Complex Adaptive Team Systems (CATS): Scaling of a Team Leadership Development Model

Complex adaptive systems (CAS), to reiterate, are systems composed of many individual parts or agents in which patterns can emerges as a result of agents deploying "simple rules" from the "bottom-up" without external control—CAS are "self-organizing" systems. "Simple rules" in health care would include seeking to optimize both patient well-being and the functioning of professionals. If elements of a CAS system are altered, the system adapts or reacts. The behaviour of a complex adaptive system can be inherently unpredictable and non-linear as elements of the system, the internal (eg, professionals and managers) and external agents (eg, patients, families, and society), have multiple perturbations, changes, and interdependencies. Despite the flurry of interest in complex systems and non-linear dynamics in recent decades, application of knowledge and innovation about complexity and adaptation in systems for health care has been slow. Critics typically state that there is no "evidence" that applying CAS and complexity science is needed or "works" in the real world of health care systems.1 It is almost a decade since the issues of practicability were first raised in this Forum in 2009.2 Has progress been made? A PubMed scan (Figure 1) provides some comfort in the growth of applications of CAS thinking in health research. In this Forum, Wietmarschen, Wortelboer, and van der Greef3 provide a highly accessible vision for the future of complex adaptive systems and why they are needed. They re-articulate why a shift is needed from static silos of diagnoses and linear structures toward a more integrated biopsychosocial way of thinking about health, using systems thinking approaches. Moreover, in their far-sighted appraisal of Western lifestyle problems of obesity and sedentary behaviours, they demonstrate practical modelling techniques integrating molecular with cognitive and psychological metrics, and variables from different layers of human functioning. A systems dynamics software tool called Method to Analyse Relations between Variables using Enriched Loops was used to create the model during the group sessions. The resulting model contained various positive and negative feedback loops connecting multiple health domains, indicating non-linear mechanisms affecting processes that cross multiple health domains. These techniques have been applied to the analyses of individual trajectories in a clinical approach to obesity in Vogellanden-Centre for Rehabilitation, Zwolle, the Netherlands. System dynamics modelling (SD), is an interdisciplinary modelling method used for representing and understanding the behaviour of complex systems. An SD model consists of a series of stocks, which represent the total people receiving a type of service at a given time, interconnected through flows, which represent the movement of people from one stock to another over time. Participatory approaches align stakeholder understanding of the underlying causes of a problem and can achieve consensus for action. Advances in software are allowing the participatory model building approach to be extended to more sophisticated multimethod modelling that provides policy makers with more powerful tools to support the design of targeted, effective, and equitable policy responses for complex health problems.4 Cepoiu-Martin and Bischak5 utilized a system dynamics model of the Alberta Continuing Care System (ACCS), Canada, using stylized data to assist service planning. They explored policies of introducing staff/resident benchmarks in both supportive living and long-term care (LTC) in the background of predicted increases in the population of people with dementia and the provision of staffing benchmarks, The ACCS model developed, by going beyond linear cause-effect considerations, and allowed the exploration of the entire network of causal relationships between various components of the system. It provided evidence of applicability of SD simulation to analysis of the impact of adopting benchmarks related to the staff/resident ratios in the continuing care system in Alberta. The model provides a basis for future evaluations of interventions in the workforce development area, capturing all feedbacks that modify balance between staff supply and demand in the age care sector. The following three papers highlight practical applications at the clinical coal-face, albeit all are early stage studies. Bandini et al6 have successfully piloted a clinical tool for episode complexity in inpatient care on internal medical wards. Episode complexity represents the need for greater time and effort (compared with other patients and episodes) with respect to clinical assessment and treatment; relationships with the patients, caregivers, other specialists, and actors in the health care network; and information gathering and processing. A very interesting emergent finding from their study is that multimorbidity as measured by the Charlson comorbidity index was not a good predictor of episode complexity, as patients with multiple comorbidities often had simple hospital episodes while those without little comorbidity (low Charlson comorbidity score) had much more complex episodes with much less certain outcomes. The dynamics of those individual illness trajectories were not predicted by standard static disease based metrics nor supported by guidelines. Individual trajectories or journeys is a recurring theme in the developing CAS approaches in health care, representing the opportunity for responding to