Living and Working in a White-Water Environment: Given these characteristics of a “white water” world, we find that the personal impact is likely to be great for any of us who are living and working in this environment. The white-water environment requires a search for balance and direction which in turn requires ongoing attention.
Apparently, we need a kayak when navigating the white water. A canoe will just tip over, for it doesn’t’ have the flexibility of a kayak. Furthermore, we must find our center of gravity when steering our kayak through the white water. Peter Vaill (2008) goes so far as to suggest that this center of gravity is often found in our embracing of a core set of principles and values—even operating from a spiritual perspective on life and work.
One might wonder if this core can’t be found in basic religious beliefs and in an alliance with some authoritarian figure. Don’t we find balance when we find guidance in a set of firm religious tenants? We would suggest that this rarely is the case, for these beliefs, alliances and tenants are much too rigid. They operate like canoes that can only move in one direction (forward). Furthermore, the person operating the canoe has a one-bladed paddle that must be moved from one side of the canoe to the other side.
Counterbalancing and adjusting to changes in the water’s direction is difficult—as is also the case in a white-water organization or society. By contrast, the person navigating the kayak is provided with a two-bladed paddle that makes counterbalancing and shifting directions much easier. The term agility can readily be applied to the successful operations of a kayak—and to the successful leadership of a mid-21st Century organization. This term does not readily apply to someone or some organization that is caught up in the vice-grips of authoritarian rule.
Leadership in Turbulent Environments: Many mid-21st Century health care organizations do not, at least on the surface, appear to be as fortunate as the more stable organizations. They exist in an environment that is unstable and highly turbulent, hovering on the brink of both order and chaos. VUCA-Plus is swirling all around the operations of these organizations.
Along with a potential loss of mission, contemporary organizations that exist in unstable environments are often vulnerable to a loss in any sense of commitment on the part of those working in the organization. The unclear boundaries, the shifting values of workers and the newly emerging emphasis on knowledge as capital make it hard for organizations to elicit commitment from their employees.
We are likely to find that mid-21st Century health care organizations are becoming less top heavy or that communication across the levels of existing hierarchy is becoming more important and, as a result, the focus of considerable training and review. The knowledge worker who resides at the “middle” level of most organizations will have much to say in the future about the success of their organization if it is operating in a turbulent environment.
Contradiction: Leadership and Cultural Agility
Leadership in contemporary health care systems is challenged not only by the turbulence caused by the confluence of multiple environments, but also by the contradictory forces that operate within these systems. Specifically, these contradictions reside within the multiple sub-culture that operate in these systems. For instance, it is interesting and informative to note that one half of the documents cited in the Scoping Review of complex leadership came out of Nursing publications. This is quite understandable since nurses stand at the crossroads between two dominant cultures in contemporary health care—the professional culture and the managerial culture (Bergquist, Guest and Rooney, 2003).
