Table 2.

Attributes of complex adaptive systems

ATTRIBUTE	DEFINITION	PRIMARY CARE PREVENTIVE SCREENING EXAMPLES
Agents who learn	People can and will process information, as well as react to changes in information	Team members access knowledge translation tools to understand a conditional recommendation and then apply the knowledge in discussions with patients
Interconnectedness	Individuals and groups connect and interact in multiple ways, formally and informally and changing over time	Different 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-organization	Order is created in a system without explicit hierarchical direction	Nurse 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-evolution	The system and the environment influence each other’s development	Over 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