Complexity science: Complexity, leadership, and management in healthcare organisations

doi:10.1136/bmj.323.7315.746

BMJ 2001;323:746-749 ( 29 September )

Education and debate

Complexity science

Complexity, leadership, and management in healthcare organisations

This is the third in a series of four articles

Paul E Plsek, director ^a, Tim Wilson, director, St Paul RCGP Quality Unit ^b.

^a Paul E Plsek & Associates, 1005 Allenbrook Lane, Roswell, GA 30075, USA, ^b Royal College of General Practitioners, London SW7 1P

P E Plsek paulplsek@directedcreativity.com

The first 150 words of the full text of this article appear below.

Current management thinking largely assumes that a well functioning organisation is akin to a well oiled machine.¹ Thisleads to the notion that performance is optimised when work isspecified in detail and shared out to distinct operational units.²Clinicians often object to these detailed specifications, whilemanagers bemoan a lack of cooperation.³

The first article in this series introduced an alternative to the machine metaphor; that of a complex adaptive system (CAS).⁴In this article we describe applications of complexity thinkingin the organisation and management of health care.

Table Removed (Available Only in the Full Text)

(Credit: LIANE PAYNE)

Whole system performance: managing generative relationships

The interactions within a complex adaptive system are often more important than the discrete actions of the individual parts.As the examples below illustrate, a productive or generative relationshipoccurs when interactions among parts of a complex system producevaluable, new, and unpredictable capabilities that are not inherentin any of the parts acting alone.⁵

Although health care depends largely . . . [Full text of this article]

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