Complex Adaptive Systems Perspective Research Articles

Person-centered medicine from a complex adaptive systems perspective

Miles and Mezzich have proposed person-centered medicine as the way forward to overcome the rapidly escalating crisis of dehuminisation of medical care and the healthcare system at large. The crisis in medical care is caused by a Zeitgeist characterised by 2 themes – conquering disease and profit maximising activities. Overcoming this crisis requires a change of the prevailing worldview and its reductionist thinking about discrete diseases to a worldview that recognises the complexities arising from the interconnections and interdependencies between all facets of a person’s life – his health and illness and disease trajectories. As Kant said: each man has his particular way of being in good health.This paper presents 5 themes that argue for a complexity based framework to achieve a person/patient-centered understanding of health and healthcare: (1) health, illness and disease are complex adaptive states that impact personhood; (2) healthcare must grow health; (3) healing results from personal sense-making and must be fostered; (4) complex adaptive systems thinking allows an exploration and understanding of personal and community health issues and (5) person/patient-centeredness results in an effective and efficient healthcare system.A person/patient-centered focus, the person/patient at the centre of concern, will result in a seamlessly integrated healthcare system. Such a system will show great diversity between communities, each having emerged as a result of best adaptation to local circumstances. Such a system will have substantial benefits – for the person (in terms of staying healthy) / patient (in terms of regaining his health), the community and the economy.

How to Make Development Plans Suitable for Volatile Contexts

Development plans are central tools in spatial planning practice. They create a vision of how places should develop and prescribe how desired patterns of development will be realized. However, development plans are increasingly regarded as inflexible and even rigid when confronted by changes in their context. Conceptualizing urban districts in terms of complex adaptive systems (CAS), this paper identifies ways in which more flexible development plans can be designed. This is investigated through a case study of a development plan for Blauwestad in the Netherlands, which enabled sources of rigidity to be analysed. The paper concludes with the view that from a CAS perspective, development plans are part of the structures necessary to facilitate self-organization, and if designed with certain principles in mind, can play a key role in assisting the endogenous evolution of spatial developments.

Institutionalizing Patient Safety Culture: A Strategic Priority for Healthcare in India

Fledgling steps in the form of policy measures, surveillance mechanisms and safety initiatives have been taken in the Indian healthcare context to address the increasing evidence base of patient safety events. The paper examines whether structural and processual measures alone would contribute to safer care. The article posits that healthcare organisations in India need to look beyond the structural-procedural efforts and evaluate an essential component of healthcare which serves to bind these efforts; that of safety culture. The paper draws on literature from health services and safety culture research as well as news articles in order to examine adverse incidents in care, safety theories and assess whether structural and procedural efforts would alone contribute to safer care. The review examines the current burden of adverse events in care as well as patient safety initiatives in the Indian context. An emergent strategy comprising policy, regulatory and structural measures has evolved over a period of time to address various facets of patient safety. Global research evidence over the years suggests that such structural-processual measures alone have not been able to address the burden of adverse events in care. Safety culture has emerged as an important concept binding quality and performance measures in most high-risk organizations including healthcare. Institutionalizing safety culture has become a strategic priority in most health care organisations globally. Taking a complex adaptive system perspective, the paper argues that synergizing policy, regulatory and structural-processual measures with safety culture engineering at multiple levels would fetch greater dividends in the Indian patient safety landscape.

A complex adaptive systems perspective of innovation diffusion: an integrated theory and validated virtual laboratory

In this paper we integrate the rich yet fragmented insights from the extensive literature on the diffusion of innovation into an elegant, coherent model. Using complex adaptive systems theory as the overarching framework, we integrate prior literature around three constructs: agents, interactions, and an environment. The integrated model is presented in both natural language and as an agent-based simulation model. A series of validation experiments instill confidence that our agent-based model (and similar others) can be used as a virtual research laboratory. We provide theoretical and methodological directions for future research.

The reconstruction of narrative identity during mental health recovery: A complex adaptive systems perspective.

1) to understand the reconstruction of narrative identity during mental health recovery using a complex adaptive systems perspective, 2) to address the need for alternative approaches that embrace the complexities of health care. A narrative review of published literature was conducted. A complex adaptive systems perspective offers a framework and language that can assist individuals to make sense of their experiences and reconstruct their narratives during an often erratic and uncertain life transition. It is a novel research direction focused on a critical area of recovery and addresses the need for alternative approaches that embrace the complexities of health care. A complexity research approach to narrative identity reconstruction is valuable. It is an accessible model for addressing the complexities of recovery and may underpin the development of simple, practical recovery coaching tools.

