Home Organizational Psychology System Dynamics / Complexity The Complexity of 21st Century Health Care

The Complexity of 21st Century Health Care

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At times we find that the issue actually is embedded in several sets of nested dilemmas. One set of conflicting priorities exists within another set of conflicting priorities. For instance, we want to give our son a chance to be in love but are concerned that if we do so other members of our family (and our son himself) will be at risk. This dilemma, in turn, rests inside an even bigger dilemma: we want to be considerate of the feelings experienced by each member of our family; yet we are concerned that feelings take the place of security. We want to live a high-quality life (complete with feelings), yet we also want to remain alive so that we can have this high-quality life. These are very complex dilemmas – not readily solved puzzles or even complicated problems.

As in the case of problems, dilemmas can be described as “rugged landscapes.” However, because dilemmas involve multiple elements that are intimately interlinked, they are far more than a cluster or range of mountain peaks of similar size. This type of complex landscape is filled not only with many mountains of about the same height, but also with many river valleys and forests. Think of the Appalachian Mountains (in the Eastern United States) or the Alps (in Europe). Compare this with a landscape in which one mountain peak dominates or in which a series of mountains dominate. In a complex, rugged landscape, one finds not only abundant competing viewpoints and values, but also an intricate interweaving of these differing viewpoints and values.

Effectively engaged members of a family, community or society can hold opposing and contradictory views. They can meet the challenge of VUCA-Plus. The sign of a viable family, organization or society is that it can live with and manage its dilemmas in real time, without questioning its identity at every turn in the road, whip-lashing its strategies, tearing and rebuilding its structures reactively, or scapegoating its people.

To return to our landscape metaphor, we may find that we are living not in a complex rugged landscape but in what Miller and Page call a “dancing landscape.” Their term is certainly very appropriate in describing our current challenge. Priorities during the COVID-19 crisis are not only interconnected–they are constantly shifting, and new alliances between old competing perspective are being forged. Clearly, when a world of complexity collides with a world of uncertainty and a world of turbulence, the landscape begins to dance–and we must all learn how to make our families, organizations, communities and societies dance (Kantor, 1989).


Like dilemmas, polarities are not only multi-dimensional with many moving parts—these parts will stand against one another. Polarities are unlike dilemmas, however, in that these parts (and the perspectives and priorities associated with them) don’t just stand there I opposition. They create a dynamic oscillation in the system (often an organization or society) in which they operate. Furthermore, this oscillation can be quite destructive to this system, bringing about either a state of freeze or in stability.

Barry Johnson (1996), the “dean” of polarity management, suggests we are often confronted in our contemporary world with two or more legitimate but opposite forces at work in what we have been calling a condition of contradiction. One then analyzes each side’s benefits and disadvantages. Organizationally, the two or more opposing and contradictory forces are often embodied in “camps.” For example, the health care administrator’s interest in minimizing expenses is pitted against the primary care department’s need to invest in new equipment. A centralized health care system has the need to standardize its offerings, but the offices of specific health care facilities need flexibility in running their daily affairs. Neither position is “wrong.” “Exquisite truth” is to be found in the positions taken by both camps.

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