Science Of Complex Adaptive Systems Research Articles

A fRAmework of the DetermInants of Arts aNd Cultural Engagement (RADIANCE): integrated insights from ecological, behavioural and complex adaptive systems theories.

Arts and cultural engagement (ACEng) is ubiquitous across every human culture since palaeolithic times, but in contemporary society, ACEng is unevenly distributed, demographically, socio-economically, geographically and politically. But what are the "determinants" of ACEng (i.e., the facilitators or barriers to people's engagement) and how can they be optimised? Despite a large body of theory and evidence on individual determinants, this work has largely occurred in disciplinary silos, which has led variously to contrasting discourses and approaches, criticism, and inconsistent findings. What we lack is a rigorous comprehensive understanding of these determinants (both those already theorised and those that have been little recognised as determinants to date) that goes beyond descriptively showing inequalities, instead explaining why these inequalities exist and how they can be overcome. This paper explores the currently recognised determinants of ACEng, and existing theoretical approaches to these determinants. Drawing on the theoretical bases of ecological systems theory, ecosocial theory and complex adaptive systems science, we conducted a review and iterative theorising process. We propose a new theoretical framework of the determinants of arts and cultural engagement (RADIANCE) developed through cross-disciplinary literature reviewing, domain mapping, and consensus building. Overall, we identified 35 different factors that can act as determinants of ACEng across micro, meso, exo, macro and chrono levels. We broadly categorised these as social (i.e. a primary feature being the interaction of people), tangible (i.e. a primary feature involving physical assets or resources or the production of physical assets), and intangible (i.e. constructs that do not have a primary physical basis but instead have a virtual or imaginary basis). The relevance and implications of this framework for broader research, policy, and practice and case studies of it in use are presented.

The insights and gains achieved by the fusion of two concepts: Disorder and complexity theory.

The aim of this manuscript is to put forward the justification and efficacy value of the unification of both the adjective disorder and the science of complex adaptive systems (CAS) as a new recognised science of disorder. Why? Because arguably there has never been a time when it is as imperative to understand the dynamics master disorder as it is currently. At a time when rapid change and the consequential disorder is occurring in every sphere of life. When globally mankind was unprepared for the covid pandemic.  The Covid 19 virus might be extremely minuscule - 17 nanometre wide, but few would now doubt its power and capability to cause rampant disorder. Catching nations unprepared, causing insecurity, the sudden threat of death, and the inability to predict, or to prevent this new virus throwing the world into global chaos. The global disorder was and still is influencing all spheres of life: biopsychosocial – medically: environmentally, politically, and economically. However, the very nature of any disorder is that it is ubiquitous, it possesses inherent characteristics which cause a ripple effect; it is impossible to put it back in the box. The word "disorder" in this article is intended to cover all disorder and not to be restricted or identified with just one area of concern, e.g., a disorder caused by acts of terrorism or medical disorders etc.    The very nature of disorder is that it can and often does occur suddenly it is unforeseen. The consequences have the potential to generate unconsidered reflexive, alarmist reactions.  Reactions with hindsight which may impede the preferred logistical coping strategies. Any response to disorder whether it be microbes, or on the macro level such as war are naturally dependent on the scale, magnitude, impact, and then the resources necessary to restore or attempt order as previously mentioned. This article questions whether the prevailing arena must be and makes an argument for the need for a scientific approach – a progression from being vulnerable to disorder to being in control of disorder whichever way it is manifested.   The recommendation is to see disorder as a whole: a CAS system of disorder with many interacting parts and variables, using all the predictive modelling now available by employing the new science of CAS.

A review on advances in design and development of complex adaptive systems for healthcare using concept maps

: The purpose of this paper is to demonstrate the unique contributions made by several researchers including the author to the design and development of complex adaptive systems for healthcare. The article first presents definitions of complex adaptive systems and associated terms provided by other scholars. This is followed by a discussion on the ideas that lead to the development of different complex adaptive systems. This discussion includes unique contributions to systems engineering applied to healthcare information systems. A further elaboration on these unique contributions made by these systems considering applications such as Concept Map-Based Personal Health Information System (C-PHIS) and Data Completeness Analysis Package (DCAP) is presented. Here the author provides emphasis on advances in the design and development of complex adaptive systems using concept maps. This discussion also includes their applications in critical segments of healthcare delivery such as dementia and mental health. Finally, a pathway for future research work in this field of research is discussed to provide new insights on a possible roadmap for advancing the science of complex adaptive systems. Overall, the article presents a few critical ideas and contributions thereby adding to the body of knowledge associated with complex adaptive systems applied to healthcare information systems. Also, anticipate the unexpected and deal with outcomes of system engineering in complex adaptive systems with respect to healthcare.

