Leader as Change Agent in a Time of Complexity NURS 560 Fall 2015 Dr. Mileva Saulo Lewis Professor Emerita Dr. Lewis All rights reserved

At the completion of this session, learners will be able to: Compare and contrast theories of change Differentiate among models as appropriate for health behavior change and organizational change Analyze a situation for readiness to change

Samuel Merritt University, School of Nursing Dr. Lewis All rights reserved NURS 560 FA 2015 Dr. Mileva Saulo Lewis All rights reserved.

“You can’t solve a problem from the same level of consciousness that created it.” Albert Einstein Courtesy Dr. Phyllis Kritek Dr. Lewis All rights reserved

Martha Rogers, PhD, RN Science of Unitary Beings New York University 1967 Dr. Lewis All rights reserved

Thomas Kuhn Paradigm Shift From Newtonian Physics – linear, predictable Quantum Physics – interrelatedness, action/reaction, constant movement Kuhn, T.S. (1962). The structure of scientific revolutions. (2nd ed.). Chicago: The University of Chicago Press.

Science of Unitary Human Beings Chinn, P. L. & Jacobs, M. K. (1987) Science of Unitary Human Beings Chinn, P. L. & Jacobs, M.K. (1987). Theory and nursing: a systematic approach. St. Louis, MO: Mosby. Individual Nursing Society Environment “Man” is an energy field Endless boundaries Characterized by: Unified wholeness Openness Unidirectionality Pattern and organization Sentience Science of humanity Synergistic wholeness Life processes are the core of nursing Principles of homeodynamics: Reciprocity Synchrony Helicy Resonancy Environment and man are energy fields coexisting with the environment

Dr. Mileva Saulo Lewis, All rights reserved

Complexity Science Paradigm shift from mechanistic dualism to quantum physics Cause and effect only is an incomplete theory Quantum physics – subatomic particles are synchronized, cooperative, and interlinked Essential Ingredients – Interconnected Universal Web of Energy Impact of awareness Relationship between observer and observed Koerner, J. (2009). Insight: The application of complexity science in decision making. Creative Nursing, 15(4), 165-171. Dr. Lewis All rights reserved

“Change agents continue to struggle with outmoded models, tools, and techniques---ones that were sufficient in slower and simpler times, but that are counterproductive when complex adaptation is the only viable survival strategy”. Edwin Olson and Glenda Eoyang Facilitation Organizational Change (Courtesy Dr. Phyllis Kritek) Dr. Lewis All rights reserved

Insanity is doing the same thing, over and over again, but expecting different results. Albert Einstein Courtesy Dr. Phyllis Kritek Dr. Lewis All rights reserved

Complexity Science and Adaptive Systems The Butterfly Effect Seemingly small changes large effect on the results Groundwork for the mapping of chaos mathematically. Small changes in the initial characteristics of an active system can dramatically affect the long-term behaviour of that system. Referred to as the ‘butterfly effect’. If a butterfly flaps its wings somewhere in the world today, there will be a hurricane somewhere else at some future point Holden, L.M. (2005). Complex adaptive systems: concept analysis. Journal of Advanced Nursing, 52(6), 651-657 Dr. Lewis All rights reserved

Change Agents Understand Systems Motivation Change Complexity Science Change Agents Understand Systems Open systems – flows and constraints 1972 - Bertlanfy researching international postal system – WW II Inputs Throughputs Outputs Social Systems – Seeing the world through interactions - Social groups Perceptions that shape social interactions Purpose and goals of the system Process Systems - Seeing the world from information flow Living systems – Seeing the world through the interactions of self-creating entities Senge,P. (1991). The fifth discipline: The art & practice of the learning organization. New York: Doubleday Currency. Dr. Mileva S. Lewis, All rights reserved Mileva S Lewis, All rights reserved

Small Groups Relevance and Application of Gerardi to Nursing Practice

Complexity Science and Healthcare Organizations Complex Adaptive Systems Dynamic, interdependent activities occurring simultaneously Qualities: Self-organizing Patterns emerge over time Non-linear (future is unpredictable) Patterns result from personal interactions and relationships Organizational effectiveness, quality, clinical outcomes depend on quality of relationships Gerardi, D. (2015). Conflict engagement: a new model for nurses. American Journal Of Nursing, 115(3), 56-61.

High Performing Primary Care Practices (Emotional & Social Intelligence) Individual Traits & Interpersonal relationships characterized by: Trust Mindfulness Heedfulness Respect Social and task relatedness Diversity Communication Gerardi, 2015

How about a Break Dr. Lewis All rights reserved