Principles Of Complexity Science Research Articles

Complexity Science and Myth in Big History

From early on, David Christian’s vision of big history as a “modern creation myth” faced criticism for introducing elements of spirituality. This essay contends that the resulting controversy arises from a misunderstanding of the nature of myth. The mainstream model of myth depicts it as fanciful stories of supernatural agents that members of a society use to address their anxieties. While this is often the case, the author argues that myth can be more profitably explored as a neurobiological imperative that plays a critical role in cultural evolution. To make this case, he examines how the principles of complexity science helped him understand how human history has gone through periods, such as the Axial Age and Modernity, when the change produced by societies’ greatest successes demanded new ways of thinking about the world in order for those societies to survive. He then examines current neurobiology to explain how reinventing myth has allowed such societies to transform in ways that enabled them to meet the challenges produced by change. With this understanding of myth, the essay concludes with a discussion of how the myth of big history can allow us to contribute to the new ways of thinking that are emerging today, as culture evolves so we can meet our current existential challenges.

The extended care team for people with multimorbidity as a complex adaptive system: How to raise the adaptability of your own team.

1.Short summary: Rapid changes in healthcare structure and demands require continuous adaptability of healthcare teams. This workshop will describe a case vignette of a patient with multimorbidity to start a theoretically underpinned reflection on how teams can be supported to adapt to changing contexts.
 2.Why: Traditionally healthcare delivery has been structured based on disease-specific guidelines, procedures and teams in which effectiveness and quality of interventions is often measured by means of disease specific clinical outcome indicators defined in disease-specific randomized clinical trials. However, for people with a combination of disorders or with a complex context, outcomes are often a lot more uncertain. In addition, patients with multimorbidity are often followed by different professionals in different healthcare and welfare services, each with their own perspective and priorities. Therefore, interprofessional healthcare teams often operate in complex situations. Moreover, they tend to operate in fragmented order throughout different primary and secondary healthcare and welfare services. Complexity science has been introduced in healthcare as a theoretical framework to better understand complex situations. Interdisciplinary healthcare teams can be viewed as Complex Adaptive Systems (CAS) by focusing more on the team members' interactions than on the characteristics of individual team members. Viewing teams in this way can provide us with insights into the origins of team behavior. Insights that can be supportive to improved team functioning and improved integrated care.
 3.Audience: Clinicians, teamleaders, managers
 
 Structure (90')
 
 Introduction (10') on changes in population needs (e.g. multimorbidity) and healthcare delivery (e.g. interprofessional collaboration) including the related challenges. The need for optimizing the adaptability of clinical teams towards this changing working context will be emphasized as focus of the workshop. Theoretical background on complexity science as a lens to better understand working in VUCA (volatile, uncertain, complex, ambiguous) conditions
 Group work (30') A case vignette will be provided of a patient with multimorbidity taken care of by a multiprofessional team. Based on the case vignette participants will fill in the CAL questionnaire (Complex Adaptive Leadership Organisational Capability Questionnaire). Group discussion on the meaning of the scores will be guided by the moderators
 Theory (10')The constructs of the Questionnaire will be explained and the use of the questionnaire as a monitoring tool during team transitions will be discussed
 Group work (10') discuss/brainstorm about strategies to influence the topics defined in the different questions of the questionnaire.
 Reporting back (20') small groups will report back about the strategies they have defined for each question.
 Wrap up and key messages (10') Two minutes of repetition of the theoretical principles of complexity science in healthcare by the moderators. Group formulation of preferred strategies defined during the workshop to optimize the adaptability of clinical teams in working with complex patients
 5.How to engage
 Small group discussions – plenary discussions
 Case vignette – clinical reflection – brainstorm
 Dscussion on transferability of ideas to real world situation
 6.Take home messages?
 Partly by moderators, partly by participants
 One pager with theoretical underpinning + further reading suggestions will be provided

Simplifying complexity science principles: developing healthcare faculty for using simulation as an educational method

