ONLINE CONTENT
A model of nursing as a complex adaptive system
Mary W. Chaffee, ScD (h), MS, RN, FAAN
Margaret M. McNeill, RN, MS, CCRN, CCNS, CNA
currently.2 The purpose of this article is to examine how
complexity science can be applied to the profession of
nursing and to offer a visual display of the model.
The science and theory of complex adaptive systems,
also known as complexity science, has emerged as
an alternative to existing paradigms. Complex adaptive systems demonstrate identifiable characteristics:
embeddedness, self-organization, non-linearity, unpredictability, and others. These systems exhibit emergent behavior that arises from simple rules and interconnections among diverse elements with porous
boundaries, as they interact with and respond to the
environment. The health system and the profession of
nursing can be viewed as complex adaptive systems,
and when done so, new insight can be gained. While
several authors have stated they believe nursing is
indeed a complex adaptive system, a visual model
has not yet been advanced. This article offers a model
of nursing viewed as a complex adaptive system, a
discussion of key properties of a complex adaptive
system, and potential implications of the use of complexity science in nursing and health care.
WHAT ARE COMPLEXITY THEORY
AND SCIENCE?
Complex adaptive systems are not merely complicated
systems that change over time. Glouberman distinguished “complex” from “complicated” by explaining
that a complicated system, like a car, has many parts.
Changing the oil doesn’t affect the tire pressure. He
contrasts the complicated system of the car with the
complex system of the car as mass-produced transportation and its influence on society, health, law, behavior, insurance, and other systems.3
Complexity theory attempts to explain complex behavior that emerges from dynamic, non-linear systems.
Complexity theory is not a single theory but is a
collection of overlapping and complementary theories
from a variety of sciences. These include chaos theory,
self-organization, and fractal geometry.4 The Plexus
Institute5 regards complexity science as the intellectual
successor to systems theory and chaos theory.
Complexity science is focused on CASs—the patterns of relationships within them, how they are sustained, how they self-organize, and how outcomes
emerge.6 Evolving over 40 years, complexity science
emerged in response to the unpredictable activity of
phenomena under study in many scientific disciplines.
It is highly multi- and inter-disciplinary, and its proponents include biologists, chemists, anthropologists,
economists, sociologists, physicists, and many others.
These diverse disciplines have turned to complexity
theory and science in a quest to answer some fundamental questions about living, changeable systems.7
Complexity theory attempts to explain why some systems show patterns of adaptability and progress in
response to an ever-changing environment, in contrast
to others that wither and die. Examples of complex
adaptive systems include bee hives and the stock
market.
The work of groups such as the New England
Complex Science Institute, the Santa Fe Institute, and
others have brought researchers together to study how
patterns emerge from seeming randomness (see Figure
The nature of the whole is always different from
the sum of its parts.
Frithof Capra, The Web of Life
T
he science of complex adaptive systems (CASs),
also known as complexity science, has emerged as
a powerful force influencing many fields and has
great potential for use in nursing. Complex adaptive
systems are characterized, according to Anderson and
McDaniel, as a number of elements interacting locally
in a dynamic, non-linear manner. Interactions in the
system are intricate; system activities are a function of
what has previously occurred and are open to energy
and information from the environment.1 Complexity
science has value in examining systems during times of
rapid change—a situation in which the health system is
Mary W. Chaffee is a Captain, Nurse Corps in the US Navy, and is a
PhD Candidate, Doctoral Program, School of Nursing at University of
Maryland, Baltimore, MD.
Margaret M. McNeill is a Colonel in the U.S. Air Force, Nurse Corps,
and is a PhD Candidate, Doctoral Program, School of Nursing at
University of Maryland, Baltimore, MD.
Reprint requests: Mary W. Chaffee.
E-mail: [email protected]
Nurs Outlook 2007;55:232-241.
0029-6554/07/$–see front matter
Copyright © 2007 Mosby, Inc. All rights reserved.
doi:10.1016/j.outlook.2007.04.003
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A model of nursing as a Complex Adaptive System
PROPERTY
Chaffee and McNeill
DESCRIPTION OF PROPERTY
Adaptable elements
Elements in a CAS can evolve.
Attractors
Co-evolution
Catalysts in a CAS that allow new behaviors to emerge.
Progress in the CAS occurs with constant tension and balance.
Context and embeddedness
The CAS resides within and interacts with other systems that
influence it.
