Table 2.

Attributes of complex adaptive systems

ATTRIBUTEDEFINITIONPRIMARY CARE PREVENTIVE SCREENING EXAMPLES
Agents who learnPeople can and will process information, as well as react to changes in informationTeam members access knowledge translation tools to understand a conditional recommendation and then apply the knowledge in discussions with patients
InterconnectednessIndividuals and groups connect and interact in multiple ways, formally and informally and changing over timeDifferent practice staff groups (physicians, nurses, nurse practitioners, administrative staff) are involved in developing pathways toward shared decision making that respect patients’ preferences about cancer screening
Self-organizationOrder is created in a system without explicit hierarchical directionNurse practitioners develop their own approach to organizing patient flow for diabetes risk assessment, which is then included in the practice’s overall preventive screening plan
Co-evolutionThe system and the environment influence each other’s developmentOver the course of a year, recognizing that the practice waiting times for doctor appointments are rising, the team pilot-tests additional monthly nurse-led group information sessions about cancer screening tests
  • Adapted from Leykum et al.22