Professional development in simulation-based education (SBE) is a complex process. Individual components have overlapping boundaries and relationships, rendering them suitable for Complex Adaptive Systems (CAS). This complexity is multifold in low-resource settings, unfamiliar with simulation, and augmented by hierarchical culture and linguistic diversity. This study aimed to conduct a professional development course through SBE using principles of CAS for faculty in a Pakistani medical college. A simulation educator team (six on-site, three online) from Pakistan and North America constructed and facilitated a 6-hour-long hybrid course following CAS in three phases. Planning phase consisted of needs assessment and inclusion of stakeholders in decision-making. Implementation phase involved remote facilitators joining the in-person team using Zoom and demonstrating evidence-based practices in case design, pre-briefing, facilitation and debriefing. In the evaluation phase, participants completed an immediate Twenty-three faculty members from basic medical ( We suggest using CAS as a framework for professional development programs to train faculty in simulation. A CAS framework can help the organizers to integrate systems thinking into educational interventions.

Describing the Value of Physical Therapy in a Complex System Using the Socio-Ecological Model

A system is a collection of entities (ie, widgets, molecules, people, businesses) that interact in such a way that their resulting collective behavior is not immediately apparent by viewing the collected items separately. Hospital-based health care meets the definition of a system, but further specification is helpful to describe the value of components in the system. Complexity science offers a chance to reconceptualize our understanding of health care to an environment of connected parts operating together and adapting on the basis of inputs and outputs. The purpose of this conceptual article is to apply complexity science principles to acute care physical therapy in order to provide perspective on the value of the physical therapist in the hospital environment and on the contextual factors that influence the profession's value. We present a model, the Socio-Ecological Model for Acute Care, and apply this model to physical therapy in order to describe the interrelated factors influencing the profession's value to individual patients, to the hospital units on which they practice, to the hospital system as a whole, and how they contribute to policy discussions. Yet, this value is difficult to distinguish due to the multifarious inputs into the system. Providing a clear description of the value of physical therapy in hospital settings is essential in our current health care environment that is increasingly cost-conscious. We provide perspective for clinicians and health care leaders while suggesting needs for future research.

The converging paradigms of holism and complexity: An exploration of naturopathic clinical case management using complexity science principles.

Traditional whole systems of medicine, such as naturopathy, are founded upon holism; a philosophical paradigm consistent with contemporary complexity science. Naturopathic case management is predicated upon the understanding of an intimately interconnected internal physiological and external context of the human organism-potentially indicating a worldview aligned with a complexity perspective. In this study we investigate naturopathic clinical reasoning using a complexity lens with the aim of ascertaining the extent of correspondence between the two. Mind maps depicting case presentations were sought from Australian degree qualified naturopaths. A network mapping was undertaken, which was then analysed in accordance with a complexity science framework using exploratory data analysis and network analysis processes and tools. Naturopathic case schematics, in the form of mind maps (n = 70), were collected, network mapped, and analysed. A total of 739 unique elements and 2724 links were identified across the network. Integral elements across the network were: stress, fatigue, general anxiety, systemic inflammation, gut dysbiosis, and diet. A modularity algorithm detected 11 communities, the primary ones of these representing the nervous system and mood; the gastrointestinal tract, liver, and nutrition; immune function and the immune system; and diet and nutrients. Naturopathic case management is holistic and based on a perspective of an integrated physiology and external context of the human organism. The traditional concept of holism, when subjected to a complexity lens, leads to the emergence of a contemporary holistic paradigm cognisant of the human organism being a complex system. The application of complexity science to investigate naturopathic case management as employed in this study, demonstrates that it is possible to investigate traditional philosophies and principles in a scientific and critical manner. A complexity science research approach may offer a suitable scientific paradigm to develop our understanding of traditional whole systems of medicine.

