Question 1 Explain the common characteristics of complex adaptive systems.

Question 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? Provide examples and literature support.

Some of the features of Complex Adaptive Systems (CAS)

 Complex Adaptive Systems (CAS) are characterized by several key features:Complex Adaptive Systems (CAS) are characterized by several key features:

 Emergence:

 Definition: Self-organization means that structures or patterns that are not by design appear from the intrinsic interactions of the characters in the system.

 Example: In a hospital context, planning (for example, enhanced patient outcomes) results from interactions of a patient care team, and not from individual behaviour.

 Nonlinearity:

 Definition: As implied in CAS, such augmentations even though small in quantity could produce proportions that are equally unpredictable. The transformation process that occurs in an organization does not have a direct correlation where the quantity of input always equals with output.

 Example: Pharmacokinetics and the patients’ response to medication are log-linear and therefore small alterations in the patients’ medication schedule might produce wide ranging effects on the patients’ condition.

 Self-Organization:

 Definition: Thus, CAS can self-organize without the need for exterior management, and can create new frameworks or patters.

 Example: In emergency care, work is done as groups without necessarily being assigned any specific roles as is witnessed with the formation of a sudden surge groups.

 Adaptation:

 Definition: Elements of a CAS flex in the external environment as well as in their response to other elements in order to preserve stability or enhance the CAS’s performance.

 Example: In patient care, therefore, the various stakeholders respond to the patients’ reaction, and situations as they change in their approach to the patients and the treatment plans.

 Dynamism and Feedback Loops:

 Definition: CAS are active, and have feedback that changes the behavior of the system on going.

 Example: These patient monitoring systems entail the feedback loops in which the treatment plans are altered depending on the real-time data collected including insulin dosage depending on the level of blood glucose.

 Diversity and Complexity:

 Definition: CAS are multi-component systems which can be composed of structurally and functionally very different entities.

 Example: Nature of their care responsibilities (nurses, doctors, therapists) shows how different it is and how everyone has a part of work to do so the effort has to be mutual.

 Perceived Use of CAS Concepts by DNP-Prepared Nurses

 A Doctor of Nursing Practice (DNP) prepared nurse can apply the principles of CAS to patient care in various ways:A Doctor of Nursing Practice (DNP) prepared nurse can apply the principles of CAS to patient care in various ways:

 Facilitate Self-Organization:

 Example: Translating cooperative care systems in which a patient’s care is delivered by provider groups who are themselves organized by patient demand. For example, in a patient-centered medical home, the care team may switch around its functions or negate a functio

 Promote Adaptability:

 Example: Actually, the idea of scalability presented herein also concerns flexibility in care plans, which may be altered depending on the course and reactions of the patients involved. For example, changes made to an individual patient’s diabetes management plan based on primary parameters such as blood glucose measurements on a day-to-day basis.

 Leverage Feedback Mechanisms:

 Example: The use of EHR to offer constructive feedback to the healthcare organizations so that changes can be made, at a more real time basis, on the perceived measures within the continuum of care delivery.

 Encourage Interdisciplinary Collaboration:

 Example: Co-ordinating interdisciplinary teams to intervene in patient’s clinical management plans where different professional practice perspectives are used to enhance patient care. It enables the system to harness the diverse view in the team member and their skills especially when working in a new envorunment.

 Utilize Evidence-Based Practices:

 Example: Adapting the guidelines derived from scientific literature that may adjust from time to time according to the research done and practice experiences. For instance, changing treatment guidelines of heart failure because the evidence and patients’ experiences show that this is necessary.

 Literature Support

 Gittell, J. H. (2009). High Performance Healthcare: The Role of Relationships in Delivering Quality and Efficient and Adaptable Health Care. Indeed, this book argues and shows how relational coordination in healthcare teams sustains or fosters adaptive as well as emergent ways of working in CASs.

 Mitleton-Kelly, E. (2003). Complex Systems and Evolutionary Perspectives: Towards a New Synthesis Paul Fenton For copies of this book, please contact your Oxford University Press representative. From the covers: Stanislav Kondur, VNIIG, St Petersburg, Russia Slobodan Grgić, Gamna Hrvatska 2006 and Bruno Urizar, Universitat Autònoma de Barcelona, Spain. In this paper, the author briefly discusses the concept of CSM and its fields of usefulness that may extend to even as far as health care management to provide a starting point on the importance of complexity in adaptive systems.