New behavior is a feature of the CAS represented by constant
innovation and creativity.
Order is maintained in a CAS even without central control.
Emergent behavior
Inherent order
Nonlinearity
Implies that in response to a stimulus a variety of behaviors are
possible, and the cause and effect relationship is not directly
evident or linear.
The boundaries of the elements in a CAS are blurry and porous,
allowing exchange and movement between them.
Process where many local interactions create order without
direction from above.
Local application of simple rules can result in broad, complex
outcomes.
Forecasting is inexact in a CAS because elements change,
behavior is emerging and activities are nonlinear; the trajectory of a
system is unknowable.
Porous boundaries
Self-organization
Simple rules
Unpredictability
Data from references 9 and 27.
Figure 2. Properties of a complex adaptive system (CAS).
1 online at www.nursingoutlook.org). The work of
these groups, including research, education, and application, has advanced the science and spurred interest.
Researchers are developing tools and applying them to
the examination of CASs of all kinds including biological, economic, and social. Not-for-profit groups and
commercial entities are using complexity science to
find solutions to challenging problems.
DESCRIPTION, PROPERTIES, AND
CHARACTERISTICS OF A COMPLEX
ADAPTIVE SYSTEM
Complexity science provides a framework to study
systems that display perplexing behaviors if looked at
through the lens of traditional thinking. What might
appear chaotic may really be progressive and adaptive.
And what might have been seen to be good because it
was stable, orderly, and predictable, may in fact be
evidence of an impending death spiral.
Complex adaptive systems are exemplified by a
number of identifiable characteristics (see Figure 2).
Relationships are critical to understanding the system.
The behavior in a CAS grows out of interactions
between the agents within the system.8 They contain a
network or group of related diverse elements that
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respond in a positive way to the environment. The
elements (or agents) are independent but interconnected
to other agents. An agent might be a person, a cell, or
an organization. The reactions of an agent can have
wide-ranging influence because of the many relationships within the system. And the agents can have
different or changing roles as the CAS evolves and the
environment changes. The interconnections are important because they allow a diverse system response in an
adaptive way. Interconnections make learning and
co-evolution possible. A system does not evolve independently from its environment and the larger systems
in which it is nested. The systems co-evolve.8
In a CAS, one action does not cause a single
expected result (as one would see in a mechanical
system), but the effect can spread in unpredictable
ways. This is the property of non-linearity— one action may result in a variety of subsequent actions. A
small change may have an extensive effect and a large
change may have a small effect.8
Complex adaptive systems are not controlled by a
central authority but, instead, react to their local environment. Self-organization occurs in CASs, where
order is created through patterns of organization that
follow simple rules, such as occurs in a school of fish.
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This portrayal of activities on a hospital nursing unit illustrates the principles of a
complex adaptive system as defined by Plsek (25) and how they can be identified within
a nursing system.
Every bed in the 16-bed intensive care unit (ICU) is filled as the day-shift nursing
staff arrive, including the day-shift charge nurse. The nurses, medical interns, residents
and attending physicians begin their patient assessments (inherent order). Nurse
Breckinridge tells Medical Resident Blackwell his drug order for an intravenous antibiotic
is incorrect. Grumpy from little sleep, he pulls out his reference book. Realizing his
error, he changes the order to the correct dose– preventing potential harm to the patient
(co-evolution).
There are three critical patients in the emergency department likely to be
admitted to the ICU and a surgical procedure scheduled with a planned admission to
ICU. Because no patients are stable enough to be transferred to other units, the ICU
charge nurse consults with the Director of Operating Room Services and a decision is
made to cancel the elective surgery (adaptable elements).
A small area of tissue in the left ventricle of the Patient Stewart is becoming
irritable. A few irregular heartbeats appear on the EKG monitor before sustained
ventricular tachycardia ensues – throwing the heart into an ineffective rhythm as the
patient lapses into unconsciousness. Nurse Dix drops a phone as he glances up at the
cardiac monitor and says in a loud voice, “Call a code in room 6.’ Like bees heading to a
(Continued)
Figure 3. A example of the characteristics of a complex adaptive system: A day in the life of a complex, adaptive critical
care nursing unit.
