DNP 815 Explain the common characteristics of complex adaptive systems

DNP 815 Explain the common characteristics of complex adaptive systems

DNP 815 Explain the common characteristics of complex adaptive systems

Organizational and clinical procedures such as innovations, suppliers, new technologies, and growing knowledge are seemingly growing complex in today’s health systems. Complex adaptive systems (CAS) theory to nursing practice has a significant impact on the processes and structures of health services, where nurses increase their focus on creative adaptation promotion, diversity, and information flow (Kvilience & Blazeviciene, 2019). Variables increase the flow of information through the nursing process and the promotion of timely nursing, leading to improve patient outcomes, whereas barriers can lead to adverse events and errors. The health system and the nursing profession can be viewed as CAS to gain new insight. One characteristic of the CAS is emergence, where the system develops new patterns of behavior over time and emerges in response to internal and external factors (Munro et al., 2020).

Healthcare developed complex science as a theoretical framework to better understand complex situations. The principles in CAS provide a framework enabling insight into how those operating within social networks communicate with each other to manage any concerns that are relevant to determining actions. It is very important to pay attention to the nurses’ work (Kiviliene & Blazeviciene, 2019). When caring for an individual patient, the nurse must always keep in mind to look at the bigger picture of the possibility of being disturbed by unexpected possibilities.

The use of complex adaptive systems as a tool such as process optimization and quality assessment is taking an important role in nursing and health care, which can be used to guide nurses in assessing the needs of the patients, nursing process optimization, improving teamwork, and learning needs analysis (Kiviliene & Blazeviciene, 2019). A DNP nurse should look into the inclusion of complexity science into nursing leadership practice and encourages new ways of looking at the organization and the ideals and expected results of skilled nursing.  


Kiviliene, J., & Blazeviciene, A. (2019). Review of complex adaptive systems in nursing practice. Journal of Complexity in Health Sciences2(2), 46–50.

Munro, S., Kornelsen, J., Wilcox, E., Kaufman, S., Bansback, N., Corbett, K., & Janssen, P. (2020). Implementation of shared decision-making in healthcare policy and practice: A complex adaptive systems perspective. Evidence & Policy: A Journal of Research, Debate and Practice16(3), 393–411.

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Complex adaptive systems in health care are networks that interact with one another but are seen as independent and join with a common goal. This system has principles that define it. Paype et al. (2017) explain it with seven principles. First, it must have multiple components in which rich interaction must occur. It does not include only understanding the organization’s structure. Second, the interactions that occur are not always predictable behaviors. Third, there is a history and sensitivity, including initialing conditions. Fourth, their interactions are influenced by the environment. Fifth, an interaction that occurs is non-linear. Therefore, the result is dependent on elements and the input. If minor inputs occur, they can have significant effects, and major effects can have negligible effects. Sixth interactions create emergent behaviors, but this does not mean that the study of elements can explain and cannot be predicted. Lastly, as the systems are open when they are being observed, the individual that is an observer is part of the system.

A doctoral nurse prepared (DNP) nurse can use these concepts to improve the delivery of patient care. This tool assists in adapting to an ongoing change. With the increased needs of patients and changing societal contexts, a DNP must understand this system to effectively implement change and identify clinical needs. For example, Paype et al. (2017) use this approach with a focus on increasing interpersonal interaction. They implemented a Complex Adaptive Leadership Organisational Capability Questionnaire. The tool was demonstrated to be feasible for evaluating day-to-day operations and identifying quality improvements.

Another example is Munro et al. (2020) study which used complex adaptive systems to implement shared decision-making. They found that this approach goes beyond the limits of reductionism and disentangled. It fragmented the problem into barriers, facilitators, and outcomes. They were also able to have greater insight into implementation and address challenges. It explored patterns, self-organization, and interactions. In this study, this approach helped to identify solutions to address the patients, providers, and policy factors that influence the implementation of shared decision-making. These are two great examples of how this complex adaptive system can improve patient care.


Munro, S., Kornelsen, J., Wilcox, E., Kaufman, S., Bansback, N., Corbett, K., & Janssen, P. (2020). Implementation of Shared Decision-Making in Healthcare Policy and Practice: A Complex Adaptive Systems Perspective. Evidence & Policy: A Journal of Research, Debate and Practice16(3), 393–411.

Pype, P., Krystallidou, D., Deveugele, M., Mertens, F., Rubinelli, S., & Devisch, I. (2017). Healthcare teams as complex adaptive systems: Focus on interpersonal interaction. Patient Education and Counseling100(11), 2028–2034.

