DNP-815A Topic 7 DQ 1
DNP-815A Topic 7 DQ 1
DNP-815A Topic 7 DQ 1
Explain the common characteristics of complex adaptive systems. How can the DNP-prepared nurse apply the concepts of a complex adaptive system to patient care?
Complexity science belongs to the latest generation of systems thinking, studying complex systems, also known as Complex Adaptive Systems (CAS), by focusing on the component of a system’s relations and interconnections instead of the individual members themselves (Pype, P. et al. 2018).
DNP-815A Topic 7 DQ 1
A theoretical framework of complexity science introduced understanding complex healthcare situations to understand complex problems better. The use of complexity science in the healthcare study provided insights that could not have been reached when using the traditional explanatory model in medicine based on scientific positivism that describes the linear cause-effect relationship between two isolated events.
The way clinicians handle uncertainty during the diagnostic process, the way physiological processes regulate, for instance, blood glucose levels, and the way healthcare practices organize themselves according to several simple rules are examples of complex system behavior that cannot be fully understood through linear thinking alone. Many healthcare concepts (e.g., diseases) and systems (e.g., hospitals) have subsequently been described as CAS (Pype, P. et al., 2018).
Interdisciplinary healthcare teams have been studied through the lens of complexity science. The relationship patterns between individuals resulting in local interaction strategies that affect the quality-of-care delivery, the rate
DNP-815A Topic 7 DQ 1
of information flow, and the adaptability during uncertain conditions have all been studied.
DNP-815A Topic 7 DQ 1
It has been illustrated that inter-individual interaction is a driving force and a defining factor for the whole system’s behavior. So far, most studies have focused on a few – usually three or four – selected attributes of complexity theory, with relationships, self-organization, and diversity being the most studied ones.
In addition, the learning effect of collaboration, the so-called workplace learning, as an emergent behavior has been described by focusing on collective competence as a distributed system has distributed capacity or by explaining adaptive practices based upon case
DNP-815A Topic 7 DQ 1
DNP 815A Topic 7 DQ 1
descriptions. The DNP-prepared nurse is enabled to apply the concepts of a complex adaptive system to patient care because due to the quality of relationships, feedback loops are created, and information is shared, which, in turn, influences knowledge growth and generates new behavior in a team. With some exceptions, another common feature of most studies is that they report on steady healthcare teams working in one institution, such as a hospital or nursing home.
These interdisciplinary teams are performing demanding tasks in ever-changing working environments that require high adaptability of the units. Research shows that workplace learning occurs during this collaboration, enabling the DNP-prepared nurse to apply the concept of CAS.
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Pype, P., Mertens, F., Helewaut, F., & Krystallidou, D. (2018). Healthcare teams as complex adaptive systems: understanding team behaviour through team members’ perception of interpersonal interaction. BMC health services research, 18(1), 570. https://doi.org/10.1186/s12913-018-3392-3
DNP-815A Topic 7 DQ 1
Thank you Roselyn for your informative post. Complexity theory is incorporated in many ways across various research designs to explore a multitude of phenomena. According to Thompson (2016), although complexity theory shows promise in health services research, particularly related to relationships and interactions, conceptual confusion and inconsistent application hinder the operationalization of this potentially critical perspective. Generalizability from studies that incorporate complexity theory is, therefore, complex.
Complexity science has been introduced in healthcare as a theoretical framework to understand complex situations better. Interdisciplinary healthcare teams can be viewed as Complex Adaptive Systems (CAS) by focusing more on the team members’ interaction with each other than on the characteristics of individual team members (Thompson D. et al., 2016).
DNP-815A Topic 7 DQ 1
Viewing teams in this way can provide us with insights into the origins of team behavior. Research shows that applying complexity science to understanding healthcare system improvement highlights the need to consider interdependencies within the system. A critical aspect of the interdependencies in healthcare delivery systems is how individuals relate to each other.
Complex adaptive systems in health care are networks that interact with one another but are seen as independent and join with a common goal. This system has principles that define it. Paype et al. (2017) explain it with seven principles.
First, it must have multiple components in which rich interaction must occur. It does not include only understanding the organization’s structure. Second, the interactions that occur are not always predictable behaviors. Third, there is a history and sensitivity, including initialing conditions. Fourth, their interactions are influenced by the environment. Fifth, an interaction that occurs is non-linear. Therefore, the result is dependent on elements and the input. If minor inputs occur, they can have significant effects, and major effects can have negligible effects.
DNP-815A Topic 7 DQ 1
Sixth interactions create emergent behaviors, but this does not mean that the study of elements can explain and cannot be predicted. Lastly, as the systems are open when they are being observed, the individual that is an observer is part of the system.
A doctoral nurse prepared (DNP) nurse can use these concepts to improve the delivery of patient care. This tool assists in adapting to an ongoing change. With the increased needs of patients and changing societal contexts, a DNP must understand this system to effectively implement change and identify clinical needs. For example, Paype et al. (2017) use this approach with a focus on increasing interpersonal interaction. They implemented a Complex Adaptive Leadership Organisational Capability Questionnaire. The tool was demonstrated to be feasible for evaluating day-to-day operations and identifying quality improvements.
DNP-815A Topic 7 DQ 1
Another example is Munro et al. (2020) study which used complex adaptive systems to implement shared decision-making. They found that this approach goes beyond the limits of reductionism and disentangled. It fragmented the problem into barriers, facilitators, and outcomes. They were also able to have greater insight into implementation and address challenges.
DNP-815A Topic 7 DQ 1
It explored patterns, self-organization, and interactions. In this study, this approach helped to identify solutions to address the patients, providers, and policy factors that influence the implementation of shared decision-making. These are two great examples of how this complex adaptive system can improve patient care.
References:
Munro, S., Kornelsen, J., Wilcox, E., Kaufman, S., Bansback, N., Corbett, K., & Janssen, P. (2020). Implementation of Shared Decision-Making in Healthcare Policy and Practice: A Complex Adaptive Systems Perspective. Evidence & Policy: A Journal of Research, Debate and Practice, 16(3), 393–411.
Pype, P., Krystallidou, D., Deveugele, M., Mertens, F., Rubinelli, S., & Devisch, I. (2017). Healthcare teams as complex adaptive systems: Focus on interpersonal interaction. Patient Education and Counseling, 100(11), 2028–2034. https://doi.org/10.1016/j.pec.2017.06.029