Module 4 Introduction

Organizational leadership continues to be influenced by a Newtonian view of the world in which organizations are predictable machines comprised of replaceable parts.    Organizations like machines can be dissected or taken apart and each piece studied.  By understanding the parts, the organization is understood.  This has led to a top down thinking with command and control and “just do it” approach to human resource management in order for the organization to run like a “well-oiled” machine.    Each employee is a “cog in the wheel” that can be discarded or changed at any time without disruption of the whole.    If this Newtonian view of the world is indeed accurate, why is it that organizations are not predicable, do not behave as told, and do not reach wide spread improvements that most are attempting.   Why do healthcare organizations not comply with all regulations?  Why is it so difficult for health care organizations to adopt best practices or achieve the massive improvement demanded by the IOM?  Why do all nurses and physicians not wash their hands prior to entering and upon leaving a patient’s hospital room?  Complexity theory would suggest that the reason is simply that an organization is a system that can only be understood an as integrated whole with all components reacting to each other.  The relationships among the parts are very intricate and always emerging or changing.    Organizations are complex and dynamic systems comprised of individuals who all have their own view of the work, organization, colleagues, and the world in general.  They are not predictable.  They are not “cogs in a wheel”.

One of the most important aspects of the leadership role in an organization is dealing with change in all of its complexity.   The phenomenon of change is particularly important in health care organizations due to the underlying changes in the science and technology associated with health care delivery as well as the pace of change in the fiscal, regulatory, and political environments affecting health care.    In fact, success in leadership roles in healthcare is associated with being able to provide leadership to affect positive organizational change.    Therefore it is important that leaders in healthcare organizations have both a conceptual and practical understanding of the key aspects of change processes in organizational settings.

 One purpose of this module is to consider health care organizations as complex adaptive systems and the role of leadership in a complex adaptive system (CAS).

Secondly, in this module emphasis will be placed on an integrative approach to change in A CAS which incorporates:  (1) the aspects of change management -  processes for motivating change, shaping the political dynamics of change, and managing the transition;  (2) understanding and sensitivity to the effect of change on the individuals affected directly and indirectly by the change; and on  (3) the importance of  incorporating scientific evidence and clinical expertise in selecting or designing the nature of the change, and (4) the important of collaborating teams.