As a complex adaptive system, healthcare is associated with several issues on different organizational levels, or all of them at once, since the complex nature of the health system has its consequences. One of the corresponding concerns is related to leadership, as this element of the healthcare system may be significantly affected on multiple levels (Belrhiti et al., 2018). Any organizational system can be compared to a tree: the more profound the system level, the more branches there are. Leadership flows through those branches from top to bottom, creating a complex system. Braithwaite (2018) argues that the agents of complex adaptive systems may have “degrees of discretion to repel, ignore, modify, or selectively adopt top down mandates” (p. 2). In other words, a request or order given from the macrolevel of healthcare can significantly change while going to the microlevel. Therefore, an intended action may be performed differently and not lead to the desired outcomes, meaning that the general performance of an organization within a complex adaptive system may be endangered.
It is difficult to identify whether the leadership issue primarily occurs on the microlevel, mesolevel, or macrolevel since the phenomenon of management is present everywhere, and the “leadership flow” of strategic decisions and orders is ubiquitous. However, a scoping review conducted by Belrhiti et al. (2018) shows that scientists researching leadership-related problems in healthcare are primarily interested in the microlevel of complex adaptive systems as most papers (18 out of 33) are concentrated on that subject. That fact can be explained by the number of steps a leader’s decision has to take on its path to the destination point. The microlevel of healthcare systems involves individuals, teams, and care units working in a specific facility, which means they represent the lowest level of the complex adaptive system. Suppose a top manager or management team from the macrolevel makes a decision that involves an individual worker from microlevel to perform a particular action. That decision has to go through the longest chain of managers, meaning that it may be subjected to the highest potential number of transformations. Thus, the leadership issue mainly affects the performance on the microlevel.
The best possible way to address the issue under discussion is to enhance the transition of leadership influence by putting more effort into ensuring that lower agents of complex adaptive systems strictly follow higher agents’ will. Churruca et al. (2019) report that those systems initially displayed weird, chaotic, and dynamic behavior while also exhibiting homeostasis degrees, balancing between the unpredictable and predictable. In other words, complex adaptive systems can turn the organization’s internal processes into a two-phase basis. The contradictory nature of complex adaptive systems has led to the creation of complexity science. According to Churruca et al. (2019), that science “provides an understanding of systems that are between phase transitions and are often found just at the edge of chaos” (p. 1). As it is known, a chaotic environment can negatively affect leadership outcomes, which means the corresponding issue in healthcare should be eliminated by stabilizing the system in a predictable phase.
However, interfering with complex adaptive systems may have consequences, especially on the microlevel. As a complex adaptive system, the healthcare industry involves various agents, from physicians and patients to politicians and non-governmental organizations (Churruca et al., 2019). Although the number of interactions between them is enormous, the microlevel agents are closer to the actual healthcare, meaning that patients are those who have conditions and clinicians who treat them and ensure positive health outcomes. Braithwaite (2018) suggests that the healthcare system “is governed far more by local organisational cultures and politics than by what the secretary of state for health or a remote policy maker or manager wants” (p. 2). The main reason the microlevel agents of the complex adaptive system may ignore or modify the received orders is the levels of those agents’ involvement in the working process of a specific organization. In the healthcare case, physicians, nurses, and care units apply their internal experience and knowledge to the mandates from the top to achieve the best possible outcomes and ensure the healthcare system’s efficiency.
That said, interprofessional collaboration could resolve the issue and maintain leadership effectiveness. According to Braithwaite (2018), clinicians’ behavior is conditioned by their vision of what should be done, which is why they do not always respond to their managers’ admonitions strictly, using their own logic and ideas instead. Physicians, nurses, patients, care units, and local managers influence and learn from each other, which creates a unique behavior within a local team based on its members’ interactions. In many respects, the microlevel of the healthcare system is a frontline of care that navigates change, adjusts to the local circumstances, and acts in the organization’s best interests (Braithwaite, 2018). Interprofessional collaboration in this sense makes the healthcare industry naturally resilient, which helps it avoid unnecessary changes coming from the top of the complex adaptive system. Thus, the microlevel agents use their experience in care-delivering to improve leadership efficiency and achieve the best possible outcomes of the organizational activity.
References
Belrhiti, Z., Giralt, A. N., & Marchal, B. (2018). Complex leadership in healthcare: A scoping review. International Journal of Health Policy and Management, 7(12), 1073-1084.
Braithwaite, J. (2018). Changing how we think about healthcare improvement. BMJ, 361.
Churruca, K., Pomare, C., Ellis, L. A., Long, J. C., & Braithwaite, J. (2019). The influence of complexity: A bibliometric analysis of complexity science in healthcare. BMJ Open, 9(3).