Complexity Science or the study of complex adaptive systems (CASs) can be intimidating with all sorts of mathematical, biological, and physical science language etc. Yet there are some really fascinating fundamentals that don’t require experience in brain surgery or rocket launching! (Although both may be illuminating). With my background in biochemistry, nursing, and organizational behavior, I see all sorts of connections between key people skills we need in healthcare and the properties of Complex Adaptive Systems. In fact, because relationship is so integral to CASs, so too are communication, collaboration, & emotional intelligence!
Emergent behavior is closely related to adaptability and describes how the agents behave in the moment in relationship to others. To gossip or not to gossip, to offer or take in constructive feedback vs avoiding conflict, or putting a wall up, to listen to the gossiping or step up to the plate and say, “this isn’t OK”, to yell at someone for not knowing something or to teach someone something new are all examples of emergent behaviors that will contribute to different outcomes. Because the practice of nursing is in a continual and dynamic interface with other professionals and patients and families, emergent or spontaneous behaviors are always happening. Respectful communication can and should be integrated into nurses’ moment -to-moment interactions at all times. Lapses, slips, or misunderstandings will occur and represent opportunities for apologizing or making time for a more difficult conversation. This ideal or respectful behavior represents a platform from which all sorts of creative ideas and problem solving can arise in a CAS.
What do positive emergent behaviors look like in healthcare?
The social worker who reminds the unit coordinator that computer system is going to be down during the evening shift.
The nurse who tells her peers she does not want to talk about another nurse behind her back.
The nurse leader who negotiates budget allocations for delegation skill training for nursing staff and a part-time nurse assistant during the busiest times.
The surgeon who tells the OR team she expects each of them to watch for and report problems.
The housekeeper who shares her insight with the clinical team that a post-op patient’s fear of falling was the reason she was afraid to walk with the physical therapist.
The nurse assistant who went in and held a patient’s hand in the middle of the night when she sensed the patient was anxious.
Can you see how these behaviors emerge spontaneously in the context of relationships and are key for safe care, optimal patient experience, rewarding careers, and cost-effective delivery of care. Respectful communication = positive workplace relationships = safe care etc!
How do we promote emergent behaviors that lead to safe care, positive workplaces and rewarding careers? In addition to the obvious communication training in giving and receiving constructive feedback, Medical Improv offers huge promise for building individual people skills and interdisciplinary relationships! Learn more about this innovative and fun process! Medical Improv Youtube or contact firstname.lastname@example.org Also, check out the newly launched Medical Improv Website by Professor Katie Watson and Dr. Belinda Fu! We can create the right conditions for healthy change in our many CASs.
How can I learn more about CAS in relationship to healthcare?
- Adapted From: Edgeware: Lessons From Complexity Science for Health Care Leaders, by Brenda Zimmerman, Curt Lindberg, and Paul Plsek, 1998, Dallas, TX: VHA:
- Appendix B by Paul Plsek in the landmark IOM book, Crossing the Quality Chasm is an excellent introduction to CASs with a focus on healthcare systems. And it is only 10 pages!