Health system quality in the time of COVID-19

Health system quality in the time of COVID-19

The Complexity of the Homeopathic Healing Response Part 2: The Role of the Homeopathic Simillimum as a Complex System in Initiating Recovery from Disease.

Evidence indicates that homeopathic medicines are complex self-organizing nano-scale systems that generate unique low-intensity electromagnetic signals and/or quantum coherence domains. In Part 1, we reviewed relevant concepts from complex adaptive systems science on living systems for the nature of homeopathic healing. In Part 2, we discuss the complex-system nature of homeopathic medicines. The aim is to relate the evidence on the nature and properties of homeopathic medicines to the complex systems model for homeopathic healing. The work is a narrative review, with complexity model development for the nature of homeopathic medicines. Studies suggest that homeopathic manufacturing generates nano-structures of source material, silica and silicon quantum dots if succussed in glassware or including botanical source materials; or carbon quantum dots if succussed in plastic or including any organic source materials, as well as solute-induced water nano-structures carrying medicine-specific information. On contact with physiological fluids (e.g., blood plasma), there is evidence that nano-structures additionally adsorb individualized patterns of the recipient's own proteins on to their surfaces to create a unique protein corona coat (shell). Thus, the simillimum may generate a personalized biological identity upon administration. Consequently, a medicine can serve as an individually salient, self-similar information carrier, whose protein corona constituent pattern reflects the individual's current internal state of health/disease. Homeopathic medicine complexity emerges from interactions of the component parts from source, silica from glassware or carbon from plastic containers, solvents (lactose, water, ethanol), adsorbed biomolecule layers from plant or animal sources, and adsorbed biomolecules of the recipient. Low doses of these complex medicines can act as biological signaling agents to initiate hormesis via a network-wide pattern of adaptive responses by the recipient complex adaptive system, rather than as conventional pharmaceutical drugs. Biological mediators of adaptive responses include inter-connected network elements of the cell danger/damage defense system: for example, gene expression, reactive oxygen species, heat shock proteins, cytokines, macrophages, T-cells, and associated brain-immune system mediator pathways. Every homeopathic medicine is a complex nano-scale system involving multiple inter-connected, interacting components, and emergent properties. Simillimum individualization derives from formation of a unique personalized protein corona shell adsorbed to the reactive surface of the homeopathic nano-structures on contact with the recipient's body fluids. Low doses of such complex nano-structures initiate the adaptive processes of hormesis to mobilize endogenous healing of a disease state. The capacity for self-organization and self-similarity in complex systems is the key to future research on the nature of homeopathic medicines and systemic healing during individualized homeopathic treatment.

The development, application, and refinement of a Regenerative Development Evaluation Tool and indicators

Abstract Ecological indicators are foundational for holistic guidance toward thriving living systems, yet existing indicators are incomplete, fragmented, and do not fully integrate living systems principles. We suggest that thriving living systems (i.e., social-ecological or complex adaptive systems) can and should be the aim of sustainability and sustainable development. Thriving living systems, also called regenerative living systems, are those in which complexity, diversity, capacity to support all life, and the potential to change to provide future options increases. Holistic ecological and sustainability indicators and evaluation tools are needed. The emerging field of regenerative development (RD) offers theoretical and practical guidance for such indicators and tools. We integrate complex adaptive systems science, ecology, sustainability, and regenerative development to construct and pilot the first iteration of a holistic sustainable development evaluation tool—the Regenerative Development Evaluation Tool—in two river restoration projects. The tool identifies RD Principles and Core Characteristics of Regenerative Living Systems that provide general guidance for thinking and decision-making. From these general indicators, place-based quantitative and qualitative indicators are constructed through a co-creative community process. Our case studies reveal factors correlated with degrees of engagement with RD and potential place-based indicators for each project. We recommend continuing the development and expansion of the RD Evaluation Tool, adding RD indicators and strategies. We also recommend developing an RD process tool that can work explicitly across scales, integrating the neighborhood, city, landscape, and regional scales since they are pivotal for sustainability efforts and manifesting thriving living systems. Finally, we recommended integrated research and practice to test and adapt RD tools and processes.

