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Leadership in CUSP
Marlies van DijkBC Patient Safety and Quality Council
Complex adaptive systems are composed of many interdependent, heterogeneous parts
that self organize and co-evolve.
UNPREDICATABLE - RESILIENT – UNCERTAIN
(and difficult to manage)
(Camazine, 2001; Kauffman, 1995; Allen & Varga, 2006)
Self-Organization
Self-organization is a process whereby local interactions give rise to patterns of organizing.
H.J. Lanham et al., How complexity science can inform scale-up and spread in health care:Understanding the role of self-organization in variation across local contexts. Social Science & Medicine (2012)
InterdependenciesOverarching term for relationships, connections, and interactions among parts of a complex system.
Pre-Intervention Post-Intervention
Lindberg, C., & Clancy, T. R. (2010). Journal of Nursing Administration
Sense Making
TECHNICAL
CULTURE/ADAPTIVE
11
“the most common cause of failure in leadership is produced by treating adaptive challenges as if they were technical problems.”
Ron Heifetz
Senior Lecturer in Public Leadership, co-founder of the Center for Public Leadership[1] at the John F. Kennedy School of Government
, Harvard University, and co-founder of Cambridge Leadership Associates
So now what? How do we lead in a complex system…
Acknowledge Unpredictability
Tailor to local context
Recognize Self-Organization
Develop “good enough”Facilitate sense-making
Facilitate Interdependencies
Foster new relationships
Encourage Experimentation
Ask questions, admit ignorance and deal with paradoxH.J. Lanham et al., How complexity science can inform scale-up and spread in health care:Understanding the role of self-organization in variation across local contexts. Social Science & Medicine (2012)
Not New!Adaptive Leadership
Lau Tzu's Tao Te Ching (c. 500BC) wrote of the best leader: "when the task is done, the people
will say we did it ourselves".
“I have a dream” “I have some
new clinical guidelines for you….”
Compliance Commitment
A minimum performance standard that everyone must achieve
A collective goal that everyone can aspire to
Uses hierarchy, systems and standard procedures for coordination and control
Based on shared goals, values, and sense of purpose for coordination and control
Threat of penalties, sanctions, shame creates momentum for delivery
Commitment to a common purpose creates energy for delivery
WHY?
HOW?
WHAT?
Where do you fit?
How can we shift all team members to distributed leaders?
Create EnergyBurning Platform Versus Burning Ambition
• Need to move from a burning platform to a burning ambition
• We need to articulate personal reasons for change as well as organizational reasons
• If the fire goes out, all other factors are redundant
@PeterFuda
At present, prevailing strategies [in healthcare] rely largely on outmoded theories of control and standardisation of work. More modern and much more effective, theories seek to harness the
imagination and participation of the workforce in reinventing the system
Don Berwick, Former CEO, Institute for Healthcare Improvement