Learning from failed supply chains: the application of complex adaptive systems and a modified SAFE framework in evaluating proposed system improvements

This paper developed a framework for evaluating and improving failed supply chains, based on two case studies set in the mango industry of Indonesia, a developing country. It analysed the cases from a complex adaptive systems (CAS) perspective and applies a sustainability, acceptability, feasibility, efficiency (SAFE) framework. The paper also identified issues relevant to supply chain sustainability in a developing country context. Improvements were suggested from the identification of system-level leverage points through a process of cross case analysis, supported by interviews and consensus-seeking focus groups with multiple stakeholders. Using a modified SAFE framework, proposals for system improvements were identified for setting-up the system, measuring system performance, and establishing the behaviours of the system. Lessons learned from these two cases of supply chain failure centred on increasing learning capacity, establishing commitment among stakeholders and lowering the resistance of the system environment.

A problem structuring method for ecosystem-based management: The DPSIR modelling process

The purpose of this paper is to learn from Complex Adaptive Systems (CAS) theory to inform the development of Problem Structuring Methods (PSMs) both in general and in the specific context of marine management. The focus on marine management is important because it is concerned with a CAS (formed through the interconnection between natural systems, designed systems and social systems) which exemplifies their particularly ‘wicked’ nature. Recognition of this compels us to take seriously the need to develop tools for knowledge elicitation and structuring which meet the demands of CAS. In marine management, chief among those tools is the DPSIR (Drivers – Pressures – State Changes – Impacts – Responses) model and, although widely applied, the extent to which it is appropriate for dealing with the demands of a CAS is questionable. Such questioning is particularly pertinent in the context of the marine environment where there is a need to not only recognise a broad range of stakeholders (a question of boundary critique) but also to manage competing knowledge (economic, local and scientific) and value claims. Hence this paper emphasises how a CAS perspective might add impetus to the development of a critical perspective on DPSIR and PSM theory and practice to promote a more systemic view of decision-making and policy development.

Reframing the challenges to integrated care: a complex-adaptive systems perspective.

Despite over two decades of international experience and research on health systems integration, integrated care has not developed widely. We hypothesized that part of the problem may lie in how we conceptualize the integration process and the complex systems within which integrated care is enacted. This study aims to contribute to discourse regarding the relevance and utility of a complex-adaptive systems (CAS) perspective on integrated care. In the Canadian province of Ontario, government mandated the development of fourteen Local Health Integration Networks in 2006. Against the backdrop of these efforts to integrate care, we collected focus group data from a diverse sample of healthcare professionals in the Greater Toronto Area using convenience and snowball sampling. A semi-structured interview guide was used to elicit participant views and experiences of health systems integration. We use a CAS framework to describe and analyze the data, and to assess the theoretical fit of a CAS perspective with the dominant themes in participant responses. Our findings indicate that integration is challenged by system complexity, weak ties and poor alignment among professionals and organizations, a lack of funding incentives to support collaborative work, and a bureaucratic environment based on a command and control approach to management. Using a CAS framework, we identified several characteristics of CAS in our data, including diverse, interdependent and semi-autonomous actors; embedded co-evolutionary systems; emergent behaviours and non-linearity; and self-organizing capacity. One possible explanation for the lack of systems change towards integration is that we have failed to treat the healthcare system as complex-adaptive. The data suggest that future integration initiatives must be anchored in a CAS perspective, and focus on building the system's capacity to self-organize. We conclude that integrating care requires policies and management practices that promote system awareness, relationship-building and information-sharing, and that recognize change as an evolving learning process rather than a series of programmatic steps.

A Complex Adaptive Systems View of Resilience in a Project Team

Using a complex adaptive systems perspective, this case study explored project team resilience through analysis of group development and panarchy. Three research questions focused on a team's consciousness of a need to change under adversity, its response through adaptive action, and its potential for innovation through creative destruction. The subject team consisted of approximately 200 students, building a solar house over a 2‐year period in an international competition sponsored by the US Department of Energy. A multilevel analysis culminated in an integrated systems perspective with conclusions, specifically the role of environmental feedback. Implications suggest using complex adaptive systems as a theoretical foundation for studying group development, as well as organizational culture, inflection points, nested adaptive cycles, emergence of leadership, and emergence of innovation. This research contributes a deeper understanding of project team resilience in organizational systems such as companies, non‐profits, governmental, and non‐governmental entities by revealing the importance of building adaptive capacity through organizational learning. Copyright © 2012 John Wiley & Sons, Ltd.

The Challenge of Adaptive Capability in Public Organizations

This article describes an attempt within the Danish Crime Prevention Council to improve adaptive capability. The article applies a complex adaptive system perspective and analyses the organizational identities of the Council to determine how processes of integration, differentiation and fragmentation influence adaptive capability. The findings emphasize the importance of path dependency in actor's attempts to adapt. Based on this finding, the article suggests that the complex adaptive system perspective can be enriched by an institutional theory.