Evidence-based medicine-Not a panacea for the problems of a complex adaptive world.

The recent sacking of Peter Gøtzsche from the Cochrane Collaboration Board raised strong responses and highlights the neglected issue about priorities-maintaining the reputation of the organization or vigorously debating the merits of scientific approaches to find answers to complex problems? The Cochrane approach hales the randomized trial (RCT) as the gold standard research approach and affirms that meta-analysis provides the ultimate proof (or platinum standard) to settle contentious issues confronting the clinician. However, most published medical research is wrong, and critics coined the acronym GIGO (garbage in, garbage out) as a meme to highlight the risks of blind faith in the hyped-up procedures of the EBM movement. This paper firstly explores the differences between the prevailing scientific method arising from the linear cause-and-effect assumption and the complex adaptive systems science methods arising from observations that most phenomena emerge from nonlinearity in networked systems. Most medical conditions are characterized by necessary features that by themselves are not sufficient to explain their nature and behaviour. Such nonlinear phenomena require modelling approaches rather than linear statistical and/or meta-analysis approaches to be understood. These considerations also highlight that research is largely stuck at the data and information levels of understanding which fails clinicians who depend on knowledge-the synthesis of information-to apply in an adaptive way in the clinical encounter. Clinicians are constantly confronted with the linked challenges of doing things right and doing the right thing for their patients. EBM and Cochrane with their restrictive approaches are the antithesis to a practice of medicine that is responsive to constantly changing patient needs. As such, the EBM/Cochrane crisis opens a window of opportunity to re-examine the nature of health, illness and disease, and the nature of health care and its systems for the benefits of its professionals and their patients. We are at the cusp of a paradigmatic shift towards an understanding a praxis of health care that takes account of its complexities.

Modelling competition in health care markets as a complex adaptive system: an agent-based framework

ABSTRACT Health market reforms necessitate continuous re-evaluation of initiatives, competitive regulations, and antitrust policies. Synergistic implications, evolution, and behaviour changes associated with the market competition are often overlooked due to methodological limitations. To rectify these limitations, parallels between defining features of health care markets (HCM) and complex adaptive systems (CAS) are drawn. The science of CAS develops complex system-level models of dynamic interactions to allow insights for heterogeneous agents and emergent behaviours. Agent-based modelling (ABM) is a computational tool of CAS science suitable for investigating competition in HCM. The proposed agent-based framework conceptualises agents, environment, and interactions, and formalises agent-specific attributes and modules that achieve agent roles to recreate HCM dynamics. The framework conceptualises competition in HCM into an implementable ABM for a CAS assessment, identifies data sources, and develops face-validity procedures. Developments in data, computational power, and decisions theory compel CAS approach to complement studies on pressing HCM issues.

\u201cDon\u2019t Mind the Gap!\u201d Reflections on Improvement Science as a Paradigm

Responding to this issue’s invitation to bring new disciplinary insights to the field of improvement science, this article takes as its starting point one of the field’s guiding metaphors: the imperative to “mind the gap”. Drawing on insights from anthropology, history, and philosophy, the article reflects on the origins and implications of this metaphoric imperative, and suggests some ways in which it might be in tension with the means and ends of improvement. If the industrial origins of improvement science in the twentieth century inform a metaphor of gaps, chasms, and spaces of misalignment as invariably imperfect and potentially dangerous, and therefore requiring bridging or closure, other currents that feed the discipline of improvement science suggest the potential value and uses of spaces of openness and ambiguity. These currents include the science of complex adaptive systems, and certain precepts of philosophical pragmatism acknowledged to inform improvement science. Going a step further, I reflect on whether or not these two contrasting approaches within improvement science should be treated as incommensurable paradigms, and what each approach tells us about the very possibility of accommodating seemingly irreconcilable or incommensurable approaches within improvement science.

Teaching Complex Adaptive Systems Science in Natural Resource Management: Examples from Forestry

Teaching theoretical concepts, such as complexity theory, provides unique challenges, especially in applied disciplines. Current trends such as global change will require natural resource disciplines, for example forestry and agriculture, to expand their scientific basis and possibly shift their dominant paradigms to adopt a broader view of the ecosystems they manage as complex social-ecological systems. This likely will result in borrowing and adapting theories and concepts from other disciplines such as complexity science. Students in natural resources will need more training in these paradigms and learn to incorporate concepts such as thresholds, uncertainty, and cross-scale interactions as they affect ecosystem dynamics and thus management or restoration prescriptions. Numerous courses and approaches exist that teach general complexity concepts, including management implications at the governance levels. However, we do not know of any courses where these concepts are specifically applied to practical management challenges. This article aims to overcome this shortcoming by sharing our experiences. Specifically, we provide examples of field exercises that can be used to link theoretical concepts from complexity science to applied forest management issues, regardless of management objectives. Instructors are encouraged to evaluate these examples and modify them as necessary for uses in graduate classes and workshops. We hope that these exercises will help expose graduate students and professionals to a wider range of theories and concepts.

