First, in this essay, we offer several alternative theories and perspectives on complexity and the other VUCA-Plus conditions. We focus on leadership being engaged in a team setting, leadership as coaching, and leadership as engaged alongside the process of emergence, We believe that these three perspectives open new doors in our understanding regarding how Complexity Leadership actually operates in contemporary health care systems. We close by considering the two conditions that we have added to VUCA that make it VUCA-Plus. These two conditions are turbulence (leadership in a “white water world”) and contradiction (leadership in competing organizational subcultures).
Team-Based Operations
We are in the midst of a cultural, generational, and technological revolution within US Healthcare. There is wide-based dissatisfaction with our healthcare system, yet we lack tangible ways to lead ourselves into a better future due to the high complexity of the system which limits accountability, transparency, and levers to shift us in new directions. In the midst of this challenge, we have rising competition from industries like IT that have developed advanced team-based leadership models, distributive and democratic models and others that appear to be far more adaptive and agile than our models in healthcare which have been top-down and hierarchical in nature. Shifting toward team-based leadership will take time and require new mind-set that recognizes and embraces the value of teamwork within the healthcare context. Ironically, some of the earliest team-based models came out of healthcare—particularly in the Operating Room, which requires a high-performance team to reduce risk and improve outcomes. The OR was also the first site in healthcare to establish safety checklists based on the Airline industry after exposure of high levels of error in the OR, including leaving instruments and other items in the patient or removing the wrong limb creating enormous pressure to improve communication and teamwork in the OR.
Why is team-based leadership so important now in healthcare? Because time and time again, when we explore the root causes of harm in healthcare, we find fragmentation of care, fragmentation of communication, with lasting negative impacts on all involved. A skilled surgeon must apply for privileges to perform procedures in a hospital, yet may lack training and skill in communication that can lead to enormous malpractice risk and adverse outcomes despite his or her enormous operative skills. Our technological emphasis in healthcare has been primarily on higher and higher tech robotics and procedures that continue to increase the cost of care. Even the introduction of Electronic Health Records has been focused primarily on excessive documentation to justify billing and coding—not on improving communication, workflows, teamwork, and outcomes for patients.
So, as the information age overflows healthcare, we produce nearly 1/3 of all information on the internet—yet lack basic team-enforcing communication tools to support patients within the context of their healthcare team. We make the patient and her family the sole connection amongst the many fragmented ways we try to take care of her. This irresponsible shift of communication to the patient and her family creates enormous stress and confusion for patients, who often struggle to simply find out about their own healthcare. Recent new Chart-review and e-mail / in-basket “MyChart” type engagements only serve to introduce the patient to their own highly fragmented and confusion EHR and appear to lead to excessive electronic contacts with physicians which further strain the physician: patient relationship. Teamwork with healthy communication, role clarity, effective communication strategies must be developed and the first step in doing that is to reduce the sense of threat and fear in healthcare, so that trust-based relationship building can flourish.
The SCARF Model
Neuroscientists have identified a set of social threats that are triggered often on a daily basis for most humans, which David Rock (2008) has compiled into a very simple SCARF Model to help us recognize the many ways we experience Social Threat which our brains perceive as the same as Physical Threat. Gaining insights into the SCARF model can help us all begin to reframe from a threat-response toward a healthier and more effective challenge-response or reward-response. This fundamental shift in mind-set is essential to trust-and-safety within teams—the key to high-performance teamwork as demonstrated by Amy Edmondson (2018).
