Current and future healthcare leaders will need to adapt traditional top-down leadership directives toward more agile and flexible collaborative leadership engagement. Breathwaite and associates point out the many shortcomings of strict hierarchical management, which relies on the “putative ability of a single person or executive grouping ‘at the top’ to be in charge, [yet it] can in reality never cope with all the complexities present in a system, let alone an entire chain, health region or jurisdiction.” They propose a set of alternative models of leadership and management in complexity, focusing on:

1. Strategies such as distributive leadership
2. Decentralized responsibility
3. Communities of practices
4. Relationship-building
5. Opinion Leaders
6. Shared Mental Models
7. Networked Influence

In essence they are describing the leadership model of fluid, dynamic complex systems like flocks of birds, schools of salmon, and hives of bees. All of these CAS rely on a small number of basic rules, local (move left to avoid an attacking predator) and distant feedback (move north to return to our nesting/spawning site / hive), self-organizing teams, and emerging behaviors that help produce the best outcomes in often novel and productive ways.

Improving healthcare is highly complex and integrating complexity science and the concept of complex adaptive system now brings us to the next level of strategic advantage toward predictions and forecasting—perhaps by learning from fields like meteorology on ways to begin to more accurately forecast events like Covid-19 and other epidemics which tend to drastically disrupt the healthcare environment in seemingly sudden and random ways.

Prediction and Forecasting

We are where the meteorologists were in the 1960’s now before infrared sensors were sent across the globe and into space to help forecast the weather.  Although their prediction models are far more sophisticated and accurate than the 1960’s, people’s faith in weather predictions seem no more accurate than in the past demonstrating even evolved forecasting models in healthcare will not be widely believed at first. We suspect that Covid will produce a new CA5 forecasting models—and our hope is that we use it beyond infectious diseases into broader areas of contagion that include ideologies, conspiracy theories, and ideas that create their own form of pandemic in the age of worldwide web connections and air travel.

We want to embrace more complex forecasting models, along with potential for early interventions intended to provide broad Community Immunity across things well beyond infectious diseases as they are traditionally regarded—transmitted by parasite, virus or bacterium, contagious ideas, ideologies, conspiracy theories, and thoughts that create pandemics on a near continuous basis. In order to fully appreciate new forecasting models, we must turn first to the traditional model that has dominated health care planning.