The Evolutionary Theory of Globalization: Interaction, Co-Evolution and Specialization As Sources of Diversity in Highly Interconnected Societies

Do the complex dynamics of international relations resemble the longterm evolution observed in living systems? This chapter will try to identify the mechanisms associated with those dynamics, and to determine if the science of complex adaptive systems can aid in the understanding of international development. It tries to address the weaknesses of current theories of international political economy to adequately explain global diversity and queries its empirical and theoretical limitations. Providing insight on the mechanisms by which divergence is a response to heightened interconnectivity, complexity theory offers a way to overcome the limitations of conventional political economy analysis.We find that at a qualitative level the dynamics of the international system resemble known aspects of biological behavior, speciation and intermittent behavior. The next frontier for the study of social development is to find quantitative measures that define these processes.

Evolution of Decision Making Processes in Command during Irregular Warfare Operations

Stability operations and irregular war are increasingly complex and continually changing constructs which are no longer served by the traditional processes of the western military forces. This essay examines the significant work that has been carried out in recent years in an effort to develop new problem framing constructs that hope to offer the commander processes for utilizing and manipulating complex adaptive systems. What is becoming apparent is that the process of developing frameworks will not be of value to the military commander unless these frameworks can be embedded in the decision making process at an instinctive and experiential level. For the past 5 years The technical cooperation programme (TTCP) has been operating with the objective of harnessing complexity within the defense arena. The introduction of unknown risks associated with the incomplete and shifting information, and continuous readjustments due to the multi cell structure of irregular warfare would create significant base level noise in an adaptive system framework. This low noise introduced into the operational art of command would have the potential to damage the measurement schemas and feedback systems of the immediate adaptive framework and alter the responsiveness and sustainability of advancements based on these decisions. At present, significant work has been done to translate the science of complex adaptive systems into tools the commander can incorporate into his decision making process in high pressure scenarios. This has not yet been successful.

Dossier : « À propos des relations natures/sociétés » − The shift toward social-ecological systems perspectives: insights into the human-nature relationship

This study examines how social and natural scientists converged on a new ontological approach to science. Three distinguishing features comprise this new approach. They include: (1) an integration of the social and ecological into a fully coupled social-ecological systems perspective, (2) a holistic view of scientific phenomena requiring a transdisciplinary approach to its study, and (3) the refutation of a purely equilibrium-based understanding of systems. We explore this by first introducing complex adaptive systems science and reconsidering systems theory. We next look at the application of complex adaptive systems in institutional analyses conducted by political economists. Following this, we show how ecologists used the concept of resilience to apply a similar approach to the study of ecosystems. Finally, we show how a growing community of social and natural scientists have united to utilize a social-ecological systems framework to take a more holistic and transdisciplinary approach to science.

Complex Adaptive Systems and Global Capitalism: The Risk of a New Ideology of Global Complexity

Since the foundation of the Santa Fe Institute, the new science of complex adaptive systems (CAS) has seen extraordinary development, breaking with previous, more epistemological, trends in complexity theory. This article makes a critique of CAS as a model of the current global complexity. Its basic model, the cellular automaton, which focuses on the interactive dynamics among components, ignores the nature of any complex system as constructed by the observer/actor and is unable to explain the sociohistorical construction of the agents/subjects (analyzed by Foucault) and the social structure in which they are located (analyzed by Bourdieu), thus being unable to accurately represent the overall social complexity.

