Chapter 11: Complex Adaptive Systems Flashcards
complexity science
study of complex adaptive systems
implications for the practice of nursing in complexity science
regard to patient safety, organizational culture, teamwork, career satisfaction
examples of a complicated system
patient-controlled analgesia (PCA) pump and cardiac monitor
made up of parts that exist and change in relationship with the other parts and in response to the environment
complex system
individual parts have the ability to adapt and learn, while doing so impact other parts of the system
complex system
when broken or not working, parts must adapt, grow, and enhance their relationships in ways that are congruent with desired outcomes
complex system
examples of a complex system
ecosystem, red blood cell, staff in a home health organization
what were nursing and medical sciences initially based on
mechanistic and linear way of studying systems and reductionist philosophy
what did linear thinking contribute to?
top-down, command-and-control, and hierarchal business structures
problems associated with command-and-control
- rise in medical errors due to lack of collaboration, “silo” mentalities, and status-driven power dynamics
- new information and rapid advances in technology creating and environment of constant change
- cost-containment efforts and budget constraints forcing nurses, doctors, and others to work at a faster pace
made up of distinct parts that exist separately and have a cause-and-effect relationship
complicated system
system that can be controlled and is predictable
complicated system
system where if one part breaks, the system may fail or have limited function until the part is fixed or replaced
complicated system
Complex Adaptive System (CAS)
vision for future healthcare system in which care would be safe, effective, patient-centered, timely, efficient, and equitable
what are CAS’s made up of?
elements or agents that are interconnected and able to respond to change in their environment in varied ways
rules of CAS
constant, but allow its members to spontaneously adapt to change in various ways
importance of emergence
behavior emerges in response to changes in environment
what keeps things together and optimizes collaboration?
interconnectedness between teams and within organizations
butterfly effect or nonlinearity
- small instance in one location causes a big impact in another
- respectful communication is important to minimize negative reverberations and maximize positive outcomes
adaptibility
- ability of the elements of a CAS to respond to and learn from changes in the environment
- encourages nurses to look for ways to empower others or themselves to make healthy choices
emergent behavior
- closely related to adaptability, how the agents of CAS behave in relationship with others
- healthcare professionals who practice respectful communication influence emergent behavior or moment-to-moment interactions
context and embeddedness
- individuals, their teams, the work they do, and work environment all matter
- the actions of one person will be felt in infinite ways throughout each system
diversity
- professionals who respect diversity tap into creative opportunities that differences offer
- consideration of patients’ diversity may contribute to meeting patients’ needs
self-organization
- antithesis of hierarchal structure, group that forms without directives
- leaders and staff must determine when hierarchal structure is helpful and when self-organization may work better (or when both are needed)
simple rules (straightforward rules) in CAS’s
lead to desired outcomes
to achieve safe, quality care, a few simple rules might be:
speak up assertively, listen respectfully, create a safe and just culture
with simple rules in place, collaboration is…
respectful, and care is likely to be safe
American Association of Critical Care Nurses standards:
- skilled communication
- true collaboration
- effective decision-making
- appropriate staffing
- meaningful recognition
- authentic leadership
four activities that contribute to a healthy (and safe) work environment for nurses are:
- “designing out” system barriers to care
- designing and implementing appropriate technology
- focusing on the direct care function
- supporting the new RN