health status dynamics in a timely manner.7 This notion of intellectual work and time as markers of clinical complexity was also raised by Katerndahl et al in a previous analysis of medical work across clinical specialities.8 In complex systems, as the information in the input increases linearly, the complexity of the system increases exponentially. Thus, a simple rule is suggested, that clinical work complexity reflects the amount of care provided weighted by its diversity and variability. Primary care, because of its diversity and variability, scores highly on the amount of work demanded of its practitioners. In this theme, Fink et al9 describe the application of a clinical tool—Diagnostic Protocols (DP)—in a single handed practice over a 14-year period. Based on several decades of work by Braun and colleagues, DP represents a series of simple rules to reduce uncertainty in primary care presentations of serious conditions that may seem at first contact to be routine and non-serious. Here, we have the common theme of simple rules to identify courses of action related to simple and complex dynamics in patient trajectories over time in clinical care. At an organizational level, leadership is a crucial element of success, and its role is recognized as an important factor for achieving better performance and optimizing health improvements for patients. Horvat and Filipovic,10 using complexity leadership theory, identified three types of leadership and matched them to indicators of organizational maturity. Administrative leadership is grounded in traditional, bureaucratic notions of hierarchy, alignment, and control. Enabling leadership structures and enables conditions in which CAS can optimally address creative problem solving, adaptability, and learning. Adaptive leadership exemplifies a generative dynamic that underlies emergent change activities. Organizational maturity promotes organizational learning, enables effective and efficient management performance, reduces errors, and adapts to internal and external dynamics. Sustained success can be achieved by the effective management of the organization, through awareness of the organization's environment, by learning, and by the appropriate application of either improvements, or innovations, or both.11 Their survey of Serbian managers supported the hypothesis that administrative leadership had little influence on any maturity category of health care organizations. Adaptive and enabling leadership had greater association with managerial maturity. However, both adaptive and enabling leadership were also correlated with administrative leadership reflecting the entanglement of traditional structures and cultures of health care organizations with bottom-up informal emergent forces. A question that might be asked is: whether administrative leadership maintain the status quo by constraining emergence and self-organization to the detriment of organizational adaptability and learning? On an optimistic note, de Bock et al12 provide a case study of such bottom-up informal complex adaptive forces that successfully shifted clinical decision-making from professional silos into transdisciplinary inter-professional working. These shifts were driven by the internal and external tensions about caring for a longitudinal patient journey beyond technical rescue. The personal power of the nurses who were by the bedside, and their "bottom-up" understanding of the patient's needs, catalysed interdependent interactions and self-organization within the different professional groups. Care was thus adapted to patient-centred approaches beyond reductionist repair modes of thinking. This Forum highlights this emerging implementation of practical, but early stage CAS approaches to improving the outcomes of clinical care and health care more generally. To progress, a vision and practical goals for the shift needed from a conservative medical hierarchical disease focus, toward a more integrated biopsychosocial dynamic interactive ways of thinking about health.3 Tools to enable such implementation are needed, and four different practical approaches to deploy CAS theory in clinical care are highlighted that demonstrate innovation and adaptive thinking. They demonstrate a transition into enabling and adaptive leadership roles from the bottom-up. Yet the paper by Horvat and Filipovic provides some explanation about the slowness of the such transitions related to the challenges to complexity based leadership, with the ever-present dominant conservative health organizations. Administrative leadership models and cultures seeks to maintain the status quo and, for all intense and purposes, stand in the way of innovation and the emergence of "adapting and innovative" processes of care, system organization, and leadership. The International Organization for Standardization, a worldwide federation of national standards bodies (ISO member bodies), states that achievement of sustained success for any organization in a complex, demanding, and ever-changing environment requires enabling and adaptive leadership in health organizations.11 Health care will have to go through a huge cultural change to improve its organizational maturity with enabling and adaptive leadership. There is a need to successfully shape new ways of working and organizing in the evolution of health care. The role of adaptive leadership, as Ron Heifetz pointed out so eloquently, is not to solve problems, but rather to facilitate the necessary adaptive work of the people directly confronting the problems, often in the front-line in health care.13