A Review of Human Factors Challenges of Complex Adaptive Systems

In this paper, the author explores a need for a greater understanding of the true nature of human-system interactions from the perspective of the theory of complex adaptive systems, including the essence of complexity, emergent properties of system behavior, nonlinear systems dynamics, and deterministic chaos. Human performance, more often than not, constitutes complex adaptive phenomena with emergent properties that exhibit nonlinear dynamical (chaotic) behaviors. The complexity challenges in the design and management of contemporary work systems, including service systems, are explored. Examples of selected applications of the concepts of nonlinear dynamics to the study of human physical performance are provided. Understanding and applications of the concepts of theory of complex adaptive and dynamical systems should significantly improve the effectiveness of human-centered design efforts of a large system of systems. Performance of many contemporary work systems and environments may be sensitive to the initial conditions and may exhibit dynamic nonlinear properties and chaotic system behaviors. Human-centered design of emergent human-system interactions requires application of the theories of nonlinear dynamics and complex adaptive system. The success of future human-systems integration efforts requires the fusion of paradigms, knowledge, design principles, and methodologies of human factors and ergonomics with those of the science of complex adaptive systems as well as modern systems engineering.

Knowing – in Medicine

In this paper we argue that knowledge in health care is a multidimensional dynamic construct, in contrast to the prevailing idea of knowledge being an objective state. Polanyi demonstrated that knowledge is personal, that knowledge is discovered, and that knowledge has explicit and tacit dimensions. Complex adaptive systems science views knowledge simultaneously as a thing and a flow, constructed as well as in constant flux. The Cynefin framework is one model to help our understanding of knowledge as a personal construct achieved through sense making. Specific knowledge aspects temporarily reside in either one of four domains - the known, knowable, complex or chaotic, but new knowledge can only be created by challenging the known by moving it in and looping it through the other domains. Medical knowledge is simultaneously explicit and implicit with certain aspects already well known and easily transferable, and others that are not yet fully known and must still be learned. At the same time certain knowledge aspects are predominantly concerned with content, whereas others deal with context. Though in clinical care we may operate predominately in one knowledge domain, we also will operate some of the time in the others. Medical knowledge is inherently uncertain, and we require a context-driven flexible approach to knowledge discovery and application, in clinical practice as well as in health service planning.

Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes

BackgroundDespite the development of several models of care delivery for patients with chronic illness, consistent improvements in outcomes have not been achieved. These inconsistent results may be less related to the content of the models themselves, but to their underlying conceptualization of clinical settings as linear, predictable systems. The science of complex adaptive systems (CAS), suggests that clinical settings are non-linear, and increasingly has been used as a framework for describing and understanding clinical systems. The purpose of this study is to broaden the conceptualization by examining the relationship between interventions that leverage CAS characteristics in intervention design and implementation, and effectiveness of reported outcomes for patients with Type II diabetes.MethodsWe conducted a systematic review of the literature on organizational interventions to improve care of Type II diabetes. For each study we recorded measured process and clinical outcomes of diabetic patients. Two independent reviewers gave each study a score that reflected whether organizational interventions reflected one or more characteristics of a complex adaptive system. The effectiveness of the intervention was assessed by standardizing the scoring of the results of each study as 0 (no effect), 0.5 (mixed effect), or 1.0 (effective).ResultsOut of 157 potentially eligible studies, 32 met our eligibility criteria. Most studies were felt to utilize at least one CAS characteristic in their intervention designs, and ninety-one percent were scored as either "mixed effect" or "effective." The number of CAS characteristics present in each intervention was associated with effectiveness (p = 0.002). Two individual CAS characteristics were associated with effectiveness: interconnections between participants and co-evolution.ConclusionThe significant association between CAS characteristics and effectiveness of reported outcomes for patients with Type II diabetes suggests that complexity science may provide an effective framework for designing and implementing interventions that lead to improved patient outcomes.

Linux: A bazaar at the edge of chaos (originally published in Volume 5, Number 3, March 2000)

This paper establishes a context for the work of Eric Raymond and his description of the Linux phenomenon, by examining the emerging science of complex adaptive systems pioneered by John Holland, Christopher Langton, Robert Axelrod, among others. Raymond's evolutionary view is given an extended and more formal treatment under the terms of chaos and complexity, and chaos and complexity under the terms of sociology. In addition, this paper presents an ethnographic account of Linux, amassed from a series of electronic mail interviews with kernel developers. These interviews examine Linux as a social phenomena, which has prompted wide interest and become a subject of heated discussion. Comments and feedback of this paper can be found at http://www.cukezone.com/kk49/linux/contents.html

