Know how to gauge the complexities you face; the four types of challenges[1] faced by Physician leaders and healthcare executives.
It matters because simple thinking applied to complex circumstances squanders opportunity and creates dysfunction.[2]
1.) Known Challenges: Known challenges are the simplest of the four types because cause-and-effect are repeatable, perceivable, and predictable. If you don’t sanitize the operating room, for example, your infection rates go up. Rational choice and intentional capacity will serve you well in Known circumstances, as will best practices, standard operating procedures, and process reengineering.
Sense, categorize, and respond when you face a Known challenge.
2.) Knowable Challenges: Knowable challenges still have some semblance of order, but they are more complicated because cause-and-effect are separated by time and space. For example, “Our hospital has always managed physicians, but now we have all these APPs, and we won’t know exactly how that will play out for some time.” When faced with Knowable challenges; analyze, apply past and parallel experience, plan scenarios, and apply systems thinking.
Sense, analyze, and respond when you face a Knowable challenge.
3.) Complex Challenges: When faced with Complex challenges*, you must understand that you have crossed over into the world of unordered circumstances. Rational choice, logic, and intentional capacity won’t necessarily serve you here. Cause-and-effect don’t repeat because there are too many factors. In other words, what worked yesterday won’t necessarily work today. For example, “I’m in charge of expanding our NICU, but two of my neonatologists threatened to quit because they’re unhappy with the expansion, and we’re already short staffed.”
Probe, sense, respond, and then repeat when faced with Complex challenges.
4.) Chaotic: There is no perceivable relationship between cause-and-effect in Chaotic circumstances. The fanatics are flying planes into your buildings, some of your staff is being attacked in the ED, etc. Stability-focused interventions and crisis management are the go-to leadership mechanisms here.
Act, sense, respond, and then evaluate when faced with Chaotic challenges.
Leaders must do the work to develop themselves so they can function competently in complex environments. If they don’t, they will yearn for simplicity, expect all solutions to be Known or Knowable, and/or apply technical or simple solutions to complex problems.
The Rub: *Most healthcare leadership challenges are Complex.
Ninety years ago, when your great grandfather was managing an assembly line, complex thinking may not have been necessary, but leaders can’t get away with that anymore. Today’s world is highly complex, especially in healthcare.
Fern EPC helps physicians, physician leaders, and executives develop their ability to think and lead in complex environments.
[1] From David Snowden’s Cynefin Model
[2] Ronald Heifetz