Table 2 Principles for managing complex adaptive systems.

Principle	Operationalization	Application to our example
Good enough vision	Provide minimum specifications rather than planning every detail	Focus on patient and family schedules (for example, CT bookings should be as close as possible to clinic visits)
Tune to the edge	Foster the right degree of information flow, connectivity, diversity, and difference instead of controlling information and forcing agreement	Foster relationships between booking clerk and families
Chunking	Allow complex systems to emerge out of the links among systems that work well and are capable of operating independently	Reinforce the links that are effective, such as interface booking systems between CT scan and clinic
Clockware/swarmware	Balance data and intuition, planning and acting, safety and risk	Explore whether the parents can do their own booking online. If so, follow to see what patterns emerge to build upon
Paradox	Uncover and use paradox rather than avoiding it as if it was unnatural	Ask questions that expose the paradoxes. For example, how can you coordinate CT scans and clinic visits when emergency CT scans take precedent over elective ones?

Adapted from Zimmerman et al.¹⁹