There is no single “fish leader”: the patterns of movement are non-linear and dynamic. Self-organization is
often seen in crises where individuals have to improvise
to achieve goals. Simple rules in a CAS allow for
exciting behaviors and innovations because there is not
a burdensome and stifling compendium of directives
that must be followed. The CAS learns and, as a whole,
provides multiple and creative paths for action.7
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Complex adaptive systems are embedded in other
CASs. A nurse is a CAS and is also an agent within
the CAS of a nursing unit, which is an agent within the
CAS of an organization, which is a CAS and an agent
within the broader health care system. Since each agent
and each system is nested within other systems, all
evolving and interacting, a single entity cannot be
understood without considering the others.9 The
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hive, personnel move quickly to room 6, a detached female voice on the hospital
loudspeaker calmly states, ‘Code Blue, ICU; Code Blue ICU.” Throughout the hospital,
pages go off alerting personnel to the emergency and they respond rapidly moving to
the ICU (simple rules). Resuscitation efforts are not going well. Nurse Barton knows the
patient’s family and pastor are in the waiting area and talks to them about what has
happened (context and embeddedness). The cardiac arrest team leader calls for a drug
and learns the pharmacy discontinued it to save money. Nurse Sanger calls the
Pharmacy Director to request that the pharmacy try to borrow the medication from a
hospital nearby; one agrees and sends it over via a messenger (emergent behavior).
During the response to the cardiac arrest, Nurse Goodrich received a sharps injury and
required health care services – thereby become one of those cared for (porous
boundaries).
Patient Stewart had been hospitalized for several weeks, had developed a close
rapport with many ICU nurses, and died unexpectedly. Following his death, several
nurses gathered to talk about their grief and experience during the lengthy cardiac
arrest response (self-organization).
Nearby the hospital a driver talking on a cell phone fails to notice the warning lights
at a railroad crossing and a train carrying chemicals slams into the car. Chlorine gas
escapes from the crumpled rail cars causing an evacuation of hundreds of residents
and over 200 patients present at the hospital’s emergency department (simple rules,
unpredictability).
Figure 3. Continued
boundaries between different elements of the system
and between the CAS and its environment are illdefined and porous. This allows exchange of information, matter, and energy, and interaction between the
components of the elements.10 Attractors, values or
behaviors people are drawn towards, exhibit influence
in a CAS.11
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Emergent (new) behavior arises from the co-evolution resulting from the relationship between the CAS
and the environment, where change is constantly in
evidence as the two co-exist and influence one another.
Emergence may be viewed as the sudden appearance
of unpredicted phenomena due to myriad interactions
and the self-organization of agents.12 As a result of the
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reactions to and interaction within the environment, a
CAS is resilient and robust. In addition, CASs are
history dependent; they are shaped and influenced by
their past.13 Figure 3 provides an application of the
characteristics of CASs as they might appear on a
clinical nursing unit.
Nursing roles and scopes of practice have expanded;
over 100 specialty nursing associations serve their
members. Nurses are positioned in every part of the
health system providing and coordinating care for
people, in government agencies including the military
and Congress, in the private sector as executives and
consultants, as well as in academia, not-for-profit agencies, faith-based organizations, legal firms, and research
institutes. Multiple entry points to practice exist; at least
10 educational degrees in nursing are available and
graduate programs span specialties from neonatal nursing to geriatric care, from oncology to disaster nursing,
and from informatics to forensics.
THE COMPLEX NATURE OF
CONTEMPORARY HEALTH CARE
For most of the period of time that humans have
inhabited the earth, health care has been fairly uncomplicated. Until recently, there were quite simply few
effective strategies to deal with the diverse maladies
and traumas that befall human beings. But fast-forward
to today—past the development of homeopathy, the
establishment of medical societies and medical licensing, the development of anesthetic techniques, the
discovery of the microbe, the flourishing of surgical
procedures, and the transition from general practitioner
or private duty nurse to board-certified medical specialist. Continue past the urbanization of America and the
introduction of vaccinations, public health measures,
and visiting nurses. Consider the birth and growth of the
hospital—the built environment that became the womb
of sophisticated clinical and technological advances. As
treatment options expanded, requiring diverse care
providers and equipment, patient care moved into the
hospital until the end of the 20th century. The burgeoning hospital economy demanded trained workers—
especially nurses.