Clinical care and healthcare organizations can be gleaned from emerging paradigm integrated into healthcare literature as an approach in nursing practice. Traditional science entails the laws of science compared to complexity science that emerges from simple rules (Butts & Rich, 2017). Complexity science finds usefulness in neuroscience, social and organizational behavior, and economics. Complex adaptive theory has application of complexity that shares similarity with the systems theory. “The science based in physics and mathematics that uses basic principles such as simple rules or functions to explain the relationship between variables, and that allows for variations and emergent behaviors that are not fully predictable” (Butts & Rich, 2017, p. 168). For that reason, the complex adaptive theory could be extrapolated and related to nurses as a theoretical framework.

Complex adaptive system integrates individual patient, family, and the whole healthcare system, one that resonates with nurses. Systems theories are theories of organization, and they provide the framework for the integration of different fields in science (Lalande & Baumeister, 2021). Complex adaptive system is a special type of complex systems applicable to research in physical, biological and social science. Like complex system, complex adaptive system could be adopted to solve real-life problems. Complex adaptive system is made up of agents (nurses) and pattern (formed by agents acting from a set of internalized rules). As a DNP-prepared nurse, work and work products, including change, would be carried out using complex adaptive systems theory as a theoretical foundation.  Adaptation occurs through the learning system that could be fitted for a dynamic changing environment, allowing an organization to respond to the stimuli of change. 


Butts, J. B., & Rich, K. L. (2017). Philosophies theories and for advanced nursing practice (3rd ed.). Jones & Bartlett Learning.

Lalande, D., & Baumeister, R. F. (2021). Systems theories (psychology). Salem Press Encyclopedia of Health.

The complex adaptive system is defined as a system of a high degree of adaptive capacities while keeping flexibility in the presence of agitation. Concerning adaptation, communication, cooperation, specialization, reproduction, and temporal organizations are some of the characteristics of the complex adaptive system.

The DNP-prepared nurse can implement the ideology of a complex adaptive system to patient care by performing quality empirical research on quality improvement practices. The nurse can apply the concept while using basic information of the primary care unit while heading towards the most practiced models which are clinically preferable. The integration of clinical management programs including the use of electronic care records helping the nurses to avoid medication errors while providing healthcare services to patients (Kiviliene and Blazeviciene,

2019). The successful application of the concept is possible by working on the greater volume of inter-professional coordination and communication. For this purpose, certain actions and frameworks are required to be advised by the DNP nurse to facilitate a network of communication and determination of certain activities for the management of related complexities in healthcare services. Concerning experiences and application of advanced healthcare practices, there is a need to broaden the progress of the integration of nursing knowledge and skills in healthcare services.

It is because of the fact the integration of nursing knowledge and complex system capacities can

better help in the organization of effective patient care. The integration of nursing knowledge

and complex adaptive system capacities can better help the nurses to overcome the challenges of

a complicated situation, introducing effective alignment of a professionally organized system of treatment while spreading the idea of collaborative teamwork and facilitate the introduction of a bureaucratic environment easy to manage commands and to control approaches of patient care (Pype et al., 2018).

Nowadays, the is an increasing need for the dissemination of information from the bottom up instead of top-down. For this purpose, the origin of the information can be the patients themselves and this fact increasing the need for the development of successful physician-patient interaction for the effective delivery of healthcare services. Hence, the DNP nurse can play an effective role in the application of CAS through the evolution of new mechanics and supporting

the system with loving wisdom in an attempt to provide quality healthcare services to patients.


Kiviliene,J. and Blazeviciene,A. (2019). Review of complex adaptive systems in nursing practice. Journal of Complexity in Health Sciences, 46-50.

Pype, P., Mertens, F. and Helewaut, F. (2018). Healthcare teams as complex adaptive systems: understanding team behavior through team members; perception of interpersonal interaction. BMC Health Serv Res, 570

Complex adaptive systems (CAS) include many parts that make up and work within a system (Butts & Rich, 2017). Some common characteristics of a complex adaptive system are dynamic, adaptive, and connected. Agents are the individual components in a hospital system and could be anyone working in that hospital. There is not an agent that works solo in a CAS, such as a hospital. For example, a nurse in the ED works with providers, ancillary departments, patients, visitors, family members, vendors, and contract staff. The decisions that the nurse makes will impact the others involved. The nurse does not work in a silo. Being dynamic, healthcare can adapt to internal and external environments. I think our recent events of COVID highlighted the ability of healthcare as a CAS to adjust to the internal environment of changing protocols and medical knowledge and the outside environment of those coming to the hospital for care.

A DNP nurse must see the agent as a department and how the departments interact. Leadership is complex and must understand how one can communicate and influence department interactions (Belrhiti et al., 2018). Being dynamic when organizing and coordinating activities while supporting decentralized decision-making is crucial. The DNP nurse must make decisions by understanding the organizational culture and the external environment. DNP nurses focus on the multilevel process of the organization and must be adaptable when things change. Instead of providing answers and direction, there is more of a focus on creating an environment and the conditions needed for others to work well in the system. On a personal level, some characteristics include self-reflection, learning from one’s mistakes, and valuing the importance of empowering the ones around them.


