A complex adaptive system perspective on role of the Youth Support Coordinators (YSC) in Teenage/Young Adult (TYA) cancer care.

Case Description
Teenage Cancer Trust, a UK charity created YSC roles to provide youth focused social support to TYA with cancer, complimenting the multi-disciplinary team (MDT) and reporting to nurses in the National Health Service (NHS). Therefore, as non-regulated workers, they act within in an interrelated system of healthcare and philanthropic organisations with differing agendas.
Discussion
TYA cancer healthcare experiences comprise networks of components that interact nonlinearly, on different scales and can create unintended consequences e.g., non-compliance, service transitions, family disruption, peer-group challenges, impaired fertility, hair-loss. YSC’s support TYA to negotiate this. Reporting structures for YSC are within numerous horizontal and vertical subsystems. Elements of YSC work could be done by others e.g. Social Work, Youth Work, Occupational Therapists or Nurses. The labour boundaries of the work of the MDT and YSC are unclear and fuzzy. YSC’s are firmly seated within in complex adaptive systems (CAS) where there is inherent non-linearity as well as systems embedded with other systems which appear to co-exist (Plsek and Greenhalgh 2001).
The lack of professional identity (and regulation) for YSC who stem from various professional backgrounds is problematic and poses a challenge for definition of their role and competence development.
Key Learning
Arguably their role is a consequence of unintended outcomes of creative, dynamic and philanthropic innovation. We need to move beyond the system of professions to consider a system of work as a whole (Allen et al 2002), and look to what we mean by providing youth focussed support in cancer care. Further research is needed.
The YSC role is likely to evolve, as in any CAS. In keeping with Fraser and Greenhalgh’s (2001) views on coping with complexity, much rests on the NHS not merely aiming for change, improvement and responses in successful health systems, but to seek changeability, improvability and responsiveness.