to keep a ‘living’ system safe, stable and functional. This requires the ongoing expenditure of energy and effort, as well as the adoption of a broader sociotechnical perspective.

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