Emergent Intelligence in Smart Ecosystems: Conflicts Resolution by Reaching Consensus in Resource Management

A new emergent intelligence approach to the design of smart ecosystems, based on the complexity science principles, is introduced and discussed. The smart ecosystem for resource management is defined as a system of autonomous decision-making multi-agent systems capable to allocate resources, plan orders for resources, and to optimize, coordinate, monitor, and control the execution of plans in real time. The emergent intelligence enables software agents to collectively resolve conflicts arising in resource management decisions by reaching a consensus through a process of detecting conflicts and negotiation for finding trade-offs. The key feature of the proposed approach is the ontological model of the enterprise and the method of collective decision-making by software agents that compete or cooperate with each other on the virtual market of the digital ecosystem. Emergent intelligent systems do not require extensive training using a large quantity of data, like conventional artificial intelligence/machine learning systems. The developed model, method, and tool were applied for managing the resources of a factory workshop, a group of small satellites, and some other applications. A comparison of the developed and traditional tools is given. The new metric for measuring the adaptability of emergent intelligence is introduced. The performance of the new model and method are validated by constructing and evaluating large-scale resource management solutions for commercial clients. As demonstrated, the essential benefit is the high adaptability and efficiency of the resource management systems when operating under complex and dynamic market conditions.

Primary health care case management through the lens of complexity: an exploratory study of naturopathic practice using complexity science principles

BackgroundAdvances in systems science creates an opportunity to bring a complexity perspective to health care practices and research. While medical knowledge has greatly progressed using a reductionist and mechanistic philosophy, this approach may be limited in its capacity to manage chronic and complex illness. With its holistic foundation, naturopathy is a primary health profession with a purported alignment with a complexity perspective. As such this pilot study aimed to investigate the application of complexity science principles, strategies, and tools to primary health care using naturopathy as a case study.MethodsA network mapping and analysis of the naturopathic case management process was conducted. Mind maps were created by naturopathic practitioners to reflect their clinical conceptualisation of a common paper clinical case. These mind maps were inputed into Gephi, a network mapping, exploration, and analysis software. Various layouts of the data were produced, and these were analysed using exploratory data analysis and computational network analysis.ResultsSeven naturopathic practitioners participated in the study. In the combined network mapping, 133 unique elements and 399 links were identified. Obesity, the presenting issue in the case, was centrally located. Along with obesity, other keystone elements included: systemic inflammation, dysbiosis, diet, the liver, and mood. Each element was connected on average to 3.05 other elements, with a degree variation between one and 36. Six communities within the dataset were identified, comprising: the nervous system and mood, gastroinstetinal and dietary factors, systemic inflammation and obesity, the endocrine system and metabolism.ConclusionsThis pilot study demonstrates that it is feasible to apply a complexity science perspective to investigating primary health care case management. This supports a shift to viewing the human organism as a complex adaptive system within primary health care settings, with implications for health care practices that are more cognisant with the treatment of chronic and complex conditions and research opportunities to capture the complex clinical reasoning processes of practitioners.

Scar formation from the perspective of complexity science: a new look at the biological system as a whole.

A burn wound is a complex systemic disease at multiple levels. Current knowledge of scar formation after burn injury has come from traditional biological and clinical studies. These are normally focused on just a small part of the entire process, which has limited our ability to sufficiently understand the underlying mechanisms and to predict systems behaviour. Scar formation after burn injury is a result of a complex biological system-wound healing. It is a part of a larger whole. In this self-organising system, many components form networks of interactions with each other. These networks of interactions are typically non-linear and change their states dynamically, responding to the environment and showing emergent long-term behaviour. How molecular and cellular data relate to clinical phenomena, especially regarding effective therapies of burn wounds to achieve minimal scarring, is difficult to unravel and comprehend. Complexity science can help bridge this gap by integrating small parts into a larger whole, such that relevant biological mechanisms and data are combined in a computational model to better understand the complexity of the entire biological system. A better understanding of the complex biological system of post-burn scar formation could bring research and treatment regimens to the next level. The aim of this review/position paper is to create more awareness of complexity in scar formation after burn injury by describing the basic principles of complexity science and its potential for burn care professionals.

