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The Complexity of 21st Century Health Care

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VUCA Plus Meets COVID-19 in American Health Care

The challenges in mid-21st Century American Health Care are many and quite diverse. They become even more diverse when COVID enters this system of care. They can be captured, in part, through the introduction of six words: volatility, uncertainty, complexity, ambiguity, turbulence and contradiction. Together these interacting and intertwining challenges constitute what we label VUCA-Plus. We will dwell briefly on the meaning to be assigned to each of the four original elements of VUCA and then introduce VUCA-Plus terms. We relate all six of these elements to the impact of COVID on the American Health Care system.

The Four Elements of VUCA

Complexity concerns the many elements and dynamic interaction among elements that have to be taken into account, while Volatility refers to the rate and shifting rate of change among the elements. The other two terms have to do with epistemology (the way in which knowledge is acquired and reality is defined). Ambiguity concerns the assessment of both the evidence available regarding reality and the meaning assigned to this reality. The fourth term, Uncertainty, is about the stability of any assessment being made regarding reality. Does reality change over a short period of time? Why do an extensive assessment if our world is constantly shifting?

COVID adds a new element to the health care system, thus increasing complexity. It also increases volatility because various strains emerge that require new treatments. It seems that this virus is re-evolving faster than our medial understanding. With the rapid changes and inability to keep up with this very “smart” virus, the level of uncertainty is on the rise.

We assumed that our world of increasingly sophisticated medical research and health care planning would soon enable us to “get hold” of the virus and provide clarity regarding its treatment and future. Such is clearly not the case—and the American public is becoming increasingly impatient and restless in the face of this uncertainty. All of this, in turn, leads to the fourth major condition: ambiguity. At times we don’t even know what we don’t know about COVID-19. It has become a mystery with many perspectives to be honored and many culprits to be blamed. We have met a very skillful and resilient opponent that (who) seems to fully understand the human condition and its weaknesses.

An Expanded VUCA

VUCA is deservedly becoming the coin-of-the-realm among contemporary organizational analysts. These four terms (volatility, uncertainty, complexity and ambiguity) clearly capture much of the dynamics swirling around in the perfect storm of contemporary American health care life—with COVID amplifying everything. However, our categories expand upon VUCA We suggest that leaders in health care systems also are faced with an environment of turbulence and contradiction—that suggest something about the success of COVID-19.

In describing Turbulence, we turn to a metaphor offered by Peter Vaill (2008). He suggests that we are living in a “white water” world. This white-water world represents a turbulent system. Furthermore, we go beyond Vaill’s analysis and propose that this white-water system incorporates four subsystems that are exemplified by the properties of a turbulent stream: (1) rapid change (flowing segment of the stream), (2) cyclical change (the stream’s whirlpools), (3) stability/non-change (the “stagnant” segment of the stream), and (4) chaos (the segment of a stream existing between the other three segments).

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