Partnership Working in Public Health: The Implications for Governance of a Systems Approach

Most of the research on partnerships has centred on health and social care, and while many of the findings remain relevant, public health partnerships concerned with 'wicked issues' give rise to a different and more complex set of issues which merit exploration. The study aimed to identify those factors promoting effective partnership working for health improvement; to assess the extent to which partnership governance and incentive arrangements were commensurate with the complexities of the problem; and to explore how far local partnerships contributed to better outcomes for individuals and populations. A three-year study of public health partnerships (2007-10) in nine localities across England involving semi-structured interviews at strategic and operational levels. Successful partnerships shared a number of characteristics: they were clear about goals and purpose; they were aware of partners' roles and responsibilities; and they had a clear strategic overview of performance through robust monitoring and evaluation. In many cases, partnerships were facades with a 'silo mentality' prevailing - there was an unwillingness to share information or resources, or to accord partnership working sufficient priority or support. Despite enthusiasm for partnerships and an insistence that they were essential, it was impossible to establish evidence of their impact on health outcomes. While the focus on partnerships tends to be on structures, relational factors, including high levels of trust and goodwill, were important ingredients of a well-functioning partnership. Less formal and more organic, operational partnerships were more effective than more formal, strategic level ones which were driven by targets. Finally, partnerships were, in part, shaped by the national policy context, with constant policy and organizational churn making it difficult to sustain long-term relationships. Future partnerships might be undertaken differently, adopting a complex adaptive systems perspective. This advocates an approach to partnership working that is less focused on rigid structures and much more on relational factors like trust and goodwill.

Research on the evaluation model of Chinese enterprises' technological innovation system

PurposeThe purpose of this paper is to focus on the evaluation model of the enterprises' technological innovation system, based on the theory of complex adaptive system.Design/methodology/approachCombined with the status quo and recent studies of Chinese enterprises' technological innovation, the paper discusses the complex‐system features of the technological innovation. The stimulus‐response model is used to establish the two‐level framework for enterprises' technological innovation system. By means of the adaptive fitness function, the economic and social utility of enterprises' technological innovation is measured from two dimensions. Finally, the fuzzy catastrophe model is introduced to evaluate the enterprises' technological innovation.FindingsThe enterprises' technological innovation system has attributions of the subject aggregation, the systematic openness, nonlinearity and diversity. Thus, the macro‐micro based technological innovation system from the perspective of complex adaptive system is proposed. The system utility is considered based on the system subjects and system structure, and the calculation framework of the adaptive fitness for the whole system is obtained by considering the emergent property describing the system scale effect and structure effect. In fact, the fuzzy theory can well reflect the influential situation that the interactions between different factors may cause the mutation of the higher level and the interactions between enterprises can lead to the shifts of the system.Originality/valueThe paper proposes the complex adaptive system for the enterprises' technological innovation based on the special macro environment in China. A new framework for the research of technological innovation is provided by analyzing the system inner model. Fuzzy catastrophe model can reduce the evaluation irrationality due to the subjective index weights.

A Conceptual Model for Developing Mindsets for Strategic Insight Under Conditions of Complexity and High Uncertainty

This article addresses an important, yet often underattended to, aspect of the strategy development process: fostering the use of strategic learning practices in the simultaneous practice of developing strategy and cultivating strategic mindset awareness. The need for addressing this aspect of the strategy development process is increasingly important because of the intensifying complexity of the task environment. Following a framing of this context in terms of a complex adaptive systems perspective, a conceptual model for addressing this strategic HRD challenge is presented. The model is based on two distinct, yet in terms of potential implications for HRD practice, interconnected streams of literature: strategic learning practices, and adult development theory (specifically, constructive developmental theory and developmental action inquiry). The implications for HRD practices seeking to address this need, along with implications for future research, are also discussed.

Capturing the Complexity of Evaluations of Health Promotion Interventions: A Scoping Review

Abstract: Evaluation designs that can capture the complexity of health promotion (HP) interventions are needed. Our objective was to assess if such evaluations use a Complex Adaptive Systems (CAS) perspective, by using a scoping review of evaluations of HP interventions concerning alcohol and tobacco use in the peer-reviewed (PR) and grey literature (GL). We developed indicator questions to assess CAS aspects. Our study revealed that none of the 45 PR and 9 GL evaluations that we reviewed explicitly used a CAS perspective; however, most indirectly assessed complexity aspects. Our indicator questions are a step toward addressing the challenges of the practical application of a CAS perspective.