In popular dialogues, describing a system as "complex" is often the point of resignation, inferring that the system cannot be sufficiently described, predicted nor managed. Transport networks, management infrastructure and supply chain logistics are all often described in this way. Academic dialogues have begun to explore the collective behaviors of complex systems to define a complex system specifically as an adaptive one; i.e. a system that demonstrates 'self organising' principles and 'emergent' properties. Based upon the key principles of interaction and emergence in relation to adaptive and self organising systems in cultural artifacts and processes, this paper will argue that complex systems are cultural systems. By introducing generic principles of complex systems, and looking at the exploration of such principles in art, design and media research, this paper argues that a science of cultural systems as part of complex systems theory is the post modern science for the digital age. Furthermore, that such a science was predicated by post structuralism and has been manifest in art, design and media practice since the late 1960s.

PurposeThe aim is to investigate the state of complex adaptive system (CAS) theory in the organizational theory literature and to provide a map for future studies of CAS theory.Design/methodology/approachAbstracts were searched via electronic database and a range of recently published (1996‐2004) books and articles were identified that contained a relatively concise description of CAS. Content analysis is used to deconstruct the CAS descriptions into “component concepts.” Those concepts are analyzed from multiple viewpoints.FindingsThere is no single, shared, sense of CAS theory. Differing understandings of CAS theory are identified based on “expert version” and “most popularly identified concepts.” Also, differences and similarities are identified between an “academic” version of CAS and a version developed by those who are influenced by both academic learning and practical experience.Research limitations/implicationsStudy is limited to concise definitions of CAS, so could be improved by including more lengthy conversations. Additionally, study is limited to organizational theory, so may be less applicable in other disciplines.Practical implicationsWhen working within a CAS framework, academics should specify their CAS perspective to improve clarity of their work. When using a CAS framework to study organizations, researchers should include a comprehensive suite of concepts. Though not described in depth, no effective application of CAS for organizational change were found.Originality/valueFor those who study CAS theory and theory of theory, this paper provides an important benchmark by identifying a bifurcation in the evolution of CAS theory.

A model of nursing as a complex adaptive system

This article applies complex adaptive system (CAS) theory to research the growth path of OEM upgrades to OBM, and points that growth path of OEM upgrades to OBM is a complex adaptive system, analyzes the complex adaptive system features of OEM upgrades to OBM; and then researches the interaction between agents, open, tagging, diversity, self-organization and so on aspects of the system, and further discuss the growth path of OEM upgrades to OBM.

IntroductionThe human body's response to pain is indicative of a complex adaptive system. Therapeutic yoga potentially represents a similar complex adaptive system that could interact with the pain response system with unique benefits.ObjectivesTo determine the viability of yoga as a therapy for pain and whether pain responses and/or yoga practice should be considered complex adaptive systems.MethodsExamination through 3 different approaches, including a narrative overview of the evidence on pain responses, yoga, and complex system, followed by a network analysis of associated keywords, followed by a mapping of the functional components of complex systems, pain response, and yoga.ResultsThe narrative overview provided extensive evidence of the unique efficacy of yoga as a pain therapy, as well as articulating the relevance of applying complex systems perspectives to pain and yoga interventions. The network analysis demonstrated patterns connecting pain and yoga, while complex systems topics were the most extensively connected to the studies as a whole.ConclusionAll three approaches support considering yoga a complex adaptive system that exhibits unique benefits as a pain management system. These findings have implications for treating chronic, pervasive pain with behavioral medicine as a systemic intervention. Approaching yoga as complex system suggests the need for research of mind-body topics that focuses on long-term systemic changes rather than short-term isolated effects.