As the possibilities for help, health and healing
expanded, patients demanded the best the system had to
offer. In the 20th century, the government entered the
health care arena through the direct delivery of care and
the financing of patient care, health care provider
education, and health research. As health costs skyrocketed in the late 20th century, care moved into ambulatory care centers, hospices, dialysis centers, birthing
centers, and returned to the home. Financial and organizational restructuring measures were enacted as control mechanisms. Federal and state laws were passed in
an attempt to regulate behavior in the increasingly
complex system.14 This evolution has resulted in a
hugely complex system that provides the context for the
practice of nursing today.
THE CASE FOR VIEWING NURSING
AS A COMPLEX ADAPTIVE SYSTEM
The authors contend that nursing is, indeed, a complex
adaptive system and that the profession demonstrates
the characteristics of a CAS. Therefore, it is desirable to
present a model of nursing as a CAS. When nursing is
viewed through the lens of the CAS model, it is possible
to visualize key components and relationships within
the system, and then to develop new approaches to
nursing science, practice, leadership, research, and education.
ADOPTION OF COMPLEXITY
THINKING IN HEALTH CARE
AND NURSING
A number of disciplines have adopted complexity
science thinking and have recognized the value of the
CAS model. Complexity science has begun to appear
sporadically in the health care literature (see Figure 4
online at www.nursingoutlook.org). The nursing literature contains a small number of articles about complexity science and its applications (see Figure 5 online at
www.nursingoutlook.org). Though these publications
are disseminating critical aspects of complexity science
and thinking in the nursing literature, a conceptual
model that represents this thinking has not yet been
advanced.
Why should nurses be concerned with complexity
thinking? Complexity science may be of value to many
nurses— certainly it may be an appropriate theoretical
framework for nursing research. But it may also be
valuable to a nurse manager who finds that her organization is not behaving as she expected. Looking at
employee behavior and organizational activity through
the lens of complexity science may assist that manager
in making decisions that are not futile. Clinicians may
find value in complexity science as they work to plan
sophisticated nursing care in an unstable environment.
Indeed, any nurse who works in a fluctuating, confusing
environment may understand that environment better
and, thus, be able to be more effective if he considers
that he is in a CAS.
THE COMPLEX NATURE OF
CONTEMPORARY NURSING
Modern nursing practice, grounded in nursing science,
has evolved significantly since its birth in the late 19th
century. The “trained” nurse of the late 1800s had a
narrow scope of practice most often in a hospital near
the bottom of the paid labor hierarchy.15 The American
Nurses Association16 estimates there are nearly 2.9
million licensed, registered nurses in the US today.
These nurses conduct their practice in diverse organizations and at varying points in the process of care.
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Figure 6. The Complex Adaptive Systems Model. Characteristics of complex adaptive systems—a model by Marshall
Clemens (Reprinted with permission from Marshall Clemens/New England Complex Systems Institute). Available at:
www.necsi.org/projects/mclemens/cs_char.gif.
Figure 7. A model of nursing as a Complex Adaptive System. Reprinted with permission from Marshall Clemens,
Idiagram.com—Visual Modeling and Facilitation for Complex Business Problems, www.idiagram.com.
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Figure 8. An exploded view of the metaparadigm of nursing as a complex adaptive system as proposed by the authors.
(Graphic by Marshall Clemens – Visual Modeling and Facilitation for Complex Business Problems, www.idiagram.
com)
THE VALUE OF A
CONCEPTUAL MODEL
standing, dissemination, and advancement of complex
systems science by displaying key concepts in visual
models.19 Clemons20 created a graphic model for the
NECSI that demonstrates the major characteristics of a
CAS (see Figure 6).
A conceptual model is a powerful tool for organizing,
shaping, and guiding thinking. Just as a microscope
offers a view of microbes, a conceptual model provides
a lens through which ideas and relationships come into
focus. Wilson17 wrote that outside our heads there is a
freestanding reality, and inside our heads is the reconstitution of that reality based on sensory input and the
self-assembly of concepts. A conceptual model can be
considered part of the sensory input that guides the
assembly of concepts.
Fawcett18 defines a conceptual model as a set of
relatively abstract and general concepts that address the
phenomena of central interest to a discipline, the
propositions that broadly describe those concepts, and
the propositions that state relatively abstract and general relations between 2 or more of the concepts.
VIEWING NURSING WITH THE
NECSI COMPLEX ADAPTIVE
SYSTEMS MODEL
The NECSI CAS Model is an elegant graphic that
effectively illustrates the properties that are resident in
CASs. When the graphic is adapted to display the
concept of nursing, a powerful image emerges (see
Figure 7).
