Introduction to Complex Adaptive Systems
Most analyses of health systems examine their performance, their structures, functions, or the relationships between key actors. Models for reforming health systems tend to focus on what health systems should look like, or what ‘control knobs’ need to be pushed (e.g. changing the financing of health care, the organization of services, or the use of information). These approaches have followed a largely deterministic perspective on how reforms work, and lead to answering questions about finding the right buttons to be pushed in different contexts. However, real health systems behave like Complex Adaptive Systems (CAS), where conventional controls do not work in predictable ways, adaptive behaviors are common, and unintended consequences are the norm. Understanding health systems as CAS opens up new opportunities for intervening that depend less on trying to “control” health systems, and rely more on taking advantage of local innovation and self-regulating activities, promoting constructive feedback mechanisms, and finding tipping points to change policies, programs, and relationships in a health system. These sessions will introduce CAS concepts and demonstrate the use of the use of a systems dynamics approach to CAS.