Healthcare teams as complex adaptive systems: understanding team behaviour through team members’ perception of interpersonal interaction

Abstract

BackgroundComplexity science has been introduced in healthcare as a theoretical framework to better understand complex situations. Interdisciplinary healthcare teams can be viewed as Complex Adaptive Systems (CAS) by focusing more on the team members’ interaction with each other than on the characteristics of individual team members. Viewing teams in this way can provide us with insights into the origins of team behaviour. The aim of this study is to describe the functioning of a healthcare team as it originates from the members’ interactions using the CAS principles as a framework and to explore factors influencing workplace learning as emergent behaviour.MethodsAn interview study was done with 21 palliative home-care nurses, 20 community nurses and 18 general practitioners in Flanders, Belgium. A two-step analysis consisted of a deductive approach, which uses the CAS principles as coding framework for interview transcripts, followed by an inductive approach, which identifies patterns in the codes for each CAS principle.ResultsAll CAS principles were identified in the interview transcripts of the three groups. The most prevalent principles in our study were principles with a structuring effect on team functioning: team members act autonomously guided by internalized basic rules; attractors shape the team functioning; a team has a history and is sensitive to initial conditions; and a team is an open system, interacting with its environment. The other principles, focusing on the result of the structuring principles, were present in the data, albeit to a lesser extent: team members’ interactions are non-linear; interactions between team members can produce unpredictable behaviour; and interactions between team members can generate new behaviour. Patterns, reflecting team behaviour, were recognized in the coding of each CAS principle. Patterns of team behaviour, identified in this way, were linked to interprofessional competencies of the Interprofessional Collaboration Collaborative. Factors influencing workplace learning were identified.ConclusionsThis study provides us with insights into the origin of team functioning by explaining how patterns of interactions between team members define team behaviour. Viewing healthcare teams as Complex Adaptive Systems may offer explanations of different aspects of team behaviour with implications for education, practice and research.

Understanding health professional role integration in complex adaptive systems A multiple-case study of Physician Assistants in Ontario, Canada

“…The application of a complex system theory approach as it pertains to the health human resource innovation of PA integration in Ontario is novel. Although complexity theory has not been explicitly applied to the PA profession, other research supports the use of CAS to explain why interdisciplinary teams are successful in the provision of services when cases are complex (26), and to explain how patterns of interactions between health team members define team behaviour (27). Complexity theory is well suited to explore PA role integration given the complexity of healthcare settings including multiple stakeholders, multifaceted issues, uncertainty, diverse agendas, and interconnected relationships.…”

“…Exploring PAs as one agent in a complex adaptive system was helpful for examining the iterations, complexity, emerging patterns and interrelationships that support this flexible and adaptable addition to the Ontario health care system. Complexity science provides insights that could not have been reached when only using the traditional explanatory model based on scientific positivism that describes the linear cause-effect relationship between two isolated events (27,28). Furthermore, CAS was helpful in offering potential solutions and routes for ongoing development of PA integration.…”

“…One limitation regarding use of complexity theory is variability in the application of core CAS principles which may lead to conceptual confusion (29). This limitation did indeed lead to challenges in the operationalization of complexity theory within this research study, as multiple resources reference slightly different principles or features (27,(29)(30)(31)(32)(33)(34). However, the methodological approach of iterative coding and thematic analysis within and between cases, in addition to application of complexity theory, allowed for the identification and refinement of the CAS features most relevant to participant experiences.…”

The agility of ants: lessons for grappling with complexity in health care teamwork

“…There is a growing awareness that improving team performance demands that we move beyond a focus on individuals and pay more attention to how individual members interact . Similarly, Woodruff calls into question ‘the exclusive application of rigid roles and responsibilities to teamwork (systematic approach)’.…”

“…There is a growing awareness that improving team performance demands that we move beyond a focus on individuals and pay more attention to how individual members interact. [1][2][3] Similarly, Woodruff calls into question 'the exclusive application of rigid roles and responsibilities to teamwork (systematic approach)'. He asserts that a systematic approach 'fails to provide the flexibility and leverage of diverse perspectives (systems approach) required to solve complex problems'.…”