The health system, appearing at the top of the
graphic, is a CAS, and within it are numerous other
CASs—including nursing. The 3 subsystems (or
agents) selected for use in the model are societal
elements, other health system elements, and nursing.
Societal elements are portrayed as a CAS within the
health system and may include such things as financing
strategies. Other health system elements might include
medicine, dentistry, and pharmaceutical research. Nursing is portrayed as the third entity at this level but other
agents could exist. All of these entities have porous
THE COMPLEX ADAPTIVE SYSTEM
MODEL APPLIED TO NURSING
The New England Complex Systems Institute (NECSI)
is an independent educational and research institution
dedicated to advancing the study of complex systems.
One of NECSI’s initiatives is to advance the under238
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boundaries; information, personnel, and patients move
in complex patterns within them and between them.
Each action within the system has many possible
outcomes and can influence many other elements within
the system.
NURSING’S METAPARADIGM
VIEWED AS A COMPLEX ADAPTIVE
SYSTEMS MODEL
A metaparadigm identifies and describes the global
concepts of interest to a discipline and the global
propositions that describe relationships between or
among the concepts.18 Four concepts emerged from the
early grand theories of nursing to become the metaparadigm of nursing: man, society, health, and nursing.21
Scholarly debate has ensued about these concepts and
resulted in the refinement of the labels: “Man” evolved
to “person” and then to “human being.” “Society”
became “environment.”18 The authors chose to use the
4 concepts of human being, environment, health, and
nursing in the application of the CAS model to nursing.
The exploded view of the CAS model demonstrates
these 4 concepts and proposes the next level of subsystems that may comprise them (see Figure 8).
THE “EXPLODED” MODEL OF
NURSING AS A COMPLEX
ADAPTIVE SYSTEM
Using complexity theory supports a view of nursing as
a system that contains subsystems and that each, in turn,
contains other subsystems—all displaying the properties of CASs. The exploded view of the CAS model
applied to nursing includes a visual display of the
concepts that form the metaparadigm of nursing:
Human Being
The hallmark of most nursing models is the individual person as the primary focus of the profession.22
Fawcett has proposed that “human being” is the most
appropriate concept to employ due to Leininger’s argument that “person” is not a globally understood concept.18
Nursing
Nursing is a discipline and practice that has been
socially constructed to meet human health-related needs
according to Thorne et al.,22 Meleis23 described nursing
as a human science as well as a practice-oriented,
health-oriented, caring discipline. Many definitions of
nursing have evolved since the first put forth by
Florence Nightingale in 1859 —and much debate has
occurred. Thorne et al22 proposed a unifying definition
that reflects a philosophic middle ground, and that
definition was used to guide development of the nursing
subsystem in Figure 8:
Nursing is the study of human health and illness
processes. Nursing practice is facilitating, supS
Chaffee and McNeill
porting and assisting individuals, families, communities and/or societies to enhance, maintain
and recover health, and to reduce and ameliorate
the effects of illness. Nursing’s relational practice
and science are directed toward the explicit outcome of health-related quality of life within the
immediate and larger environmental contexts.
Health
The definition of health has been the source of
significant debate and has evolved as a concept within
the nursing literature. While its definition has been
argued, health has been a phenomenon of central
interest to nursing. Recently, quality of life has gained
interest as a central focus, but neither health nor quality
of life has been clearly conceptualized in nursing.22 In
her metaparadigm of nursing, Fawcett broadly defines
health as the human processes of living and dying.18
This definition was used to develop the nursing subsystem of health in figure 8.
Environment
Originally identified as “society”, “environment”
was felt to better describe phenomena relevant to
“person” (and, later, “human being”).18 Two views of
the concept of environment in the nursing metaparadigm exist. The first is a narrow view of the environment as the immediate surroundings or circumstances
of an individual. The second is a broader view that
presents the person and environment as contiguous.22
This second view is more consistent with complexity
theory and was adopted by the authors for use in
development of Figure 8. The concepts identified in
Figure 8 depict the phenomena that are relevant to
understanding the environment in which human beings
exist.
