Chapter 11: Complex Adaptive Systems

Question 1

complexity science

Answer 1

study of complex adaptive systems

Question 2

implications for the practice of nursing in complexity science

Answer 2

regard to patient safety, organizational culture, teamwork, career satisfaction

Question 3

examples of a complicated system

Answer 3

patient-controlled analgesia (PCA) pump and cardiac monitor

Question 4

made up of parts that exist and change in relationship with the other parts and in response to the environment

Answer 4

complex system

Question 5

individual parts have the ability to adapt and learn, while doing so impact other parts of the system

Answer 5

complex system

Question 6

when broken or not working, parts must adapt, grow, and enhance their relationships in ways that are congruent with desired outcomes

Answer 6

complex system

Question 7

examples of a complex system

Answer 7

ecosystem, red blood cell, staff in a home health organization

Question 8

what were nursing and medical sciences initially based on

Answer 8

mechanistic and linear way of studying systems and reductionist philosophy

Question 9

what did linear thinking contribute to?

Answer 9

top-down, command-and-control, and hierarchal business structures

Question 10

problems associated with command-and-control

Answer 10

• 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

Question 11

made up of distinct parts that exist separately and have a cause-and-effect relationship

Answer 11

complicated system

Question 12

system that can be controlled and is predictable

Answer 12

complicated system

Question 13

system where if one part breaks, the system may fail or have limited function until the part is fixed or replaced

Answer 13

complicated system

Question 14

Complex Adaptive System (CAS)

Answer 14

vision for future healthcare system in which care would be safe, effective, patient-centered, timely, efficient, and equitable

Question 15

what are CAS’s made up of?

Answer 15

elements or agents that are interconnected and able to respond to change in their environment in varied ways

Question 16

rules of CAS

Answer 16

constant, but allow its members to spontaneously adapt to change in various ways

Question 17

importance of emergence

Answer 17

behavior emerges in response to changes in environment

Question 18

what keeps things together and optimizes collaboration?

Answer 18

interconnectedness between teams and within organizations

Question 19

butterfly effect or nonlinearity

Answer 19

• small instance in one location causes a big impact in another
• respectful communication is important to minimize negative reverberations and maximize positive outcomes

Question 20

adaptibility

Answer 20

• 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

Question 21

emergent behavior

Answer 21

• 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

Question 22

context and embeddedness

Answer 22

• 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

Question 23

diversity

Answer 23

• professionals who respect diversity tap into creative opportunities that differences offer
• consideration of patients’ diversity may contribute to meeting patients’ needs

Question 24

self-organization

Answer 24

• 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)

Question 25

simple rules (straightforward rules) in CAS’s

Answer 25

lead to desired outcomes

Question 26

to achieve safe, quality care, a few simple rules might be:

Answer 26

speak up assertively, listen respectfully, create a safe and just culture

Question 27

with simple rules in place, collaboration is…

Answer 27

respectful, and care is likely to be safe

Question 28

American Association of Critical Care Nurses standards:

Answer 28

• skilled communication
• true collaboration
• effective decision-making
• appropriate staffing
• meaningful recognition
• authentic leadership

Question 29

four activities that contribute to a healthy (and safe) work environment for nurses are:

Answer 29

• “designing out” system barriers to care
• designing and implementing appropriate technology
• focusing on the direct care function
• supporting the new RN