Coordination patterns as markers of brittleness (and resilience) in complex systems: a sterile processing case study

Area of Science:

• Healthcare Systems Engineering
• Organizational Resilience
• Complex Adaptive Systems

Background:

• Adaptive capacity is crucial for resilient systems, yet specific coordination patterns enabling it are under-researched.
• The Sterile Processing Department (SPD) presents a complex operational environment with significant coordination demands.

Purpose of the Study:

• To identify adaptive performance within the SPD under competing pressures.
• To determine coordination patterns that foster adaptive capacity in complex healthcare settings.

Main Methods:

• Conducted six direct observations and eighteen semi-structured interviews with Operating Room (OR) and SPD personnel.
• Analyzed qualitative data for thematic content and semantic relationships.
• Developed schematic diagrams to visualize adaptive workflow patterns and coordination interactions.

Main Results:

• Identified distinct coordination patterns within the SPD workflow.
• Observed that certain patterns, termed 'concatenated loops,' are indicative of system brittleness.
• Demonstrated a link between specific coordination strategies and the system's adaptive capacity.

Conclusions:

• Understanding coordination patterns is key to enhancing adaptive capacity in complex organizational systems.
• Interventions targeting specific coordination mechanisms can improve system resilience and performance.
• The findings offer practical implications for managing complex healthcare operations and fostering adaptability.