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

Coordination underpins adaptive capacity in resilient systems. However, research on specific patterns of coordination as they relate to adaptive capacity is relatively scarce. The study focuses on the Sterile Processing Department (SPD) as an exemplar of a large complex system with significant coordination challenges. The study aimed to identify adaptive performance under countervailing pressures, and coordination patterns that enable adaptive capacity. Six observations and eighteen interviews of OR and SPD workers were conducted. Data were analyzed for themes and inherent semantic relationships. Schematic diagrams were developed to compactly represent the adaptive workflow patterns along with the associated interactions supporting coordination. Coordination patterns, such as concatenated loops, were identified as markers of system brittleness. Implications for supporting coordination and adaptive capacity under complexity are provided.