1. Leading in a Complex Healthcare Environment
Module 3
NGR 6725

2. 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 *

3. 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. *

4. 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

5. 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 *

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

7. 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 *

8. 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

9. 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 *

10. 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

11. 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 *

12. 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 *

13. 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 *

14. *
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 *

15. References
Davidson, A., Ray, M. & Turkel, M. (2011). Nursing, Caring, and Complexity Science: For Human-Environment Well Being. Springer Publishers.
The Plexus Institute Website
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.