Risk-opportunity analysis for transformative policy design and appraisal

The climate crisis demands a strong response from policy-makers worldwide. The current global climate policy agenda requires technological change, innovation, labour markets and the financial system to be led towards an orderly and rapid low-carbon transition. Yet progress has been slow and incremental. Inadequacies of policy appraisal frameworks used worldwide may be significant contributors to the problem, as they frequently fail to adequately account for the dynamics of societal and technological change. Risks are underestimated, and the economic opportunities from innovation are generally not assessed in practice. Here, we identify root causes of those inadequacies and identify them to structural features of standard analysis frameworks. We use a review of theoretical principles of complexity science and the science of dynamical systems and formulate a generalisation of existing frameworks for policy analysis and the appraisal of outcomes of proposed policy strategies, to help better identify and frame situations of transformational change. We use the term “risk-opportunity analysis” to capture the generalised approach, in which conventional economic cost-benefit analysis is a special case. New guiding principles for policy-making during dynamic and transformational change are offered.

Applying Complexity Theory to a Hospital Complex Patient Care Program.

Increasingly, complexity science concepts are informing health care design and practice. The present paper describes the implementation of early complexity science principles in a Complex Care Program with the aim of strengthening the provision of integrated care. Grounded in cybernetic network theory, Stafford Beers Viable Systems Model [1] provided the guiding principles for the programs redesign. The Viable Systems Model with its broadly applicable principles [1], is now the conceptual model of information management in the program. Beers framework has enabled a relatively small number of clinicians to coordinate care for a large cohort of patients with significant clinical complexity, and a multitude of providers, in the community setting.

Beyond multimorbidity: What can we learn from complexity science?

Multimorbidity - the occurrence of two or more long-term conditions in an individual - is a major global concern, placing a huge burden on healthcare systems, physicians, and patients. It challenges the current biomedical paradigm, in particular conventional evidence-based medicine's dominant focus on single-conditions. Patients' heterogeneous range of clinical presentations tend to escape characterization by traditional means of classification, and optimal management cannot be deduced from clinical practice guidelines. In this article, we argue that person-focused care based in complexity science may be a transformational lens through which to view multimorbidity, to complement the specialism focus on each particular disease. The approach offers an integrated and coherent perspective on the person's living environment, relationships, somatic, emotional and cognitive experiences and physiological function. The underlying principles include non-linearity, tipping points, emergence, importance of initial conditions, contextual factors and co-evolution, and the presence of patterned outcomes. From a clinical perspective, complexity science has important implications at the theoretical, practice and policy levels. Three essential questions emerge: (1) What matters to patients? (2) How can we integrate, personalize and prioritize care for whole people, given the constraints of their socio-ecological circumstances? (3) What needs to change at the practice and policy levels to deliver what matters to patients? These questions have no simple answers, but complexity science principles suggest a way to integrate understanding of biological, biographical and contextual factors, to guide an integrated approach to the care of people with multimorbidity.

Applying systems and complexity science to real patient care.

To describe the application of systems and complexity science principles to real patient care. Our current global health care system is not sustainable. It is structured based on the principles of reductionist science, which was discovered and developed over the past 400 to 600 years. Because of increasing pace of change and increasing complexity in our world, we have increased fragmentation in our health care system leading to more harm and waste. Over 100 years ago, the principles of systems, or complexity, science were discovered, first in the discipline of physics. These principles accommodate the constant change and biologic variability in our world. While reductionist principles would be applicable in a static, mechanical world where parts of the system could be isolated, this does not exist in the real biologic world. For the past decade, our abdominal wall hernia team has been applying the principles of systems science to real patient care. Some of the tools we have applied include continuous quality improvement for whole hernia patient processes and non-linear analytical tools to gain insight to improve value-based outcomes. Until we learn to apply and scale these principles across our whole global health care system, we will continue to suffer the consequences of our current unsustainable system. We have learned that the application of systems and complexity science to real patient care can lead to lower costs and better outcomes in the context of patients with complex hernia problems. However, these concepts have not yet been adopted in our global health care system. Applying the principles of systems and complexity science to our global health care system has the potential to lower costs and improve patient outcomes for any patient care process to which it is applied.

