Implications of complex adaptive systems theory for the design of research on health care organizations

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Abstract
Background: Because health care organizations (HCOs) are complex adaptive systems (CASs), phenomena of interest often are dynamic and unfold in unpredictable ways, and unfolding events are often unique. Researchers of HCOs may recognize that the subject of their research is dynamic; however, their research designs may not take this into account. Researchers may also know that unfolding events are often unique, but their design may not have the capacity to obtain information from meager evidence. Purpose: These two concerns led us to examine two ideas from organizational theory: (a) the ideas of K. E. Weick (1993) on organizational design as a verb and (b) the ideas of J. G. March, L. S. Sproull, and M. Tamuz (1991) on learning from samples of one or fewer. In this article, we applied these ideas to develop an enriched perspective of research design for studying CASs. Methodology/Approach: We conducted a theoretical analysis of organizations as CASs, identifying relevant characteristics for research designs. We then explored two ideas from organizational theory and discussed the implications for research designs. Findings: Weick's idea of "design as a verb" helps in understanding dynamic and process-oriented research design. The idea of "learning from samples of one or fewer" of March, Sproull, and Tamuz provides strategies for research design that enables learning from meager evidence. When studying HCOs, research designs are likely to be more effective when they (a) anticipate change, (b) include tension, (c) capitalize on serendipity, and (d) use an "act-then-look" mind set. Implications for practice are discussed. Practice Implications: Practitioners who understand HCOs as CASs will be cautious in accepting findings from studies that treat HCOs mechanistically. They will consider the characteristics of CAS when evaluating the evidence base for practice. Practitioners can use the strategies proposed in this article to stimulate discussion with researchers seeking to conduct research in their HCO.