Jeremy Fish, M.D. and William Bergquist, Ph.D.

In this third essay, we are ready to turn in more detail to mid-21^st Century health care and the way in which our understanding and appreciation of complex adaptive systems might assist in addressing the elusive contemporary problems that exist in American (and most other) health care system. Our attention turns first to the matter of understanding health care. This understanding starts with recognition of the distinctive issues facing mid-21^st Century health care is also required.

This means identifying, living with and acting in an environment of volatility, uncertainty, complexity, and ambiguity (VUCA) – as well as turbulence and contradiction (VUCA-Plus).  In this essay and our previous essay, we have focused on complexity—but recognized that the other environmental characteristics of VUCA-Plus are closely associated with and amplified by the conditions of complexity.

Given VUCA-Plus, we must then recognize that we are facing issues that are problems, dilemmas, paradox and mysteries – and not just readily solvable puzzles. We have previously summarized the distinctive features of these different types of challenging issues (Fish and Bergquist, 2022). We will now begin to address these three challenges & identify some of the tools that are available in seeking to understand them. We turn next to ways in which predictions and forecasts might best be made given the complexity (and hoped-for adaptivity) of contemporary health care systems–as well as the VUCA-Plus environment in which these systems are operating.  We turn finally to the value inherent in high-performance teams as sources of guidance in navigating health care systems that are saturated with VUCA-Plus challenges. Specifically, it is in the promotion of teamwork and the assembly of diverse, collective wisdom that these complex systems are best navigated.

Understanding

The first step in any basic understanding of the challenges facing a health care team is discernment regarding the nature of the issue(s) being addressed. Are these issues simple and readily solved? They might be assigned Stacey’s label of “simple” and identified as what Snowden calls part of a “clear” system (see our previous essay: Fish and Bergquist, 2023). They might even be considered “complicated” with several elements under consideration. These puzzles and simple problems can usually be solved by a single person with appropriate expertise.  The more complicated the issue being addressed–the more diverse expertise is required. This is especially the case when the issue become complex. There are not just many elements and agents (as is the case with complicated issues). When an issue is complex, each of the elements and agents associated with the issue are intertwined and inter-dependent (Miller and Page, xxxx). They are related through mutual local and distant feedback, and relevant information comes from multiple sources.