Complexity Leadership
in Healthcare Organizations
Dr. Mary Uhl-Bien
Howard Hawks Chair in Business Ethics & Leadership
University of Nebraska
© 2012 Mary Uhl-Bien
What is Complexity Leadership?
Traditional Leadership
Complexity Leadership
 Alignment and control
 Interaction and adaptability
 Change efforts driven
 Change is emergent (in
top-down
 Relies on leader
vision, inspiration, and
execution
context)
 Seeds organization with
generative (i.e., adaptive)
properties and uses for
day-to-day performance
Executive Level Bureaucracy
Organization Level Bureaucracy
Production Level Bureaucracy
We have always
studied leadership
in contexts of
bureaucracy…
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Complexity brings to
leadership a lens of
Complex Adaptive
Systems (CAS)
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Complexity
Leadership
Theory (CLT)
addresses
bureaucracy
and CAS
together.
Executive Level
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CAS
Organization Level
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CAS
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CAS
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Production Level
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Complexity Leadership Model
Administrative Leadership
Adaptive System
Adaptive Leadership
Administrative System
Entrepreneurial System
Productive
Tension
Generative Leadership
Key Premise of CLT:
It takes complexity to beat complexity
High
45°
The Chaotic Regime
Variety
of
Stimuli
The Complex Regime
The Ordered Regime
Low
Low
Variety of Responses
High
Adapted from Boisot and McKelvey, 2010, Academy of Management Review
Research Findings
Purpose of Study
 To examine leadership and adaptability in
the healthcare industry using a
complexity lens.
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)
Overarching Finding
Healthcare is “in” complexity, which is evidenced by
increasing variety in (and pressures from) the
environment
2. Traditional leadership is inadequate for operating in
these contexts because it generates an “ordered”
response that does not meet the needs of
complexity.
3. Leaders who respond effectively in these
environments enable “complex” responses by
creating climates and conditions conducive to
adaptive leadership and enhanced performance.
1.
Ordered v. Complex Response
High
45°
Chaotic Regime
Pressures
from
Environment
Complexity Response
Ordered Response
Low
Low
Variety Responses
High
Adapted from Boisot and McKelvey, 2010, Academy of Management Review
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).
Ordered v. “Complex” Response
Ordered Response
 Traditional Leadership
 focuses on top-down
influence processes
to motivate and align
organizational
members around the
strategic vision
Complexity Response
 Administrative Leadership
 top-down leadership
“loosens” administrative
systems
 Generative leadership
 informal leadership fuels
entrepreneurial system
 Adaptive leadership
 enables emergence for the
organization
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.
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.
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.
Findings:
Leadership Responses and Outcomes
Hospital
Ordered
Response
Traditional
Leadership
Alpha
Moderate
Beta
High
Complex Response
Adaptive
Leadership
Leadership Outcomes
Generative Leadership
Too much
tension—put
into chaos
Weak
Moderate
Top management team
ejected
Moderate
Steady state
Absent
Absent
Status quo
Lambda Moderate
Moderate to Strong
Progressing well
Theta
Strong balance
of loosening
and tightening
Overpowering Absent
Stifled
Zeta
Overpowering Absent
Absent
CEO was new at time, and
is now no longer with
organization; they have an
interim CEO
Top management team
completely turned over
Gamma Moderate to
Weak
“Traditional” Leadership
Traditional Leadership
Focuses on
alignment
and control
Entrepreneurial System
Administrative System
Which
suppresses
adaptive
dynamics
Findings
• In our data, traditional leadership looks like
this…
Traditional Leadership
Complexity in
Environment
Pressures
on System
Desire for Control
Bureaucratization
Traditional Leadership
(Tightens Administrative
function)
Stifles Adaptive
Dynamics
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.
Adaptive Dynamics
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
Generative Leadership
Administrative System
Entrepreneurial System
Emergence
Generative Leadership
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.
Adaptive Leadership
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)
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.
Complexity Leadership Framework
Adaptive Leadership
Administrative
Leadership
Administrative System
Entrepreneurial System
Emergence
Generative Leadership
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).
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
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.
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”).
References
 Boisot, M., & McKelvey, B. (2010). Integrating modernist and postmodernist
perspectives on organizations: A complexity science bridge. Academy of
Management Review, 35(3), 415-433.
 Garud, R., Kumaraswamy, A., & Sambamurthy, V. (2006). Emergent by design:
Performance and transformation at Infosys Technologies. Organization Science,
17(2), 277-286.
 Houchin, K., & MacLean, D. (2005). Complexity theory and strategic change: An
empirically informed critique. British Journal of Management, 16(2), 149-166.
 Surie, G., & Hazy, J. (2006). Generative leadership: Nurturing innovation in complex
systems. Emergence: Complexity and Organization, 8(4), 13-26.
 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), 298-318.
References
 Boisot, M., & McKelvey, B. (2010). Integrating modernist and





postmodernist perspectives on organizations: A complexity science bridge.
Academy of Management Review, 35(3), 415-433.
Houchin, K., & MacLean, D. (2005). Complexity theory and strategic
change: An empirically informed critique. British Journal of Management,
16(2), 149-166.
Surie, G., & Hazy, J. (2006). Generative leadership: Nurturing innovation in
complex systems. Emergence: Complexity and Organization, 8(4), 13-26.
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), 298-318.