We have tended to embrace both a mathematical and social perspective on complexity. In our own studies of leadership in complex adaptive systems (Fish and Bergquist, 2022; Fish and Bergquist, 2023a; Bergquist and Fish, 2023; Fish and Bergquist, 2023b) Furthermore, we have considered the effective use of flexible, contingency-based planning and enactment in our description of effective mid-21st Century health care leadership. We believe of even greater importance is our placing of complexity within a much broader framework. In our own description and analysis of contemporary health care systems we interweave complexity (C) with volatility (V), uncertainty (U), ambiguity (A), turbulence (+) and contradiction (+)—creating a condition we have labeled “VUCA-Plus” (Bergquist, 2022) Volatility produces changing patterns of complexity, while uncertainty makes decisions regarding the engagement in complexity suspect. Similarly, the complexity being faced in most health care systems is hazy at best (ambiguity) and is often saturated with contradiction.
Perhaps of greatest important is the presence of complexity in a highly fluid—even turbulent—world where rapid change operates alongside patterned change, non-change (stagnation) and absolute chaos. The authors of the Scoping Review pose an important question concerning the scope of complexity and complex leadership: is complex leadership only to be engaged under conditions of complexity. When VUCA-Plus is introduced and the condition of turbulence is highlighted then this issue becomes moot. There is no time when complexity is absent when seeking to lead within the “white-water” world of a turbulent health care system.
These conditions of VUCA-Plus must be viewed from a social as well as mathematical perspective for sense-making, social construction and patterns of communication are constantly being challenged. VUCA-Plus leadership requires much more than complexity leadership and must be founded in a set of principles and guidelines that go well beyond the traditional leadership theories that are referenced in the Scoping Review. We seek in this essay to point toward some of the theories of leadership (and more broadly system operations) that might help guide us toward effective engagement with the many VUCA-Plus challenges.
In our next essay, we also will be offering some specific examples of effective VUCA-Plus leadership in contemporary American health care systems. We offer these case examples in part to meet the criticism offered by those preparing the Scoping Review. They suggested that there is insufficient evidence-based research to support any one model of complex leadership. While these authors are primarily concerned with quantitative evidence, we would suggest (and have provided) evidence that might be of even greater value. This is evidence “from the trenches.” Case examples of actual leadership practices and outcomes.
