Complex Adaptive Systems in Healthcare: A Leader’s Perspective – Part 1

By Greg Hunter, RT (R) (T)

      Beth Boynton, RN, MS

As long as there have been health care institutions, so is the push to improve the systems that make it work. Traditionally, the healthcare system is viewed as a hierarchy, with distinct linear levels from the lowermost which consist of the staff to the topmost board of directors. In the recent years, Complexity Science shed new light on traditional thinking about human systems. This new perspective sees the healthcare system as more complex and more dynamic, and also as structurally multidimensional.

Traditional Vs. Complexity Science

The traditional view of health organizations is taken as something like a machine wherein the functions of each part is considerably analyzed when trouble starts to set in. The cause and effect of problems in the system and the corresponding solution are found and explained by the functioning parts. This is sometimes referred to as Newtonian reductionism.

Troubleshooting using Newtonian reductionism is likened to a gadget repairman taking all the components out and starting assembly from the beginning when he cannot find a solution to a malfunction. In this concept, healthcare organizations are viewed as a unit, receiving inputs to make gears work with all parts working in harmony to finally produce an overall output of providing better health for all. In short, the traditional method examines each factor of the system and understands the mechanics of how every part works. For the healthcare system, it has been this way up to a couple of decades ago.

In the advent of the new perspective in the way systems work, it was recognized that most things are changing and evolving. There was a need to put more emphasis on the relationships between the parts than how parts work. This is how Complexity Science emerged. Complexity Science recognizes that a system is a universe in itself. Protocols and standards change over time. Roles become diversified. Some tasks even overlap. Research findings differ in a given span of time.

If an organizational chart is to be drawn under this new perspective, it would look like a multi-dimensional figure with arrows that fly all over the place, going up, under and sideways and both ways. These arrows represent non-linear interactions of components. The figure, strictly speaking, is also dynamic, ever changing. Arrows that suggest relationship may inadvertently or purposely change over time. Roles may move up or down or sideways in the organization.

Comparing Organizational Behaviors

The traditional system and Complex Adaptive Systems, which are under complexity science, differ in a variety of ways.

1.                   Roles

The traditional system emphasizes management and chain of commands while complex adaptive systems focus on leadership and collaboration.

2.                   Method of mobilizing people

In the older system, the control is done by the highest in the hierarchy. Information goes down a unidirectional channel through commands. The newer system however utilizes positive and negative reinforcements, recognizing achievements and focusing on the behavior rather than the person when rectification is needed.

3.                   Measuring improvements

In the traditional way of organizing healthcare systems, one way of measuring improvements is through realization of activities that were deemed necessary to develop a system. Ticking all activities in a checklist means success. On the other hand, Complex Adaptive Systems allow diverse ways on achieving success, measuring outcomes instead of activities.

4.                   Focus of Success

In the traditional system, focus of achieving improvements is through efficiency of each component. Complexity science looks at agility, the trends and changes within the organization.

5.                   Working Relationships

With the newer system, personal commitments describe work relationships as compared to contractual work with the older system. This coincides with the method of improvement that looks at accomplished activities regardless of the people behind the success in the traditional system. In contrast, Complex Adaptive Systems create work commitments from people who become experts in the process. This becomes part of process improvement.

6.                   Organizational Network and Design

While the older system deals with hierarchy that is adamant about its organizational design, a complex adaptive system is heterarchial that allows dynamic self-organization.

ManageUP recognizes the complexities of the healthcare system and adapts its services to changing trends. For ManageUP, leadership and collaboration is well understood and they inculcate closed loop communication and process improvement in their services.