Complex Acts of Knowing: Paradox and Descriptive Self‐Awareness

We are reaching the end of the second generation of knowledge management, with its focus on tacit-explicit knowledge conversion. Triggered by the SECI model of Nonaka, it replaced a first generation focus on timely information provision for decision support and in support of BPR initiatives. Like BPR it has substantially failed to deliver on its promised benefits. The third generation requires the clear separation of context, narrative and content management and challenges the orthodoxy of scientific management. Complex adaptive systems theory is used to create a sense-making model that utilises self-organising capabilities of the informal communities and identifies a natural flow model of knowledge creation, disruption and utilisation. However the argument from nature of many complexity thinkers is rejected given the human capability to create order and predictability through collective and individual acts of freewill. Knowledge is seen paradoxically, as both a thing and a flow requiring diverse management approaches. The Cynefin Centre Membership of the Centre, which focuses on action research in organisational complexity is open to individuals and to organisations. It focuses on high-participation action research projects seeking new insights into the nature of organisations and markets using models derived from sciences that recognise the inherent uncertainties of systems comprised of interacting agents. However, the Centre is not about attempting to apply physical or biological models to organisations wholesale without attention to the uniquely human capacities of free will, awareness and social responsibility. It is about engaging human organisational complexity in its many manifestations, including the ancient collective and emergent patterns of narrative, ritual, negotiation of identity and truth, self-representation and knowledge exchange. The Centre is not about consultants or academics conducting multiple interviews or observations and deriving static hypothesises and models based on their outside "expertise". It is about creating focused dynamic interactions between traditional and unexpected sources of knowledge to enable the emergence of new meaning and insight. The Centre is based on a model of networked intelligence, creating a broad and loosely structured coalition of academics, industrial and governmental organisations to create new insight and understanding for its members into the complexity of managing in a new age of uncertainty. The basis of all Centre programmes is to look at any issue from multiple new perspectives and to facilitate problem solving through multiple interactions among programme participants. Programmes run on a national, international and regional basis and range from investigation of seemingly impossible or intractable problems to pragmatic early entry into new methods and tools such as narrative databases, social network stimulation and asymmetric threat response.

Thinking About Institutions: Milieux and Madness

Back to table of contents Previous article Next article Book ReviewsFull AccessThinking About Institutions: Milieux and MadnessNeal Adams, M.D.Neal AdamsSearch for more papers by this author, M.D.Published Online:1 Jul 2002https://doi.org/10.1176/appi.ps.53.7.906AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Thinking About Institutions, R. D. Hinshelwood, a well-regarded psychiatrist and psychoanalyst, attempts to understand the history and transformation of the British public hospitals from traditional hierarchical institutions to therapeutic communities or milieu treatment environments. Hinshelwood believes that the lessons to be learned may reach beyond the institutions themselves and thus are especially worthy of study. His perspective is that of the psychoanalyst. He acknowledges that Freud "was pessimistic about psychoanalytic treatments of psychotic patients," but he goes on to argue that we can "substitute an optimism about addressing the caring institution with psychoanalytic ideas and descriptions." He further states that "psychoanalytic ideas must be applied rather than 'used'."This book is difficult to read, convoluted in its presentation and argument, arcane in its perspective, and of limited value and relevance to a contemporary evaluation of mental health institutions and their processes. Perhaps it is best understood and appreciated by British practitioners or by psychoanalytically oriented readers.At times Hinshelwood seems simply to pine for the good old days of reformed institutions and therapeutic communities. He tries to argue that from a psychoanalytic understanding of therapeutic communities we can generalize to issues in contemporary community care and an understanding of society in general. But it is not clear that he succeeds in showing that this is an appropriate and useful approach.At a time when exciting new ideas and theories are emerging to better understand and manage complex systems, it is difficult to appreciate Hinshelwood's view as useful or relevant. For example, the science of complex adaptive systems (CAS) has been applied to a wide range of human endeavors, and it would be a worthwhile effort to consider psychiatric institutions through this lens. The Institute of Medicine, in a recent report on health care in America (1), includes an appendix on applying the CAS framework to health care system reform. The ideas are compelling and at once simple and powerful. The institute makes it clear that our entire health care system is in urgent need of reform and suggests that the CAS framework might be a powerful tool for understanding and facilitating change. Our institutions need a new paradigm, not a reworking of outdated and misapplied theories.Dr. Adams is medical director of adult services of the California Department of Mental Health in Sacramento.by R. D. Hinshelwood; Philadelphia, Jessica Kingsley Publishers, 2001, 219 pages, $24.95Reference1. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC, Institute of Medicine, Committee on Quality of Health Care in America, 2001Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 53Issue 7 July 2002Pages 906-906 Metrics History Published online 1 July 2002 Published in print 1 July 2002