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By Sila Rogan

What is a complex adaptive system?

A complex adaptive system (CAS) refers to a system composed of multiple, interacting parts (1). Essential features of complex adaptive systems :

• Undergoing perpetual change, constantly evolving; following non-linear behaviour (2)
• Being constrained by simple rules that limit component and system behaviour (1)
• Being influenced by internal and external factors
• Control of the system is decentralized rather than hierarchical; system behaviour is thus the result of multiple interacting parts (3)
• Future behaviours of the system are unpredictable, due to the influence each part exerts on the whole system and its parts.
• Past behaviours are not predictors for future behaviours of the system (3)

How can we understand and study complex adaptive systems?

The concept of a complex adaptive system can challenge assumptions that underscore reductionist world views typical of areas such as hard science, policy development, and planning (3). For example, many reductionist approaches to research involve carefully studying one component of a system, under the assumption that it will yield information about the entire system. However, within a complex adaptive system approach, studying one component of the system in isolation will yield little information on the system as a whole as it is impossible to understand the interactions it has with the other components of the system and how these interactions change over time (3).

Complex adaptive systems are best studied and understood by focusing on patterns within the system and relationships between the parts that make up the system rather than cause and effect within the system (3).

Why are complex adaptive systems relevant in a rural health research context?

As health systems have many features of a CAS, such as being dynamic and having multiple interacting parts, using a CAS approach may be an effective way to study and plan rural health services (1). Outlined below are some ways a CAS-based approach to rural health may be useful:

Studying and developing an integrated model of care

Due to the numerous interacting factors that contribute to the health of a rural community, such as the environment, socio-economic factors, and geography, as well as limited access to specialized health services, an integrated model of care, delivered by a generalist practitioner, may be beneficial for the health of a rural community (4). An integrated model of care is a person-centred approach to healthcare that seamlessly and comprehensively meets the health needs of the patients (5). It integrates both various health disciplines as well as population health considerations into the care model (5). Within a rural context, generalist practitioners with enhanced skills are best equipped to provide integrated care as they can individually provide a wide range of health services.

Using a CAS-based approach to understand rural health and rural healthcare may facilitate integrated service delivery by breaking through disciplinary silos, exploring the interactions between various streams of care and factors that influence rural health, and taking a non-linear approach to understanding health systems (1).

Case study: In this study by Wietmarschen et al. (2016), an integrated model of care for treating obesity was developed using complexity science, a research approach that studies complex systems and the relationships and components that underlie them.

Organizational improvements in rural healthcare

Leadership and effective organizational structure are important for the success of health systems, including rural health care systems (6). Adopting adaptive leadership practices within rural healthcare systems may yield an organizational structure that adapts and responds to the needs of the community (1) which may be a promising way to improve rural resilience.

 Continuity of care

Continuity of care refers to the extent to which a patient is able to have connected and well-organized care throughout the duration of their experience accessing health care (7). As healthcare is becoming increasingly specialized and compartmentalized, continuity of care is compromised, especially within the rural health context (8). A CAS approach to health recognizes the relationships between various components of a patient’s care and is thus promising for improving continuity of care.

How does your understanding of complex adaptive systems inform your research? We would love to know!

Sources

1. Martin CM. Complex adaptive systems approaches in health care—A slow but real emergence? J Eval Clin Pract. 2018;24(1):266–8.
2. COVID-19 illustrates the benefit of managing Healthcare as a Complex Adaptive System — [Internet]. [cited 2021 Mar 2]. Available from: http://www.francishealth.co.nz/fhblog/2020/5/7/covid-19-illustrates-the-benefit-of-managing-healthcare-as-a-complex-adaptive-system
3. The Health Foundation. Complex Adaptive Systems [Internet]. 2010. Available from: https://www.health.org.uk/sites/default/files/ComplexAdaptiveSystems.pdf
4. Selby-Nelson EM, Bradley JM, Schiefer RA, Hoover-Thompson A. Primary Care Integration in Rural Areas: A Community-Focused Approach. Fam Syst Amp Health. 2018 Dec 1;36(4):528–35.
5. World Health Organization. Integrated care models: an overview. 2016 Oct;42.
6. Abimbola S, Negin J, Martiniuk AL, Jan S. Institutional analysis of health system governance. Health Policy Plan. 2017 Nov 1;32(9):1337–44.
7. Alberta Health Services. What is Continuity of Care? [Internet]. Alberta Health Services. 2017 [cited 2021 Mar 11]. Available from: https://www.albertahealthservices.ca/Blogs/lrp-calgary/256.aspx#.YErI0rRKi3I
8. Hofer A, McDonald M, Hofer A, McDonald M. Continuity of care: why it matters and what we can do. Aust J Prim Health. 2019 Jul 19;25(3):214–8.