Leading in a Complex Healthcare Environment Module 3 NGR 6725

Before Complexity Theory * Before Complexity Theory Scientists believed the future was knowable given enough data points Dissecting discrete parts would reveal how everything -- the whole system -- works Phenomena can be reduced to simple cause & effect relationships The role of scientists, technology, & leaders was to predict and control the future Increasing levels of control over nature would improve our quality of life Simplicity on the Other Side of Complexity *

Complexity Complex Systems is a new field of science studying how parts of a system give rise to the collective behaviors of the system, and how the system interacts with its environment. Social systems formed (in part) out of people, the brain formed out of neurons, molecules formed out of atoms, the weather formed out of air flows are all examples of complex systems. The field of complex systems cuts across all traditional disciplines of science, as well as engineering, management, and medicine. It focuses on certain questions about parts, wholes and relationships. These questions are relevant to all traditional fields. http://necsi.org/guide/. *

Definition of Complex Consisting of interconnected or interwoven parts Need to know & understand the parts BUT also how they act together to form the behavior of the whole It is because we cannot describe the whole without describing each part, and because each part must be described in relation to other parts, that complex systems are difficult to understand Not easy to understand or analyze

Complexity Theory How parts of a system give rise to the collective behaviors of the system How the system interacts with its environment Study of complex systems is about understanding indirect effects – push here; what happens there *

Examples of Complex Systems Weather Living Organisms Ecological Systems Mechanical Systems (esp. w/human operators) Social Systems Organizations Our Health Care System

Characteristics of Complex Systems Characteristics of CAS Dynamic non linear interacting forces What is going on now in a system is partly a function of what happened in its history Open to energy and information from the environment Agents operate under a set of rules that can change over time through encounters As agents interact and rules evolve, patterns of behavior become evident Order emerges from these interactions *

More Characteristics Characteristics of CAS (continued) Defined in terms of the connections and patterns of relationships between agents Individual agents are not knowledgeable of what is going on in the whole of the system The quality of the functioning of the system depends upon the quality of the relationships of the agents You cannot examine the CAS by examining the agents independently, you must examine the network as a unified whole

More Characteristics of Complex System Characteristics of CAS (continued) The system is self-organizing, autopoetic or self-reproducing Order emerges without the need for a hierarchical system of control However, due to the nature of relationships and the work, often hierarchies, patterns and clustering of agents and depts. emerge. The future state of the system is unknowable *

Approaches to Study Complexity Asking how interactions give rise to patterns of behavior. Understanding the ways of describing complex systems. Determining the process of formation of complex systems through pattern formulation and evolution. Recognizing that small changes can have major impact on systems – ie. The butterfly effect

How Our View of Complex Systems has Changed Then Now Focus on knowing the world Focus on making sense of the world Forecasting the future Designing the future Finding the right structure Keeping the structure fluid Overcoming the systems’ limits Unleashing the dynamic potential of the system Bureaucracy Interdependencies *

Professional Bureaucracy Key Leadership Tasks Professional Bureaucracy Professional CAS Role defining Relationship building Tight structuring Loose coupling Simplifying Complicating Socializing Diversifying Decision making Sense making Knowing Learning controlling Improvising Planning based on forecasting Thinking about the future *

Stacey Diagram Know When Your Challenges Are In the Zone of Complexity * Stacey Diagram Know When Your Challenges Are In the Zone of Complexity Far from Chaotic Seek Patterns Agreement Zone of Complexity Simple Plan, control Close to Close to Certainty Far from Simplicity on the Other Side of Complexity *

* The 15% Principle W. Edwards Deming suggested that everyone -- from the CEO to the front line worker -- has influence over 15% of their system. The other 85% is beyond their discretionary control. Recognize that you have 15% discretionary influence… it may sound small but you can use it to make a difference that makes a difference. Marry 15% principle with Multiple Actions At The Fringes – Let Direction Emerge Simplicity on the Other Side of Complexity *

References Davidson, A., Ray, M. & Turkel, M. (2011). Nursing, Caring, and Complexity Science: For Human-Environment Well Being. Springer Publishers. The Plexus Institute Website http://www.plexusinstitute.org/ Wheatley, M. (2001). Leadership and the New Science. Berrett-Koehler Publishers; Zimmerman, B., Lindberg, C., & Plsek, P. (2001). Edgeware. Insights from complexity science for health care leaders (2nd ed.). Irving, TX: VHA Inc.