William Bergquist, Ph.D. and Jeremy Fish, M.D.

We must gain greater appreciation for the unique way in which complex adaptive systems operate before turning in the next essay in this series specifically to the way in which an understanding of these systems might help us address health care issues. In our previous essay (Fish and Bergquist, 2023) we made rather extensive use of metaphors in describing the nature and dynamics of complex systems. This seems appropriate given that these systems can be quite elusive—after all they are complex!  We might best be able to gain some sense of how they operate by examining the way in which they appear in systems that are more concrete (tangible) than those found in social systems.

Keeping this approach to understanding the nature and dynamics of complex systems in mind, we offer three portraits (actually they are motion pictures) of complex adaptive systems. Our first portrait is based on a mechanistic metaphor involving the rolling of balls across a warped plane. Our second portrait is more fluid in nature. It concerns the transformation of water into both ice and vapor, along with the chaotic (“white water”) movement of water down a riverbed. Our third portrait is a bit more conceptual in nature and less graphic—but no less dramatic. It concerns the dramatic transformation that occurs in a system when emergence occurs. The ball in no longer a ball and the river is no longer a river. A profound change has occurred in this complex, adaptive system.

We begin with the movement of a ball down a plane that is warped—or more down-to-earth the rolling of a golf ball across the warped plane of a golf course green. We become even more down-to-earth when offering specific examples of the warped plane and related processes that are often found in health care systems. We will be doing the same when offering the other two metaphoric portraits.

Portrait One: Navigating on a Warped Plane

One of the most important and sometimes overlooked concepts to come out of chaos theory and the study of complexity and adaptive systems is the observed tendency of all fluid systems to bifurcate (split into two or more pathways). In essence, when fluid systems begin to break up (as a function of the speed at which the fluid is moving or as a result of the introduction of a foreign, intrusive element) parts of the system tend to move in different directions.

These diverse movements of particles, units or people will, in turn, form two or more coherent subsystems that may later subdivide again. Thus, if I pour a small glass of water on a smooth surface (such as a table or countertop) it will tend not to flow in one direction or remain together as one coherent mass. Rather, it will soon break into two or more sub-streams that flow in two or more directions across the surface of the table or countertop. This represents an essential feature of all dynamic systems—there is a strong pull toward bi-furcation.