Complex adaptive systems for management of integrated care

PurposeThe purpose of this paper is to examine how a complex adaptive systems (CAS) approach can be used to promote the integration of health and social care for the benefit of the user.Design/methodology/approachThis paper is a research review and a conceptual analysis of key issues identified in the growing literature on CAS. An application of the CAS approach to the field of integrated care is presented. The paper identifies crucial issues, notably: bringing together different providers and the place of the user as a co‐producer of care.FindingsThe benefits of the CAS approach to integrated care are distilled. Above all CAS provides managers of health and social care with an alternative mindset. Guiding principles are offered to these managers to facilitate development towards a more integrated system of health and social care. The possibility to benefit from the user's own resources is increased when organizations are viewed from a CAS perspective. CAS promotes emergent ways of working.Practical implicationsThe CAS approach makes possible a significant improvement in relationships between providers and users and managers and providers; a possibility of more productive relationships and better care outcomes, not least in terms of user satisfaction.Originality/valueThe paper shows that CAS literature applied to the health and social care field points the way for managers to rethink the functioning of the field, specifically to go beyond the present dominant but outdated machine model to one which encourages the cooperation of providers and users for better outcomes.

Understanding health system reform – a complex adaptive systems perspective

Everyone wants a sustainable well-functioning health system. However, this notion has different meaning to policy makers and funders compared to clinicians and patients. The former perceive public policy and economic constraints, the latter clinical or patient-centred strategies as the means to achieving a desired outcome. Theoretical development and critical analysis of a complex health system model. We introduce the concept of the health care vortex as a metaphor by which to understand the complex adaptive nature of health systems, and the degree to which their behaviour is predetermined by their 'shared values' or attractors. We contrast the likely functions and outcomes of a health system with a people-centred attractor and one with a financial attractor. This analysis suggests a shift in the system's attractor is fundamental to progress health reform thinking.

Critical Evaluation of Paradigms for Modeling Supply Chains as Complex Socio-Technical Systems

Each simulation paradigm is characterized by a set of core assumptions and some underlying concepts to describe the world. These assumptions, in fact, constrain the development of a conceptual model for the system of study. Consequently, the choice of appropriate simulation paradigm is an important step in model development process. In this paper, selection of a simulation approach for supply chain modeling is discussed. For this purpose, the supply chain is described from perspective of two well-established system theories. Firstly, supply chains are defined as socio-technical systems. Afterwards, they are described from complex adaptive systems perspective. This study gives a set of features for supply chains as complex socio-technical systems which is subsequently used to compare three simulation paradigms for supply chain modeling – namely, system dynamics, discrete-even simulation and agent-based simulation.

Infrastructure transitions towards sustainability: a complex adaptive systems perspective

To ensure infrastructure assets are procured and maintained by government on behalf of citizens, appropriate policy and institutional architecture are needed, particularly if a fundamental shift to more sustainable infrastructure is the goal. The shift in recent years from competitive and resource-intensive procurement to more collaborative and sustainable approaches to infrastructure governance is considered a major transition in infrastructure procurement systems. In order to better understand this transition in infrastructure procurement arrangements, the concept of emergence from complex adaptive systems (CAS) theory is offered as a key construct. Emergence holds that micro interactions can result in emergent macro order. Applying the concept of emergence to infrastructure procurement, this research examines how interaction of agents in individual projects can result in different industry structural characteristics. The paper concludes that CAS theory, and particularly the concept of ‘emergence’, provides a useful construct to understand infrastructure procurement dynamics and progress towards sustainability.

The Mentoring Relationship as a Complex Adaptive System: Finding a Model for Our Experience

Mentoring theory and practice has evolved significantly during the past 40 years. Early mentoring models were characterized by the top-down flow of information and benefits to the protégé. This framework was reconceptualized as a reciprocal model when scholars realized mentoring was a mutually beneficial process. Recently, in response to rapidly changing organizational and social environments, scholars have explored other models of mentoring such as developmental networks. However, as we, the authors, reflect on our own experience of an informal mentoring process in an academic context we find existing models inadequately describe our experience. The model that best fits our story is a complex adaptive systems (CAS) perspective of the mentoring relationship, and we offer this lens to reconfigure current models.

Accelerating STEM Capacity: A Complex Adaptive System Perspective

Journal of Engineering EducationVolume 100, Issue 3 p. 417-423 Accelerating STEM Capacity: A Complex Adaptive System Perspective Rick Stephens, Rick Stephens The Boeing CompanySearch for more papers by this authorMichael Richey, Michael Richey The Boeing CompanySearch for more papers by this author Rick Stephens, Rick Stephens The Boeing CompanySearch for more papers by this authorMichael Richey, Michael Richey The Boeing CompanySearch for more papers by this author First published: 02 January 2013 https://doi.org/10.1002/j.2168-9830.2011.tb00020.xCitations: 17AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume100, Issue3July 2011Pages 417-423 RelatedInformation