1. Complexity Leadership in Healthcare Organizations
Dr. Mary Uhl-Bien
Howard Hawks Chair in Business Ethics & Leadership
University of Nebraska
© 2012 Mary Uhl-Bien

2. What is Complexity Leadership?
Traditional Leadership
Complexity Leadership
Alignment and control
Change efforts driven top-down
Relies on leader vision, inspiration, and execution
Interaction and adaptability
Change is emergent (in context)
Seeds organization with generative (i.e., adaptive) properties and uses for day-to-day performance

3. We have always studied leadership in contexts of bureaucracy…
Executive Level Bureaucracy
Organization Level Bureaucracy
We have always studied leadership in contexts of bureaucracy…
Production Level Bureaucracy

4. Agent
Agent
Agent
CAS
Complexity brings to leadership a lens of Complex Adaptive Systems (CAS)
Agent
Agent
Agent
Agent
Agent
Agent
CAS
CAS

5. Agent
CAS
Complexity Leadership Theory (CLT) addresses bureaucracy and CAS together.
Executive Level
Agent
CAS
Organization Level
Production Level
Agent
CAS

6. Complexity Leadership Model
Administrative Leadership
Adaptive System
Administrative System
Adaptive Leadership
Entrepreneurial System
Productive
Tension
Generative Leadership

7. It takes complexity to beat complexity
Key Premise of CLT:
It takes complexity to beat complexity
Variety of
Stimuli
High
Low V
ariety of Responses
The Ordered Regime
The Complex Regime
The Chaotic Regime
45°
Adapted from Boisot and McKelvey, 2010, Academy of Management Review

8. Research Findings

9. Purpose of Study
To examine leadership and adaptability in the healthcare industry using a complexity lens.

10. Methodology Qualitative investigation in 6 hospitals
For each hospital we examined leadership processes in the context of a strategic initiative
Each hospital was visited twice
First with executive team to identify the strategic initiative
Second to “snowball” sample in organization around the initiative
Total of 195 interviews over a 16-month period (April, 2008-July, 2009)

11. Overarching Finding
Healthcare is “in” complexity, which is evidenced by increasing variety in (and pressures from) the environment
Traditional leadership is inadequate for operating in these contexts because it generates an “ordered” response that does not meet the needs of complexity.
Leaders who respond effectively in these environments enable “complex” responses by creating climates and conditions conducive to adaptive leadership and enhanced performance.

12. Ordered v. Complex Response
Pressures
from
Environment
High
Low
Variety Responses
Ordered Response
Complexity Response
Chaotic Regime
45°
Adapted from Boisot and McKelvey, 2010, Academy of Management Review

13. Findings: Complexity
In complex environments—characterized by high variety and pressures for adaptability— organizations need complex responses, i.e., enabling dynamic interaction and emergence.
This goes against natural instincts of many managers (and employees!) who want to respond to complexity with directives and control (to generate feelings of order).

14. Ordered v. “Complex” Response
Ordered Response
Complexity Response
Traditional Leadership
focuses on top-down influence processes to motivate and align organizational members around the strategic vision
Administrative Leadership
top-down leadership “loosens” administrative systems
Generative leadership
informal leadership fuels entrepreneurial system
Adaptive leadership
enables emergence for the organization

15. Summary: Leadership Outcomes
Despite the importance of “complex” responses, only 2 of the 6 hospitals engaged in leadership styles appropriate to a complex response.
The other 4 hospitals responded using traditional leadership approaches.

16. Summary: Leadership Outcomes
Of the two who engaged in complex responses:
One is thriving
The other overwhelmed the system (Houchin and MacLean, 2005), resulting in the leadership team being ejected.

17. Summary: Leadership Outcomes
Of the four who engaged in traditional responses:
Two used overpowering administrative leadership that stifled or suppressed adaptive dynamics.
The leadership teams of these hospitals are either completely turned over or in leadership transition (with CEOs of both organizations no longer there).
The other two are either in status quo or steady state.

18. Leadership Responses and Outcomes
Findings:
Leadership Responses and Outcomes

19. “Traditional” Leadership

20. Traditional Leadership
Focuses on alignment
and control
Administrative System
Entrepreneurial System
Which suppresses adaptive dynamics

21. Traditional Leadership Complexity in Environment
Findings
In our data, traditional leadership looks like
this…
Traditional Leadership
Complexity in Environment
Desire for Control
Bureaucratization
Pressures on System
Traditional Leadership
(Tightens Administrative function)
Stifles Adaptive Dynamics

22. Key Point
The key is to recognize and appreciate the value of adaptive dynamics…
…and interact with and enable them.
That is the critical difference between traditional leadership and complexity leadership.