This paper will explore the concept of resilience from its roots in ecology to the application of this ecological concept of resilience to social and community resilience in the context of climate change. In this context, resilience is seen as a property of complex adaptive communities rather than of individuals. This paper will explore how this ecological concept of resilience has been taken up both by climate adaptation research and by the Transition Town movement. This ecological concept of resilience is at odds with the individualism of both psychological and economic approaches to resilience in relation to climate change.

Emergence in stigmergic and complex adaptive systems: A formal discrete event systems perspective

PurposeWith the rapid spread of COVID-19 across the world, the consideration of effective communication strategies from Wuhan can provide valuable insight to other countries in how to manage their risk response. This study analyzes the building of a risk communication system in Wuhan, China, to aid cross-country comparison from a policy and academic perspective.MethodsWe use complex adaptive systems theory (CAS) to theorize the communication strategy adopted by the government – led by the Hubei Province COVID-19 Epidemic Prevention and Control Headquarters. Using ethnographic fieldwork and discourse analysis, we observed and analyzed the online and offline communication process to formulate an overview of the communications platforms used in Wuhan.ResultsWuhan’s adaptive crisis communication system was backed by digital and offline infrastructure, human resources support, policy development, as well as access to scientific and technological expertize. The Wuhan municipal government adapted its communication strategy in response to public feedback, and created mechanisms to ensure that two-way communication was used to drive policy and integrate feedback from the government, enterprises, social organizations and the public. Wuhan’s risk and crisis communication strategy aimed to meet emergency commitments, recover trust, regulate the public’s emotions and build consensus, operating within a complex adaptive system (CAS).ConclusionBy using complex adaptive system (CAS) theory, we argue that Wuhan quickly built an adaptive communication system consisting of five elements: 1) non-linear information output, 2) online and offline continuous support systems, 3) a public emotional support system, 4) multi-subject information interaction platforms and 5) a context-based approach.

This project investigates the issue of unwarranted escalation of commitment in the toy retailing business. Unwarranted escalation of commitment refers to situations where decision-makers allocate additional resources to failing courses of action. In addition this project aims to identify several complex adaptive system issues within the toy retailing industry in Australia, proposing that the industry satisfies the underlying assumptions of a complex adaptive system. The project is a part of a larger program initiated by Dr. Drew Wollin in pursuing the dual themes of unwarranted escalation of commitment and complex adaptive systems. The Australian toy retailing industry has, since the entrance of the two category killers World 4 Kids and Toys R Us in 1993, been undergoing some major competitive changes. Their entrance was predicted to boost sales and both were aiming for a market share of 20 per cent by late 1995. However, sales remained flat and the objectives were never achieved. After severe price wars and pushed margins, the two giants lost money every year in the period 1993 to 1998, with individual accumulated losses of approximately AU$ 200 million. This project addresses how the organisations persisted as failing ventures. In particular, did they experience unwarranted escalation of commitment to failing courses of action? While there is a lot of contemporary literature in the area of escalated commitment, there is limited research that examines the phenomenon at an organisational level. The most notable exceptions are the case studies by Ross and Staw (1986, 1993) and Newman and Sabherwal (1996). The former investigated a world fair held in Canada (1986) and a decision to set up a nuclear power plant in the US (1993), while the latter examined organisational escalation of commitment in information systems development. This earlier work indicates that models of organisational unwarranted escalation of commitment have not reached theoretical saturation. The two models available, the non-cyclic model (Ross and Staw, 1993) and the cyclic model (Newman and Sabherwal, 1996), are quite different by nature. However, they agree on the escalation determinants. These are project, psychological, social, organisational (structural), and contextual determinants, which are all (to different extents) addressed in this research. Limited amount of theory has investigated complex adaptive systems in organisational and industrial contexts. This study explores whether the theory of complex adaptive systems may contribute to more fully understand the phenomenon of organisational escalation of commitment. A three-level methodological design is proposed in order to address the relevant issues. The macro-research design is analytic induction. This study is part of ongoing research program and performs one iteration of the analytic induction process. The meso-research design is case study research, whereas the micro-research design employed is historical research, based primarily on secondary evidence. Three significant modifications to existing escalation theory are suggested. First, social determinants were found to be important in all phases of the project. As this is one of few studies investigating unwarranted escalation in competitive environments, it is proposed that game theory aspects be incorporated in the social determinants. Second, organisational determinants were significant in the initial commitment decision processes. Third, contextual determinants were to a greater extent present at all stages. This study argues that the Australian toy retailing industry is a complex adaptive system, and displays behaviour expected from such systems. It is suggested that more research be done aiming to provide explanation of organisational unwarranted escalation in terms of behaviour expected from complex adaptive systems.

