Cynefin Framework Navigating Home Healthcare during a Pandemic.

Danae West
4 min readMay 15, 2020


What is home health care?

Home healthcare is essentially just what it sounds like it is. It is care that is given to an individual within a home setting, care can be as simple as housework, grocery shopping, or as hands-on as assisting with daily personal tasks. Home health can also offer services such as rehabilitation, dressing changes and medication administration.

Who organizes it and how does it operate?

There are agencies that hire staff to operate a home health care branch of their business. Many Long term care facilities and other medical companies have some source of home health.

There are two types of home health care; staffing agencies or private hire providers. “The management of staff is the key difference between these private duty registries and both the home care and home health care agencies. Registries and staffing agencies can be reimbursed for their services sometimes through long-term care insurance, Medicaid and private pay. These agencies refer to various types of employees providing skilled care from licensed nurses to personal care and companion assistance from nursing assistants” (“Types of Home Care Agencies”).

Private hire providers have similar services they are just hired and managed by the client or client's family. Typically private hire can be cheaper considering there are no agency recruitment fees. After having gaining an understanding of what home healthcare is, you can see why COVID-19 or any pandemic could be very challenging to navigate.

You may be asking what is the Cynefin Framework and why would it help? The Cynefin Framework created back in 1999 by Dave Snowden, it is a conceptual framework that helps assist with decision-making. There are 5 parts to the framework; complex, Complicated, Chaotic, Obvious and Disorder.

Many of the issues and/or business decisions that home healthcare have can be classified into one category or another within the Cynefin framework.

Using the framework to navigate a healthcare system during a pandemic or any other issue big or small can ease the process. By sorting out the troubled areas away from the good areas can help a system see where they need to start to fix an issue.

Obvious (Best Practices)

Concerns with easy fixes, that do not require specialized expertise will fit into this category.

  • For instance if a healthcare worker is sick they should stay home.
  • If a patient is scheduled for a non-urgent appointment and they feel sick, they should stay home.
  • Monitoring patients for symptoms and exposure.

Complicated (Good Practices)

Concerns or issues that have more than one clear solution can be placed into this category. Many times these issues need an expert to review which solution fits best.

In most cases the problem is predictable, for example knowing that patients will come in contact with the virus. The question becomes “how does the healthcare system slow, prevent and/or treat those patients?” That is where the expert knowledge can be of use.

Another example could be an ill patient at home who needs services, what precautions can be used to protect the staff and the patient from getting sicker.

Complex (Emergent)

This category is used to classify issues that have a hard to identify cause. These situation often need a quick solution but take multiple people accessing the situation to determine the solution and how to implement it. An example of this could be how to operate under the new Covid-19 restrictions. It is important for the group to communicate well to brainstorm and come up with an action plan.

  • Restricting Travel for staff and knowing how/when to restrict it.
  • Ensuring proper protective equipment is available and the sanitization requirements are met.

Chaotic (Rapid Response)

This domain categorizes anything and everything that does not have a clear order to it. Issues that need solutions built from the ground up tend to end up here. Now that we are a couple months into living with COVID-19 many items have moved out of this category. They have been divided among groups who can work to create solutions for them.


Many of the other domains may seem disordered, so why add this domain? If an item or topic does not have a clear fit into another domain it lands here. The goal here is to gain more information regarding the subject so that it can be pushed to another domain and be further addressed. When the virus first came into sight there were too many unknowns to count, a lot of them could have started in this domain.

Home healthcare is not the only system that can use the Cynefin framework to organize and make decisions for their company. I would suggest implementing a group that can assess the business and classify the components into the Cynefin Framework. After that has been done I would suggest that smaller groups work with experts as needed to find long-term solutions to the issues in the categories.