Narrative instabilities

AbstractTaking Nabokov’sPale Fireas its tutor text, this chapter seeks to demonstrate that narrative functions as a complex or dynamic system. Due to the novel’s nonlinear and multiply configured format, a series of dissipative structures is provoked whereby states near equilibrium, on reaching states far from equilibrium under the weight of multiple causality, putting the system “beyond the threshold of stability” and “at the edge of chaos,” perpetually self-organize. Taking a cue from nonequilibrium thermodynamics, instabilities, it is argued, are inherent to narrative discourse. This calls into question the pertinence of the logic of linearity (“event A causes event B”) as well as the scope of such postulates as the isomorphic relation between sequence and narrative as a whole, a postulate that frames narrative as a closed system following the principle of conservation of energy in classical mechanics. As the poem “Pale Fire” in Nabokov’s novel advances linearly, it is constantly disrupted by the “Commentary” which is related to the poem only tangentially, each text fragmenting the other and self-organizing into new meanings. The effect is to render salient in narrative discourse the complexity science principles (in addition to those mentioned above) of irreversibility (the “arrow of time”) vs. reversibility, sensitivity to initial conditions, negative vs. positive feedback and the symmetry-breaking effects of bifurcation. The manifestation of these principles in Nabokov’s novel raises fundamental questions about the structuring of narrative, but also about the conceptual framework through which narrative at large might be approached.

“Hatred Is Tremendous Cement”: Complexity Science and Political Consciousness in Chaotic Times

The relationship between love and hatred is evident in Greek epic and myth, Greek philosophy, and in Jungian theory. This article examines the cement of hatred in light of the 2016 election of Donald Trump. It briefly discusses Andrew Samuel’s “action ethos” as a Jungian political response; Jung’s thoughts on emotion, conflict, and consciousness as they pertain to individuation; and the notion of the cultural complex developed by Singer and Kimbles. This framework is deepened with a short meditation on mythic Chaos and its close relationship with Eros as a generative, formative, and connecting principle. The last half of the article reaches across a disciplinary boundary to employ three principles of complexity science to understand Trump’s election and the world it has shaped: unpredictability, bifurcation, and autopoeisis. How might complexity theory help us to think differently about the eros of hatred in chaotic times, and what political actions might these thoughts inspire?

Evaluating a complex health promotion intervention: case application of three systems methods

Persistent challenges to public health and well-being are being addressed though complex interventions. Complex interventions are intentional processes designed to shift and realign the form and function of targeted system patterns by changing underlying system dynamics, structures, and conditions. The IM40 initiative was a complex health promotion intervention designed to address adolescent health and well-being through a developmental assets approach. The initiative sought to influence several levels simultaneously (e.g. individual, professional, procedural, and policy), compounding the complexity for implementation and evaluation. The purpose of this case study is to present the development and initiation of an evaluation approach based on systems thinking and complexity science principles, concepts, and methods. We used three systems methods, Group Model Building (GMB), viable systems model (VSM) assessment, and Social Network Analysis (SNA) to identify and examine underlying patterns and structures that influenced system-wide behaviors. Each method focused on a general systems-oriented question and illuminated stakeholder views of the IM40 theory of change, adaptive organization of multiple independent institutions, and relational ties among system actors. Collectively, the methods enabled us to describe systems change over time and examine shifts in boundaries, relationships, perspectives, and dynamics. The implications of this approach relative to typical evaluation activities in public health practice are contrasted and discussed.

The clinical educator and complexity: a review.

Complexity science perspectives have helped in examining fundamental assumptions about learning and teaching in the health professions. The implications of complexity thinking for how we understand the role and development of the clinical educator is less well articulated. This review article outlines: the key principles of complexity science; a conceptual model that situates the clinical educator in a complex system; and the implications for the individual, organisation and the system. Our conceptual model situates the clinical educator at the centre of a complex and dynamic system spanning four domains and multiple levels. The four domains are: personal (encompassing personal/professional needs and expectations); health services (health agencies and their consumers); educational (educational institutions and their health students); and societal (local community/region and government). The system also comprises: micro or individual, meso or organisational, and macro or socio-political levels. Our model highlights that clinical educators are situated within a complex system comprising different agents and connections. It emphasises that individuals, teams and organisations need to recognise and be responsive to the unpredictability, interconnectedness and evolving nature of this system. Importantly, our article also calls for an epistemological shift from faculty development to capacity building in health professions education, aimed at developing individual, team, organisational and system capabilities to work with(in) complexity. Clinical educators are situated within a complex system comprising different agents and connections.

