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Table 2 CAS characteristic and interdependencies’ scoring criteria

From: Interventions to reduce readmissions: can complex adaptive system theory explain the heterogeneity in effectiveness? A systematic review

CAS Characteristic
Learning People can and will process information, as well as react to changes in information.
Education occurred explicitly or there is a new strategy for information uptake.
Interconnections Change in pattern of interactions, including nonverbal communication, among agents.
Introducing new agents into the system.
Self-organization Order is created in a system without explicit hierarchical direction. Interventions explicitly allow for modifications, tailoring, adjustments, and negotiations based on patient characteristics, situations, circumstances, and uniqueness of patients, at the level of patients.
Co-evolution The system and the environment influence each other’s development.
Adaptations, additions or changes to the intervention or implementation of the intervention that affect more than one patient typically in response to new information or interim evaluation of intervention.
Emergence Intervention is leveraging the fact that non-linearities will occur in the system—Specifically plans to look (e.g., scanning, monitoring) for unintended consequences to try to use them to own advantage.
Affordances Something new (e.g., staff, process) was brought to the care transition under focus. New resources have been brought in to change an outcome of interest.
This might include new staff but could be old staff doing a new thing (i.e. reallocation of old resources or allocation of new resources).
Processes Any standard workflow change or work standardization could be in the form of a process checklist.