Laying in a field looking up at a partly cloudy sky, a late summer breeze pushes through the trees, portending the coming chill.  The breeze sets a sleek starling to flight. Immediately, hundreds of starlings follow, with a thunderous rustle of leaves. Their silent dance above, an exquisitely choreographed molding, is a wonder.  Did that first bird lead them to flight? Does it lead them now? It was only recently that scientists learned the answer is no. There is no lead starling, but there is a way to explain their behavior: complexity science. 

Complexity Science

Complexity science explains nonlinear relationships in nature. Physics, through mathematics, describes the natural forces and laws that bound our physical reality.  Gravity, momentum, the speed of sound or light have all become known as a result of scientific pursuit. Science allows us to understand how a bird flies, and how we can translate this knowledge to aerospace technology to fly with them.  

With the technical aspects of flight no longer a mystery, or the work of some mystical power, we can now study behaviors of flight.  For example, how does a flock of starlings swarm in the sky, creating a superorganism-like structure that bends and molds with plain intention.  Scientists have tried for decades to create the algorithm, the equation that would pre-determine this behavior, but each time failed to reproduce the elegant math found in physics to explain this natural phenomenon.  What became clear is it was not the math that was wrong, it was the scientific model.

The flocking of birds in flight is one of the best examples of applied complexity science, or complex adaptive system theory as it is often called.  It states that complex adaptive systems have specific and consistent principles that can explain the behavior of the system. They are:

1. Open and Adaptive
   1. Influenced by the context (a hawk swooping down will change the shape of the flock)
2. Emergent
   1. Has the ability to change
3. Non-Linear
   1. The appearance of the hawk can create a small shift in response or a drastically different one – it is impossible to predict which will occur
4. Dictated by simple rules
   1. E.g., fly close to other birds, don’t hit the bird next you, stay with the flock, avoid threats
5. Self Organized
   1. There is no lead bird

When we see a flock of birds through the lens of complexity we see how the same science illuminates the behaviors of other systems.  A school of fish, a crowd of people navigating a busy city street corner, the ecosystem in Yellowstone. The same science has been applied to healthcare for decades.  A family systems approach to care understands the unique and nonlinear relationships inherent in a patient’s life; rather than trying to fix them, family systems thinking places those relationships in context to generate understanding and allow the patient to emerge differently.  

Complexity Science and Family Systems Theory are two sides of the same coin. They are tools to identify the overt and sometimes covert components of complex systems. In short, family systems theory can be considered the application of complex adaptive systems (i.e., complexity science). It may be helpful to provide a brief overview of family systems theory and how it relates to health care. 

Family Systems Theory

The long history of family systems theory has many characters, including Gregory Bateson, an influential anthropologist from the mid-twentieth century. Bateson and colleagues used principles from cybernetics and general systems theory to frame families as complex systems with subsystems, boundaries, rules, and more. These family systems are dynamic, contextual, and able to influence and be influenced by their environment. Family systems theory has had a major influence on the development of family therapy and other psychotherapeutic treatments. It puts patients in greater context. 

In the 1980s, John Rolland, a psychiatrist and founding member of CFHA, proposed a new framework (i.e., Family Systems Illness, or FSI) that explained how illness and disability affect family systems. Factors like family communication processes, belief systems, developmental issues, and multigenerational legacies of illness and loss can facilitate or hinder coping and adaptation with health problems. Rolland argues that the type and timing of a health problem determine the psychosocial demands a patient and her family will experience. For example, the way a family responds to a chronic condition like diabetes is different than a response to a broken leg or terminal cancer. The FSI model is a useful approach for practitioners to help patients develop empowering illness narratives, seize opportunities for relational healing and growth, and make the most of precious time together. 

Attend a Pre-Con Workshop

The Collaborative Family Healthcare Association is a place to learn more about family systems, specifically how to make healthcare more patient-centered and family-engaged. Please consider attending one of the pre-conferences taking place next Thursday at the start of the 2019 CFHA Annual Conference in Denver. We especially encourage you to consider attending the workshop entitled:

Implementing Family-Centered Care: Clinical, Operational, and Financial Perspectives

The workshop will provide valuable hands on training to better meet the needs of patients and their families and the complex systems we work in.  We encourage you to consider attending one of the pre-conference workshops to get even more out of what will be a spectacular conference. If the above blog peaked your interest, or drew on connections you have already made in your desire to provide a Family Systems approach to care please join us to hear the evidence, learn how to train others in the approach, as well as how to get it paid for!

Hope to see you there.