Functional Synchronization: The Emergence of Coordinated Activity in Human Systems.

The topical landscape of psychology is highly compartmentalized, with distinct phenomena explained and investigated with recourse to theories and methods that have little in common. Our aim in this article is to identify a basic set of principles that underlie otherwise diverse aspects of human experience at all levels of psychological reality, from neural processes to group dynamics. The core idea is that neural, behavioral, mental, and social structures emerge through the synchronization of lower-level elements (e.g., neurons, muscle movements, thoughts and feelings, individuals) into a functional unit—a coherent structure that functions to accomplish tasks. The coherence provided by the formation of functional units may be transient, persisting only as long as necessary to perform the task at hand. This creates the potential for the repeated assembly and disassembly of functional units in accordance with changing task demands. This perspective is rooted in principles of complexity science and non-linear dynamical systems and is supported by recent discoveries in neuroscience and recent models in cognitive and social psychology. We offer guidelines for investigating the emergence of functional units in different domains, thereby honoring the topical differentiation of psychology while providing an integrative foundation for the field.

Complexity Analysis of Decision-Making in the Critically Ill.

Despite multiple trials of interventions to improve end-of-life care of the critically ill, there is a persistent lack of understanding of factors associated with barriers to decision-making at the end of life. To apply the principles of complexity science in examining the extent to which transitions to end-of-life care can be predicted by physician, family, or patient characteristics; outcome expectations; and the evaluation of treatment effectiveness. A descriptive, longitudinal study was conducted in 3 adult intensive care units (ICUs). Two hundred sixty-four family surrogates of patients lacking decisional capacity and the physicians caring for the patients were interviewed every 5 days until ICU discharge or patient death. Characteristics of patients, physicians, and family members; values and preferences of physicians and family; and evaluation of treatment effectiveness, expectations for patient outcomes, and relative priorities in treatment (comfort vs survival). The primary outcome, focus of care, was categorized as (1) maintaining a survival orientation (no treatment limitations), (2) transitioning to a stronger palliative focus (eg, some treatment limitations), or (3) transitioning to an explicit end-of-life, comfort-oriented care plan. Physician expectations for survival and future cognitive status were the only variables consistently and significantly related to the focus of care. Neither physician or family evaluations of treatment effectiveness nor what was most important to physicians or family members was influential. Lack of influence of family and physician views, in comparison to the consistent effect of survival probabilities, suggests barriers to incorporation of individual values in treatment decisions.

Can complexity science inform physician leadership development?

Purpose The purpose of this paper is to describe research that examined physician leadership development using complexity science principles. Design/methodology/approach Intensive interviewing of 21 participants and document review provided data regarding physician leadership development in health-care organizations using five principles of complexity science (connectivity, interdependence, feedback, exploration-of-the-space-of-possibilities and co-evolution), which were grouped in three areas of inquiry (relationships between agents, patterns of behaviour and enabling functions). Findings Physician leaders are viewed as critical in the transformation of healthcare and in improving patient outcomes, and yet significant challenges exist that limit their development. Leadership in health care continues to be associated with traditional, linear models, which are incongruent with the behaviour of a complex system, such as health care. Physician leadership development remains a low priority for most health-care organizations, although physicians admit to being limited in their capacity to lead. This research was based on five principles of complexity science and used grounded theory methodology to understand how the behaviours of a complex system can provide data regarding leadership development for physicians. The study demonstrated that there is a strong association between physician leadership and patient outcomes and that organizations play a primary role in supporting the development of physician leaders. Findings indicate that a physician's relationship with their patient and their capacity for innovation can be extended as catalytic behaviours in a complex system. The findings also identified limiting factors that impact physicians who choose to lead, such as reimbursement models that do not place value on leadership and medical education that provides minimal opportunity for leadership skill development. Practical Implications This research provides practical applications for physician leadership development and emphasizes that it is incumbent upon physicians and organizations to focus attention on this to achieve improved patient and organizational outcomes. Originality/value This study pairing complexity science and physician leadership represents a unique way to view the development of physician leaders within the context of the complex system that is health care.

International perspectives on retention, stress and burnout

International perspectives on retention, stress and burnout