There was also the upside of this crisis—related to Snowden’s mind-set. Novel practices like telehealth emerged and grew exponentially after decades of neglect. However, several disturbing questions remain unanswered. As the virus begins to recede from our daily lives, will the state of absolute chaos win out over the interplay between order and chaos that resides at the heart of complex, adaptive systems? Were we locked into an over-simplifying, clear mind-set of puzzles and problems, finding ourselves awash with chaotic and disruptive energy and events that spilled us over into chaos and disorder? Can we regain the health and strength of our healthcare systems by now shifting our mind-set away from frozen-thinking and vapor-chaos crisis toward a more effective and sustainable engagement with complexity in healthcare? How many swimmers drown in the sea of Covid while trying to fetch their life-raft of liberty from masks and social distancing? How many drown in the sea of loneliness and despair as they become isolated from their life-raft of support and social joy?
Portrait Three: Navigating an Emergent System
There are many insights to be gained regarding navigating on warped planes and turbulent seas. However, there are additional insights to be gained from an exploration of what are often called Emergent systems. We propose that a key aspect of complexity is often overlooked—and wish to portray this aspect by turning to the phenomenon of emergence. We believe that one of the greatest shortcomings in healthcare leadership concerns a lack of recognition that you simply have to “start something” and then move on to something else. At some point, there will be a tipping point when nothing remains the same. A revolution takes place. Pieces of hay accumulate and at some point, we have a haystack.
In recent years, there has been a push for urban renewal that focuses on these small steps that lead to a revolution. Specifically, an urban reformer begins by fixing the broken windows that are to be found in many “run-down” areas of a city. Then, it is time to move on with more extensive “repair” of the broken social service system as well as broken streets, buildings and transportation systems. Small, evolutionary steps (repairing broken windows) are engaged and at some point, everything begins to move and change. Evolution becomes revolution because the system is complex and not just complicated. Not only are windows and streets fixed, but the place gets cleaner, people are kinder to one another, and crime drops off.
Miller and Page (2007, p. 4) put it this way when posing a challenge regarding the relationship between emergence and the creation of a complex adaptive system:
What it takes to move from an adaptive system to a complex adaptive system is an open question and one that can engender endless debate. At the most basic level, the field of complex systems challenges the notion that by perfectly understanding the behavior of each component part of a system we will then understand the system as a whole. One and one may well make two, but to really understand two we must know both about the nature of “one and the meaning of “and.”
Miller and Page are suggesting, in essence, that when two (or more) entities are brought together that sometimes will surprise us and produce something that could never be anticipated when examining each of these entities separately. The “and” is the key here: somehow the “two” make up more than the two “ones” when viewed separately. The usual example used to illustrate this “emergent” dynamic is the outcome arising from the combination of two parts of hydrogen with one part of oxygen. These two gases surprisingly produce an entirely different and totally unpredictable entity: water. The “and” in this case is this chemical reaction has to do with the heat that accompanies the mixing of these two gases. Nothing happens if there is insufficient heat.