Belrhiti, Z., Nebot Giralt, A., & Marchal, B. (2018). Complex Leadership in Healthcare: A Scoping Review. International Journal of Health Policy and Management, 7(12), 1073–1084.

Butts, J. B., & Rich, K. L. (2017). Philosophies theories and for advanced nursing practice (3rd ed.). Jones & Bartlett Learning.

Sweetman and Conboy (2018) state that Complex Adaptive Systems (CAS) are a framework for studying, explaining, and understanding systems of agents that collectively combine to form emergent, global-level properties. CAS can be anything ranging from an object or humans with patterns observed through feedback. CAS emerged from the natural sciences helping to explain the behavior of nonlinear dynamic systems comprising many interacting parts that must adapt to a changing environment (Sweetman and Conboy, 2018). As Sweetman and Conboy (2018) describe CAS theory to take a bottom-up approach. CAS theory considers how interactions between the individual and independent parts of a system and their environment empower the system to adapt to its environment and yield higher-level emergent behavior (Sweetman and Conboy, 2018). Complexity science has value in examining systems during times of rapid change. As one action does not cause a single expected result in a complex adaptive system, the effect can spread in unpredictable ways explaining the property of non-linearity that one action may result in a variety of subsequent actions (Chaffee &McNeil, 2007). The DNP-prepared nurse can utilize the knowledge gained as a leader to initiate a plan that would involve interprofessional action across the healthcare continuum for the best patient outcomes. Since each agent and each system are nested within other systems, evolving, and interacting, a single entity cannot be understood without considering the others. Each agent though independent but interacts with each other to respond in a positive way to the environment. These interconnections are important as they allow a diverse system response in an adaptive way (Chaffee &McNeil, 2007).


Chaffee, M. W., & McNeill, M. M. (2007). A model of nursing as a complex adaptive system. Nursing outlook55(5), 232-241.

Sweetman, R., & Conboy, K. (2018). Portfolios of Agile Projects: A Complex Adaptive Systems’ Agent Perspective. Project Management Journal49(6), 18–38.

Complex adaptive systems are made up of individual agents that act independently however the actions of these agents emerge which brings a greater sum (Pype et al., 2018). The systems adapt in and evolve with a changing environment.  Characteristics of complex adaptive systems include nonlinearity, diversity, simple rules, complex outcomes, feedback loops, and emergence (Pype et al., 2018). In these systems you must consider all parts individually to get understand the entire system.  

In the healthcare setting, understanding complex adaptive systems are important. There are similarities with nursing practice and these systems as they both require resilience, structure/flow, collaboration and engaging in the unknown (Kiviliene & Blazeviciene, 2019). The DNP nurse can apply these concepts when facilitating the coordination of care.  For instance, patients may require care from several different providers, have a need to see a dietician, then may need support from social work services. While all of these interactions work independently all of the interactions will emerge into a better overall outcome for the patient from a physical and social perspective. 


Kiviliene, J., & Blazeviciene, A. (2019). Review of Complex Adaptive Systems in nursing practice. Journal of Complexity in Health Sciences2(2), 46–50.

Pype, P., Mertens, F., Helewaut, F., & Krystallidou, D. (2018). Healthcare teams as complex adaptive systems: Understanding team behaviour through team members’ perception of interpersonal interaction. BMC Health Services Research18(1). 

Complexity science belongs to the latest generation systems thinking, studying complex systems, also called Complex Adaptive Systems (CAS), by focusing on the relations and interconnections of the system components, rather than on the individual components themselves. Complexity science has been introduced in healthcare as a theoretical framework to better understand complex situations. The way clinicians handle uncertainty during the diagnostic process, the way physiological processes regulate, for instance, blood glucose levels and the way healthcare practices organize themselves according to several simple rules are examples of complex system behavior that cannot be fully understood through linear thinking alone. Pype (2018), explains that During interaction and collaboration, professionals learn from each other. This workplace learning, the acquisition of new skills as an individual or as a teamcan lead to a new way of functioning and is major emergent behavior resulting from the collaboration. Receiving advice from experts in the team makes team members less dependent in the future.