INSIGHTS FOR NURSING FROM
COMPLEXITY SCIENCE
Applying complexity science and theory in nursing, and
using a graphic model to assist their application, offers
intriguing insights and opens up new avenues of
thought and scholarship. The essence of leadership is
bringing about change in complex systems.10 Clancy
advocates for viewing nursing as a CAS and indicates
that leading in a complex environment requires managers to understand new concepts such as emergence and
self-organization.12
Relationships Rule in a CAS
A system is seen as a social entity, and behavior in a
CAS occurs due to interactions among the agents in the
system. The quality of relationships among agents
needs more attention than the quality of agents in the
system.24 Leaders who adopt complexity thinking will
focus on building and nurturing relationships with their
colleagues.5
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“Machine Model” Thinking Won’t Work
in a CAS
In a mechanical system, outcomes of actions can be
readily predicted. Mechanical systems rarely produce
surprising behavior (like CASs). When an employee in
a health care agency behaves “unpredictably” and is
considered inappropriate or unreasonable, perhaps it is
the administrator’s view of the system that is not
appropriate.25
Decentralization and Empowerment Thrive
in a CAS
Leaders who adopt complexity thinking will create
conditions that allow systems to evolve and adapt over
time. The agents must be given the tools to develop
creative solutions, and the authority and power to
implement them. Leaders should formulate the vision
and allow creativity at local levels in its implementation.
Old Dogs and New Tricks
Health care executives, managers, and other professionals must consider adopting a new mental model of
the health system if they desire to succeed in the rapid,
ongoing change in health care organizations. Because
mental models are engrained from years of use, change
is not easy. But, change is critical if entrenched views
that no longer work are to be replaced with views that
permit innovation and creative action.1
It’s Good to be on The Edge of Chaos
Complexity scientists believe CASs move between 3
states: chaos, stasis, and the edge of chaos. The edge of
chaos is viewed as the state where the system is most
ready for adaptation. Organizations in this state are ripe
for unexpected movement and new ideas.5
Recognizing Patterns is Important in a CAS
Complex organizations produce patterns but they
can be difficult to discern.12 Patterns are simply sequences of events, ideas, or behaviors that have significance. They are logical in hindsight but can be tough to
spot as they are taking shape. James26 has identified 6
ways to identify patterns: extension, elaboration, recycling, pattern reversals, strange attractions, and chaos.
Having these tools to assess an environment for patterns
may support successful leadership and action in a CAS.
Unpredictability must be Expected in a CAS
The complexity and characteristics inherent in CASs
make unpredictability an expectation. If we accept that
this is the case, we can learn to appreciate unpredictable
results. Tension, paradox, uncertainty, and anxiety are
healthy in a CAS.
CONCLUSION
Silo Thinking is Inconsistent with
Complexity Science
The boundaries of a CAS are porous and blurry.
Exchange of people, energy, resources, and other components that make up the elements of a CAS are going
to happen. The interactions that take place among the
elements make it impossible to operate in a silo mindset. Whatever one element does will have impact
elsewhere in the system—and this will happen in a
non-linear fashion. For example, changing routine medication times on a unit will have obvious impact on the
pharmacy. It may not be quite so evident that timing of
laboratory tests may have to be adjusted, which will
impact scheduling in another department, which could
fuel discontentment, decrease retention, and increase
costs.
On September 11, 2001, when the first airliner struck
the World Trade Center, most people viewed the event
through a traditional lens and believed it was an
accident. But it was necessary to view the events of
September 11, and others since, through a very different
lens. It became apparent that well-financed and highly
skilled religious extremists had attacked the US. If the
events were still viewed through traditional thinking,
current action would probably involve new measures to
improve aircraft safety near tall buildings. Only with a
much broader interpretation of the complex and related
facts that have emerged concerning September 11 can
appropriate efforts move forward.
Complexity science is a very different method of
considering nursing and its function in the health
system. It offers nurses a powerful opportunity to
design research, leadership decisions, policy, and clinical practice in new ways. Begun and White2 suggest
that adopting complexity science thinking in nursing
may be vital for the profession’s survival, as nursing is
often intransigent and held in place by inertial forces.
While some professions are embracing the concepts
of complexity science, they are few. Nursing has a
remarkable opportunity to adopt complexity thinking
and alter its worldview.27-31
Autocratic Leadership Doesn’t Work
in a CAS
Self-organization does not imply a lack of leadership; leadership is required at all levels. Leaders who
adopt complexity thinking will equip all people to be
leaders so, when something happens, they can respond
in an innovation and independent way at their level.
