Anticipation in Complex Systems: Potential Implications for Improving Safety and Quality in Healthcare

Abstract

The theoretical biologist, Robert Rosen, proposed that a capacity for anticipatory change is a fundamental characteristic of most complex systems, including all living systems. As defined in his Anticipatory Systems: Philosophic, Mathematic, and Methodological Foundations, an anticipatory system contains “a predictive model of itself and/or its environment, which allows it to change state at an instant in accord with the model’s prediction pertaining to a later instant”. In Rosen’s view, two key features which differentiate anticipatory complex systems from “simple” mechanistic systems are: (1) no single formal model or finite set of models are capable of capturing all of the information in a complex system, and (2) anticipatory complex systems are capable of change in the present based on their imperfect models of the future. Change in simple, mechanistic systems occurs only due to forces acting iteratively on the system’s current state, while change in anticipatory complex systems occurs through both iterative state transitions and from the system’s capacity to respond to anticipatory models. If Rosen’s anticipatory theory of complex systems is correct, implications for improving safety in healthcare organizations are likely to include the following: (1) Greater congruence between the models of the current situation and anticipatory models of future states among clinical team members, and among the clinical team, patient, and family increases the likelihood of attaining preferred outcomes; (2) Inputs from the anticipatory models of clinical team members, patients, and families may be useful for identifying and real time mitigation of some clinical situations in which there is an increased risk of a future serious adverse outcome; (3) Significantly discrepant present-state or anticipatory mental models between clinical team members or between team and patients/families may indicate an increased risk for an adverse outcome; (4) Clinical teams that recognize that disagreements regarding the appropriate care of a patient may indicate an increased risk of an adverse outcome may be able to create better shared present-state and anticipatory mental modes which could help mitigate future risks; and (5) Optimal team functioning should encourage anticipatory inputs from all clinical team members and should include encourage identifying significantly discrepant current state and anticipatory models among clinical team members and between clinical team and patients/families, especially in high-risk situations.