Research indicates that having multiple healthcare professions and disciplines simultaneously at the patient’s bedside improves interprofessional communication and collaboration, coordination of care, and patient-centered shared decision-making. This is a great way to solve complex issues. Walton (2019) suggests, Unit rounds have been a pivotal part of traditional hospital life in the planning and delivery of patient care.  Additionally, they provide a platform for health professionals to give and receive clinical education. Different rounding processes combine these goals in specific ways, as reflected by their titles. They involve the unit; multidisciplinary; consultant; teaching; post-take; traditional; working; and review of unit. There is a significant variance in the structure and design of rounds. Variations can include: the structure and focus of the round, such as for pharmacy or discharge; the location of the round, such as bedside or corridor; and the names of rounds can be interchangeable, as well.

Pype, P., Mertens, F., Helewaut, F. (2018). Healthcare teams as complex adaptive systems: understanding team behaviour through team members’ perception of interpersonal interaction. BMC Health Serv Res 18, 570.

Walton, V., Hogden, A., Long, J. C., Johnson, J. K., & Greenfield, D. (2019). How Do Interprofessional Healthcare Teams Perceive the Benefits and Challenges of Interdisciplinary Ward Rounds. Journal of multidisciplinary healthcare12, 1023–1032.

Complexity science offers opportunities to explain and understand the complex behavior that emerges from non-linear, dynamic processes. According to Olson, et al (2020), complexity science: “examines systems comprised of multiple and diverse interacting agents and seeks to uncover the principles and dynamics that affect how such systems evolve and maintain order. Common characteristics of complex adaptive systems are that of emergence and non-linear dynamics; the systems can move from, or include different areas of stability to very unstable behavior. 

For the DNP prepared nurse, it is necessary to focus on increasing connections, diversity, and interactions that will increase information flow and promote creative adaptation referred to as self-organization (Holden,2005). Complex Adaptive Science builds on the rich tradition in nursing that views patients and nursing care from a systems perspective. These entails application of the understanding of health care as a complex adaptive system that involves cultivating an environment of listening to people, enhancing relationships, and allowing creative ideas to emerge by creating small non-threatening changes that attract people. DNP prepared nurses, through the detailed analysis of complex adaptive system, will have the opportunity to redesign clinical practice in integrated cooperation with other healthcare professionals, and CASs can prompt the joined efforts of various healthcare professionals to solve complex problems.

In a clinical setting, the DNP prepared nurse will be focusing on patient safety by integrating nurses’ patient centered partnership, addressing the unique-ness of each patient nurse interaction using the principles of CAS. CAS can be applied to complex conditions or diagnosis such as heart failure, sepsis, diabetes management and so on. In critical and emergency situations, nurses interact and function as a team with a common goal. (Olsson ,et al. 2020). Although their actions might seem disordered, they are rather the manifestation of a complex series of interactions that are highly ordered based on a flow of interventions of shared protocols. The nursing care in this situation makes makes a difference by ensuring patient-centered care and patient safety, showing that the quality and outcome of care benefits from the use of complexity science.


Holden L. M. (2005). Complex adaptive systems: concept analysis. Journal of advanced nursing52(6), 651–657.

Olsson, A, Thunborg, C, Björkman, A, Blom, A, Sjöberg, F, Salzmann-Erikson, M. A (2020) Scoping review of complexity science in nursing. J Adv Nurs. 2020; 76: 1961– 1976.

Complexity science according to Kuvliene (2019) is one of the newest systems thinking that explores complex systems by focusing on the system components, relationships, and interconnections instead of the individual components themselves. It also allows the nurse to always keep in mind the larger picture when caring. the main characteristics of complex adaptive system theory are very distinctive:

1.    Complex systems have many constituents that interact nonlinearly

2.    The constituents are unique and interdependent

3.    The system has a structure sparring many scales

4.    The system is capable of an emerging behavior

5.    The system involves an interplay between  non-chaos and chaos

6.    The system involves an interplay between cooperation and competition (Kuviliene 2019).

The incorporation of complexity into nursing concepts into practice encourages new ideas and ways of thinking about organizations and it is a natural model for ideals and expected results of skilled nursing. The application of complex adaptive science theory, as a DNP nurse provider will help to place healthcare organization activities, improve the nursing process and also help to create a better working environment for job satisfaction (Kuviliene 2019).

Needless to say, a Complex Adaptive system is vital in social healthcare that involves interaction between professionals, patients, and organizational strategies in delivering care. It also gives a framework that explains the complexities inherent in implementing social healthcare.

Pype et al (2018) see the complex adaptive system as an important tool to increase step-by-step nursing healthcare between complex adaptive systems.

J. Kiviliene, & A. Blazeviciene. (2019). Review of complex adaptive systems in nursing practice. Journal of Complexity in Health Sciences2(2), 46–50.

Pype P., Mertens F., Helewaut F., Krystallidou D. Healthcare teams as complex adaptive systems: understanding team behaviour through team members’ perception of interpersonal interaction. BMC Health Services Research, Vol. 18, 2018, p. 570