Evolutionary mechanics: new engineering principles for the emergence of flexibility in a dynamic and uncertain world

Interchangeability in Military Interprofessional Health Care Teams: Lessons Into Collective Self-healing and the Benefits Thereof

INTRODUCTION

Interchangeability-i.e., the capacity to change places with another-is necessary for military interprofessional health care teams (MIHTs) to provide around-the-clock patient care. However, while interchangeability is clearly a necessity for modern health care delivery, it raises uncomfortable questions for civilian health care teams where it is usually labeled as unsafe. This perception surfaces because interchangeability runs counter to some of health care's cultural beliefs including those around patient ownership and professional scopes of practice. It is, therefore, not surprising that little is known about whether and how some level of interchangeability can be harnessed to improve the productivity of health care teams overall. In this article, we explore the notion of interchangeability in the particular context of MIHTs given that these health care teams are familiar with it. This exploration will offer insights into how interchangeability could maximize civilian health care teams' capacity to adapt.

MATERIALS AND METHODS

We conducted a secondary analysis of interview data as an analytic expansion: "the kind of study in which the researcher makes further use of a primary data set in order to ask new or emerging questions that derive from having conducted the original analysis but were not envisioned within the original scope of the primary study aims". Within our secondary analysis approach, we used thematic analysis as our analytical tool to describe (1) what interchangeability looks like in MIHT teams, (2) how it is fostered in MIHTs, and (3) how it is enacted in MIHTs.

RESULTS

Interchangeability was realized in MIHTs when individual team members adapted to take on roles and/or tasks that were not clearly niched in their specific areas of expertise but instead drew on the broad foundation of their clinical skill set. Cross-training and distributed leadership were ways in which MIHT members described how interchangeability was fostered. Furthermore, five features of working within MIHT teams were identified as key conditions to enact interchangeability: knowing your team members; being able to work with what/who you have; actively seeking others' expertise; situating your role within the broader picture of the mission; and maintaining a learning/teaching mindset.

CONCLUSIONS

Interchangeability can be understood through the theoretical lens of Swarm Intelligence and more specifically, the principle of collective self-healing-which is the ability of collectives to continue to successfully perform despite disruption, challenges, or the loss of a team member. Our findings highlight how MIHTs have adopted interchangeability in a wide array of contexts to realize collective self-healing. Despite the discomfort it provokes, we suggest that interchangeability could be a powerful asset to civilian health care teams.

The Continuity of Context: A Role for the Hippocampus

Tracking moment-to-moment change in input and detecting change sufficient to require altering behavior is crucial to survival. Here, we discuss how the brain evaluates change over time, focusing on the hippocampus and its role in tracking context. We leverage the anatomy and physiology of the hippocampal longitudinal axis, re-entrant loops, and amorphous networks to account for stimulus equivalence and the updating of an organism's sense of its context. Place cells have a central role in tracking contextual continuities and discontinuities across multiple scales, a capacity beyond current models of pattern separation and completion. This perspective highlights the critical role of the hippocampus in both spatial cognition and episodic memory: tracking change and detecting boundaries separating one context, or episode, from another.

Growing a social brain

It has long been assumed that social animals, such as humans, are born with a brain system that has evolved to support social affiliation. However, the evidence does not necessarily support this assumption. Alternatively, social animals can be defined as those who cannot survive alone and rely on members from their group to regulate their ongoing physiology (or allostasis). The rather simple evolutionary constraint of social dependency for survival can be sufficient to make the social environment vitally salient, and to provide the ultimate driving force for socially crafted brain development and learning. In this Perspective, we propose a framework for sociality and specify a set of hypotheses on the mechanisms of social development and underlying neural systems. The theoretical shift proposed here implies that profound human characteristics, including but not limited to sociality, are acquired at an early age, while social interactions provide key wiring instructions that determine brain development.

Pervasive flexibility in living technologies through degeneracy-based design

The capacity to adapt can greatly influence the success of systems that need to compensate for damaged parts, learn how to achieve robust performance in new environments, or exploit novel opportunities that originate from new technological interfaces or emerging markets. Many of the conditions in which technology is required to adapt cannot be anticipated during its design stage, thus creating a challenge for the designer. Inspired by the study of a range of biological systems, we propose that degeneracy-the realization of multiple, functionally versatile components with contextually overlapping functional redundancy-will support adaptation in technologies, because it effects pervasive flexibility, evolutionary innovation, and homeostatic robustness. We provide examples of degeneracy in a number of rudimentary living technologies, from military sociotechnical systems to swarm robotics, and we present design principles-including shared protocols, loose regulatory coupling, and functional versatility-that allow degeneracy to arise in both biological and man-made systems.

Degeneracy allows for both apparent homogeneity and diversification in populations

Trait diversity - the substrate for natural selection - is necessary for adaptation through selection, particularly in populations faced with environmental changes that diminish population fitness. In habitats that remain unchanged for many generations, stabilizing selection maximizes exploitation of resources by reducing trait diversity to a narrow optimal range. One might expect that such ostensibly homogeneous populations would have a reduced potential for heritable adaptive responses when faced with fitness-reducing environmental changes. However, field studies have documented populations that, even after long periods of evolutionary stasis, can still rapidly evolve in response to changed environmental conditions. We argue that degeneracy, the ability of diverse population elements to function similarly, can satisfy both the current need to maximize fitness and the future need for diversity. Degenerate ensembles appear functionally redundant in certain environmental contexts and functionally diverse in others. We propose that genetic variation not contributing to the observed range of phenotypes in a current population, also known as cryptic genetic variation (CGV), is a specific case of degeneracy. We argue that CGV, which gradually accumulates in static populations in stable environments, reveals hidden trait differences when environments change. By allowing CGV accumulation, static populations prepare themselves for future rapid adaptations to environmental novelty. A greater appreciation of degeneracy's role in resolving the inherent tension between current stabilizing selection and future directional selection has implications in conservation biology and may be applied in social and technological systems to maximize current performance while strengthening the potential for future changes.

Biological robustness: paradigms, mechanisms, and systems principles

Robustness has been studied through the analysis of data sets, simulations, and a variety of experimental techniques that each have their own limitations but together confirm the ubiquity of biological robustness. Recent trends suggest that different types of perturbation (e.g., mutational, environmental) are commonly stabilized by similar mechanisms, and system sensitivities often display a long-tailed distribution with relatively few perturbations representing the majority of sensitivities. Conceptual paradigms from network theory, control theory, complexity science, and natural selection have been used to understand robustness, however each paradigm has a limited scope of applicability and there has been little discussion of the conditions that determine this scope or the relationships between paradigms. Systems properties such as modularity, bow-tie architectures, degeneracy, and other topological features are often positively associated with robust traits, however common underlying mechanisms are rarely mentioned. For instance, many system properties support robustness through functional redundancy or through response diversity with responses regulated by competitive exclusion and cooperative facilitation. Moreover, few studies compare and contrast alternative strategies for achieving robustness such as homeostasis, adaptive plasticity, environment shaping, and environment tracking. These strategies share similarities in their utilization of adaptive and self-organization processes that are not well appreciated yet might be suggestive of reusable building blocks for generating robust behavior.