Jeremy Fish, M. D. and William Bergquist, Ph.D.
There is good reason to believe that the leaders of health care systems in the United States (and elsewhere in the world) are faced with the challenge of complexity. As noted in a recent “Scoping Review” (2018): “nowadays, health systems are generally acknowledged to be complex social systems.” Yet, as noted in this report, there are not many studies of leadership within these complex health care systems. Those preparing this scoping report found only 37 documents related to this topic—16 being conceptual in nature, with 14 being empirical studies and 7 being documents that advocated for more studies in this area. The Scoping report itself could be added to those advocating for more attention to what they term “complex leadership.”
Apparently, it not only a matter of too few studies of complex leadership but also too limited a definition of complexity. The authors “found that most researchers subscribe to the mathematical complexity perspective.’ From this perspective, complexity primarily concerns the extent to which a system is ordered and the resulting extent to which those operating in this system can accurately assess the current situation and act in a manner that leads to a desired end state. Most of the 37 studies of complex leadership rely on a mathematical-based model of complex adaptive systems.
By contrast, there is a social complexity perspective that speaks to the unique nature of human systems and the foundation of these systems in social interactions and patterns of past experience. Conversation and socially constructed meanings play a major role in the dynamic operations of socially complex systems. These systems are not rule based not do they operate in a manner that can easily be quantified or modeled on a computer. Sense-making takes priority over rule-based operations, and patterns of communication are center stage.
VUCA-Plus and Team-Based Leadership
Authors of this Scoping Review note that some authors—particularly David Snowden—propose the blending of the mathematical and social perspectives, yielding a contextual complexity perspective. From this perspective, those who lead complex health care systems adopt different “diagnostic techniques, different intervention devices and different forms of measurement depending on the ontological state.” (Snowden and Stanbridge, 2004). The holistic and adaptive view of leadership offered by Mary Uhl-Bien (Uhl-Bien, et.al., 2007; Uhl-Bien and Arena, 2017) is closely associated with this contextual perspective. Complexity is best addressed by being what many leadership theorists identify as “agile” in the identification and initiation of specific plans.