The emergence and use of complex adaptive systems remedied the need for a new alternative by resorting to existing paradigms. Both the health care system and nursing can be regarded as complex adaptive systems by applying a visual model that should be explored to empower the complexity of the science of nursing and health care. Viewed from this perspective, a nurse is a complex adaptive system, one that is dynamic and interacts, but is also an agent of a complex adaptive system in a nursing unit, which in turn is a complex adaptive system in a health organization. Today, nursing professionals seek to be current in terms of training and skilled in a variety of special fields, ranging from neonatal nursing to geriatric care, in order to do their job and to envision a working environment from the perspective of a complex system. Consequently, through complex systems based on shared knowledge among various professional and teamwork, organization of the health-care system is able to enjoy the support of the client-user-professional chain.

Complex Adaptive Systems of Systems, or CASoS, are vastly complex physical-socio-technical systems which we must understand to design a secure future for the nation. The Phoenix initiative implements CASoS Engineering principles combining the bottom up Complex Systems and Complex Adaptive Systems view with the top down Systems Engineering and System-of-Systems view. CASoS Engineering theory and practice must be conducted together to develop a discipline that is grounded in reality, extends our understanding of how CASoS behave and allows us to better control the outcomes. The pull of applications (real world problems) is critical to this effort, as is the articulation of a CASoS Engineering Framework that grounds an engineering approach in the theory of complex adaptive systems of systems. Successful application of the CASoS Engineering Framework requires modeling, simulation and analysis (MS and A) capabilities and the cultivation of a CASoS Engineering Community of Practice through knowledge sharing and facilitation. The CASoS Engineering Environment, itself a complex adaptive system of systems, constitutes the two platforms that provide these capabilities.

Complex adaptive systems are a special kind of system with emergent properties and adaptive capacity in response to external environmental conditions. In this chapter, I investigate the proposition that international environmental law, as a set of multilateral environmental agreements, exhibits the characteristics of a complex adaptive system. This proposition is premised on the scientific understanding that the subject matter displays properties of a complex adaptive system. If so, the legal system may benefit from the insights gained and from being modeled in ways more appropriately aligned with the functioning of the Earth system itself. I provide as context a scientific explanation of the Earth system as a complex adaptive system. I then consider if international environmental law can be understood as a system, which is complex and adaptive. From this exploratory review, I found evidence suggesting that international environmental law is a system with interactive elements. I also found indications of self-organization and emergence, suggesting that international environmental law is a complex system. However, it is still questionable whether the legal system has been autonomously adaptive to and co-evolving with global environmental and geopolitical change in ways that lead to net environmental improvement.