23. Adaptive Dynamics

24. Adaptive Dynamics
Adaptive dynamics are often present or trying to be present in organizations.
They look like new ideas, innovations, workarounds, pushback, prosocial rule-breaking, voice.
They are enabled by generative leadership.
Generative leadership helps generate new ideas and champion them into the system.
Generative leadership contributes to “bottom-up” emergence in organizations

25. Generative Leadership
Administrative System
Entrepreneurial System
Emergence
Generative Leadership

26. Key Point
It is critical that organizational leaders recognize and value generative leadership.
Generative leadership and adaptive dynamics are a core source of innovation and adaptability for the firm.
That said, they are easily suppressed.

27. Adaptive Leadership

28. Adaptive Leadership
Enhances organizational adaptability and performance by creating conditions that simultaneously:
Allow the organization to transform itself to navigate fundamental shifts in the environment…
…and perform seamlessly on a day-to-day basis to satisfy customers, shareholders, partners, and other stakeholders (Garud et al., 2006)

29. Adaptive Leadership
Channels energy and emergence through a combination of tightening and loosening behaviors.
Loosening behaviors (i.e., “exploration”) involve enabling conditions for interaction, search, experimentation and information flows.
Tightening behaviors (i.e., “exploitation”) involve reducing variance through choice, execution, standardization, and restricting information flows.

30. Complexity Leadership Framework
Adaptive Leadership
Administrative Leadership
Administrative System
Entrepreneurial System
Emergence
Generative Leadership

31. Emergence (and Suppression)
When engaged appropriately (e.g., “simple rules”), administrative constraints channel generative leadership to perform in productive ways.
Administrators get pressured to change from adaptors and innovators.
If administrators regularly turn down these adaptive requests, the organization “learns” to be not adaptive (generative and adaptive leadership is suppressed or stifled).

32. Conclusions Healthcare needs to respond to complexity with complexity:
Loosen the administrative system
Fuel the entrepreneurial system (and generative leadership)
Develop the adaptive system (adaptive leadership and adaptive dynamics) to capitalize on emergence

33. Conclusions: Not “Feel-Good”
This can feel very disruptive to organizational members.
Complexity leadership is not a “feel-good” model of leadership typically seen in leadership theorizing and practitioner-oriented books.
Because it goes against traditional understanding of what leaders do, many will not recognize it as effective leadership.
Adaptive leaders often feel they are going against
the tide, and it takes great tenacity to withstand the
the tremendous pressures to pull back to equilibrium.

34. Conclusions: The “Rubber Band” Effect
The key is watching for the “rubber band” effect—the snap back against the leaders that occurs when the organization gets pulled too hard and the “rubber band” breaks.
Leaders need to pull the “rubber band” (the change effort) so it is stretched (but not overly tight), and then pull gradually from the front end, making sure the back end follows, to move the entire system forward (to a “new equilibrium”).

35. References
Boisot, M., & McKelvey, B. (2010). Integrating modernist and postmodernist perspectives on organizations: A complexity science bridge. Academy of Management Review, 35(3),
Garud, R., Kumaraswamy, A., & Sambamurthy, V. (2006). Emergent by design: Performance and transformation at Infosys Technologies. Organization Science, 17(2),
Houchin, K., & MacLean, D. (2005). Complexity theory and strategic change: An empirically informed critique. British Journal of Management, 16(2),
Surie, G., & Hazy, J. (2006). Generative leadership: Nurturing innovation in complex systems. Emergence: Complexity and Organization, 8(4),
Uhl-Bien, M., & Marion, R. (2008). Complexity Leadership, Part 1: Conceptual Foundations. Charlotte: Information Age Publishing.
Uhl-Bien, M., & Marion, R. (2009). Complexity leadership in bureaucratic forms of organizing: A meso model. The Leadership Quarterly, 20, 631–650.
Uhl-Bien, M., Marion, R., & McKelvey, B. (2007). Complexity leadership theory: Shifting leadership from the industrial age to the knowledge era. The Leadership Quarterly, 18(4),

36. References
Boisot, M., & McKelvey, B. (2010). Integrating modernist and postmodernist perspectives on organizations: A complexity science bridge. Academy of Management Review, 35(3),
Houchin, K., & MacLean, D. (2005). Complexity theory and strategic change: An empirically informed critique. British Journal of Management, 16(2),
Surie, G., & Hazy, J. (2006). Generative leadership: Nurturing innovation in complex systems. Emergence: Complexity and Organization, 8(4),
Uhl-Bien, M., & Marion, R. (2008). Complexity Leadership, Part 1: Conceptual Foundations. Charlotte: Information Age Publishing.
Uhl-Bien, M., & Marion, R. (2009). Complexity leadership in bureaucratic forms of organizing: A meso model. The Leadership Quarterly, 20, 631–650.
Uhl-Bien, M., Marion, R., & McKelvey, B. (2007). Complexity leadership theory: Shifting leadership from the industrial age to the knowledge era. The Leadership Quarterly, 18(4),