by Dr. Kenneth H. Cohn

A cherished friend and mentor who lives in Atlanta described her recent spring weather as, "It’s just pollen now. All the beauty is gone because of a frost. Just as the buds begin to emerge, living things are the most vulnerable."

As I read Tony Chen's latest post, "TIME's 10 world-changing ideas and healthcare," his last line--"It's chaotic times like these where new leaders can emerge"--triggered thoughts of emergence again.

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According to Wikipedia, emergence is the way complex systems and patterns arise out of relatively simple interactions. As I wrote in "Embracing Complexity" (Cohn KH. 2005. Better Communication for Better Care: Mastering Physician-Administrator Collaboration, Chicago: Health Administration Press, p.31.), complexity science studies dynamic interactions in living systems and organizations. It is contrasted with linear, mechanical, Newtonian, cause-and-effect systems, which analyze processes by analyzing their component parts. Linear systems are like recipes, where doubling the input results in a doubling of output, something we rarely see in healthcare.

In contrast, complex adaptive systems are a collection of component parts or agents in which individual agents act interdependently, so that one agent's response changes the context for all other agents. Real-world examples include the stock market and weather patterns. Examples of complex adaptive systems in healthcare include patient flow and human illness.

People who deal with complex problems understand intuitively that formulas have limited applicability, but relationships are key. As with child-rearing, doing something once offers no assurance of future success. The only way to know how a complex adaptive system will behave is to observe or participate in it.

As Tony's post implied, complex adaptive systems are capable of self-organization, in which new leaders, structures and processes can emerge without being externally imposed on the system. Knowledge of complexity science can help healthcare professionals understand processes in which many people interact, and thus can decrease feelings of helplessness and victim-hood.

Having formal and informal conversations is an important way that people can deal with complexity. This principle underlies the success of the structured dialogue process, about which I have written in previous posts, where physicians articulate clinical priorities for their practices and their communities. (Cohn KH. 2006.Collaborate for Success! Breakthrough Strategies for Engaging Physicians, Nurses, and Hospital Executives. Chicago: Health Administration Press, p.1)

In times of uncertainty, the following principles may be helpful (Cohn KH. 2005. Better Communication for Better Care: Mastering Physician-Administrator Collaboration, Chicago: Health Administration Press, p.36.):

• Do not expect to get things right initially; look upon the challenge as an iterative journey, in the same way that software companies release "Beta versions" for testing.

• Act, learn and adapt, despite this approach feeling like "Ready, fire, aim."

• Encourage initial brainstorming and creative thinking rather than critical analytics, which suppress creativity.

• Celebrate learning rather than blaming; learning is never failure.

• Look for improved outcomes rather than ideal solutions.

• Measure personal growth by self-self comparisons over time rather than self-other benchmarking.

What do you think?

• Do you feel vulnerable as you emerge?

• Does disruptive change feel like failure when you are in the middle of it?

• Does our achievement-oriented culture make it difficult to take risks for fear of failure?

• What are the implications for patient care of living and working in these exciting times?

As always, I welcome your input.

Ken is a practicing general surgeon/MBA who divides his time between providing general surgical coverage and speaking, writing, teaching, and consulting on physician-hospital relations. Learn more about what he does by visiting http://healthcarecollaboration.com.