This doctoral thesis is centered around an Action Research inquiry aimed at revamping the ethics advisory practice at Dealers R’Us Ltd., an automotive management consulting firm located in Ontario, Canada. The inquiry occurred in four phases and over two action cycles. In Phase I, a semi-structured questionnaire administered to eighty automotive dealers and salespeople at four client organizations suggested that the firm’s ethics consulting practice was not adaptive to varied situational contexts and unpredictable changes in the regulatory domain. This resulted in abysmal ethical compliance rates, regulatory fines, and general client dissatisfaction. A thematic analysis of open-ended responses provided by respondents yielded five broad themes - knowledge gaps, organizational structure, interpersonal relationships, internal collaboration, and service design. The objective of this interventive research is to create an agile ethics advisory practice through the generation of actionable knowledge that addresses the aforementioned thematic angles. By leveraging the emancipatory capacity of social constructivism in Phase II, an internal focus group comprising of fifteen stakeholders, utilized Soft System Methodology, an Action Research approach to elucidate the organizational problem. The structured inquiry culminated in the first cycle of remedial actions with implications for the firm’s personnel, internal politics, corporate structure, and go-to-market strategy. In Phase III, organizational outcomes were validated internally and externally through the reflexive analysis of data collected with semi-structured questionnaires and focus group interviews in the post-intervention era. Open-ended responses were explored using thematic analysis. Due to the small size of the firm, a total population sampling strategy was adopted within the organization encompassing all twenty internal stakeholders. Critical case data sampling was carried out at a representative client site in a test case ethical compliance consulting project that involved twenty-eight external stakeholders. In the post-intervention survey, 87% of the external respondents agreed that Dealers R’Us’ ethics and ethical compliance program became responsive to varied and evolving ethical compliance needs in Ontario’s automotive retail industry. In contrast, only 16% of survey respondents agreed with the same statement in the pre-intervention phase. This outcome resulted from a reduction in consultant knowledge gaps; a transition from a hierarchical functional organizational structure to a matrix structure comprised of interdisciplinary teams; a deliberate focus on improving interpersonal relationships between consultants; the equalization of power within the firm and a service redesign effort that entailed the field colocation of interdisciplinary teams. In Phase IV, this outcome informed a second action cycle geared towards an entrenchment of the transformative research agenda. Based on agreements in management literature, I conceptualized agility using ideas from Complex Adaptive Systems (CAS) theory including self-organization and spontaneous emergence. Other applied theories include Social Identity Theory and Contingency Theory. The results obtained challenge the traditional approach to ethics consulting. They inspired the development and recommendation of a Conceptual Framework for Agile Ethics Consulting to the firm. This original contribution to ethics advisory practice and consulting literature codifies relevant agility drivers, enablers, capabilities and practices. Foundational recommendations border on data proximity, selective contingency, the establishment of active feedback loops, incremental solution execution; the attainment of a common internal identity and the incentivization of strong interpersonal bonds within the firm. For automotive dealerships, this inquiry provides accessibility to custom-tailored ethical compliance programs, higher compliance rates and the mitigation of risks and liabilities resulting from non-compliance. In a reflective manner, I draw conclusions on the post-intervention status of the ethics practice under review based on CAS theory metrics. In addition to taking stock of my scholar-practitioner experience, I also discuss transitions in my leadership philosophy. The small size of Dealers R’Us translates into a relatively small sample size. This is a research limitation that must be considered when interpreting the outcomes of this research. The collection of data from external sources at different intervals and the utilization of multiple dialectics afforded by Soft System Methodology helped to seek out disconfirming evidence and mitigate this limitation. The infancy of the proposed conceptual framework makes it an appropriate target for future research and validation.

To discuss multiple organ dysfunction syndrome (MODS) from a complex systems' theory perspective and to delineate a conceptual framework for the development and care of MODS. MODS is an intricate and devastating manifestation of critical illness characterized by widespread aberrant molecular, cellular and systemic responses. Narrative literature review (MEDLINE, CINAHL databases) and knowledge synthesis with the theoretical assertions of chaos and complex systems' theory. Cellular and systemic response paradoxes in MODS (including cellular hypoxia, cell death and signalling) are reviewed. The diseased person is depicted as a complex adaptive system. The relevancy of some of the principles of complex chaotic systems' theory to the proposed model is illustrated, including sensitive dependence on initial conditions, emergence, attractors, self-organization, self-organized criticality and emerging order. The transition from life-supporting to death-related organismic responses is illustrated as a critical event in MODS and care implications are drawn. Patient responses in MODS appear to conform to the principles of chaotic systems. Death is illustrated not as a consequence of homeostatic failure but as a 'deliberate' self-organized phenomenon entailing multiple dynamically evolving mechanisms. Some of the principles of chaotic complex systems may need to be taken into account to advance care in MODS. An alternative theoretical perspective may support nurses to conceptualize both MODS and their role in a way that will help them to cope better with this devastating syndrome and develop practice.