How to Lead Using Complexity Theory in Healthcare

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Healthcare fails when good people apply the wrong kind of solutions to the healthcare system.  

This post highlights concepts that will improve your leadership using complexity theory.  (see Edgeware: lessons from complexity science for health care leaders by B. Zimmerman, C. Lindberg, and P. Plsek)

Use a New Metaphor

Military and machine metaphors dominate healthcare thinking (e.g., cog, mesh, direct, follow, limit, leverage, tune, ramp up, etc.).  These metaphors shape our solutions.  Complexity offers something different:

Simple is like following a recipe to bake a cake:  anyone can follow the instructions and get a good result.

Complicated is like sending a rocket into space: a team of smart people, improving process with each attempt, can figure out the best way to fly in space.

Complex is like being in a romantic relationship or raising a child:  success with one is no guarantee of success with another.

Features of Complex adaptive systems:

  • Non-linear
  • Adaptive
  • Distributed control (central control slows system’s ability to react)
  • Size of input produces unpredictable effect (small input might create huge impact)
  • Large numbers of connections between a wide variety of elements

Leadership Principles

1. Focus on Minimum specifications / Good Enough:  Don’t even try planning all the details before you start; it’s impossible.  Get a clear enough sense of the minimum needed and get started.

2. Find Attractors:  Learn which patterns or areas draw the energy of the system.  Imagine how to attract a bird to leave your room vs. How to roll a marble down a track.

“Complexity suggests that we create small , non-threatening changes that attract people, instead of implementing large scale change that excites resistance.  We work with the attractors.”  p. 11

3. Get Comfortable with Uncertainty:  Solutions need to be rapidly adaptable.  They must be comfortable with both data and intuition, planning and acting, safety and risk.

4. Use Paradox and Tension:  lead by serving, keep authority without having control, give direction without directives

5. Tune to the Edge:  Don’t be afraid to stray from the centre.  Go to the fringes for multiple actions ; let a direction arise.

6. Be Aware of the Shadow system:  Gossip, rumor, informal relationships, hallway conversations

7. Use Chunking:  Grow complex systems by connecting simple systems that work well

8. Mix Cooperation and Competition: don’t think either/or

(photo credit: www.nytimes.com)