Freedom for the agents or elements in a CAS to act in
ways that are not predictable and controlled by others is
what makes a CAS adaptive and allows creative behavior to emerge.
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The views in this article are those of the authors and are not
necessarily the official views of the US Government, the Department
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of Defense, the Department of the Air Force or the Department of the
Navy.
The authors wish to acknowledge the effort of Marshall Clemens of
ldiagram.com in the preparation of the graphics for this article.
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2. Begun JW, White KR. The profession of nursing as a
complex adaptive system—strategies for change. Res Sociol
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3. Glouberman S, Gemar M, Campsie P, Miller G, Armstrong
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A model of nursing as a Complex Adaptive System
Agency
Center for the Study of
Complex Systems
University of Michigan,
Ann Arbor, MI
New England Complex
Systems Institute,
Cambridge, MA
Plexus Institute,
Allentown, NJ
Redfish Group,
Santa Fe, NM
Santa Fe Institute,
Santa Fe, NM
ThinkVine, LLC
Cincinnati, OH
UCLA Human Complex
Systems Program
Chaffee and McNeill
Purpose
Founded in 1999, the Center
encourages CAS research, expands
educational opportunities and
explores the boundaries of CASs
and more traditional approaches.
NECSI conducts research,
education, knowledge dissemination,
and community development to
promote the study of complex
systems and their use to better society.
Plexus is a not-for-profit group
formed in 2001 to foster the health of
individuals, families, communities
and organizations and the
environment by helping people use
concepts emerging from the science
of complexity.
Founded in 1991, Redfish Group is
an organization of complexity
researchers, software developers
and business experts who apply CAS
to business and government
problems.
The Institute is a private, not-forprofit, independent research and
education center founded in 1984
that encourages multi-disciplinary
collaboration. CASs are seen as
critical to addressing complex social
challenges.
ThinkVine is a consulting firm that
offers decision and business support;
complexity science is used to design
business and consumer strategies.
Academic program that explores
complex systems inhabited by human
beings; offers a minor degree in
human complex systems.
Weblink
http://cscs.umich.edu
www.necsi.org
www.plexusinstitute.com
www.redfish.com
www.santafe.edu
www.thinkvine.com
www.hcs.ucla.edu
Figure 1. Institutes, centers, and agencies involved in the research and application of complex adaptive systems science.
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•
Chaffee and McNeill
McDaniel, Jordan and Freeman assert that health care organizations are
complex adaptive systems. They suggest that when that is recognized, health
care organizations can be seen in new ways and new management approaches
can be devised (27).
•
Glouberman and colleagues analyzed the health of city dwellers from a CAS
perspective. They indicate their approach can serve as the basis for innovative
and effective health promotion (3).
•
Minas identified characteristics of CASs in Australia’s mental health system (10).
•
Stroebel and colleagues used complexity theory to inform a series of studies
designed to understand and improve primary care practice (24).
•
Plsek offered guidance on redesigning a safer health system using complexity
science in the Institute of Medicine’s ‘Crossing the Quality Chasm: A New Health
System for the 21st Century,’ (25).
•
Brown applied CAS theory to the clinical practice of rehabilitation in an effort to
demonstrate its relevance (28).
•
The Plexus Institute presented ‘Improving the Health of the Chronically Ill:
Insights from Complexity Science’ in December 2004; sponsored by the Agency
for Healthcare Research and Quality (AHRQ).
Figure 4. Health care applications of complexity science and theory.
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•
Chaffee and McNeill
Begun and White indicate nursing may be considered a complex adaptive
system but they identify characteristics of the profession they believe do not
wholly fit (2).
•
Anderson, Issel and McDaniel used complexity science to explain the results of a
study of nursing homes as complex adaptive systems. The purpose of the study
was to test complexity hypotheses concerning the relationship of management
practices and resident outcomes (29).
•
Walls and McDaniel explored how nurse managers could use a CAS approach to
cope with a health care merger or acquisition (30).
•
Sitterding described the use of CAS theory by a clinical nurse specialist to
prevent surgical site infection (31).
•
Rowe and Hogarth analyzed how change in the performance of public health
nurses was instituted using a CAS approach (11).
•
The Plexus Institute presented ‘Complexity Science: Opportunities for Nursing
Education’ in August 2005; hosted by the University of Kansas School of
Nursing.
Figure 5. Nursing applications of complexity science and theory.
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