The current COVID-19 situation is an example of complexity - and an opportunity for reflection on how systems respond to the challenges it is causing.

We need to understand that complex, adaptive systems such as healthcare are dynamic, have multiple interacting elements, are unpredictable and have the following characteristics:A complex adaptive system has the capability to self-organise, accommodate to behaviours and events, learn from experience and dynamically evolve but not necessarily in predictable ways. The system’s performance and behaviour changes over time and cannot be completely understood simply by knowing about the individual components. Read more in Adaptive Spaces, Networks…. and a Challenge Called Spread and Braithwaite 2018.

Mary Uhl-Bien recently joined Matthew Mezey from the Q community and me for a virtual conversation to share her insights on the current complex challenges COVID-19 brings, and illustrate these insights with examples of responses seen in USA and UK.

Mary has previously explained that organisations need to respond to complexity in the environment with complexity (Q community webinar December 2019).

COVID-19: what would a complexity based response be?

During our conversation, Mary outlined what complexity leadership theory would predict would happen, and how we would need to respond - she contrasted this with how the USA has responded. You can watch Mary talking about this in the video - click 'show more' to find the timestamps - select Complexity Leadership Response.

What complexity leadership theory says should happen is two-fold. 

Firstly, immediate action is needed to produce a good operational response e.g. for testing, or PPE supply. However, often when leaders are faced with complexity they go into an order response - this is a pattern we are seeing repeated. A classic order response to complexity is to deny it exists, believe it will settle down and go away and that all will go back to the way it was before, while thinking that existing structures will be adequate to cope. This order response reaction was often seen in Mary’s longitudinal research on change in healthcare and in the current US response to COVID-19.

Secondly, an adaptive response is needed. This should involve a good strategic, operational response combined with a local, entrepreneurial response which will drive the adaptive responses which should be at a local level i.e. local innovations and adaptations. Local responses are needed as they tend to be more appropriate to the situation.

The described order response to the COVID-19 crisis demonstrates the need for a greater understanding of complexity.

At 44:53 in the video Mary suggests that the NHS needs to identify the big forces in the environment, consider how they will pressure the system and what will therefore need to be done differently at both macro and micro levels.

The COVID-19 crisis provides an opportunity for us to look at where we have adapted and where we did not and to understand why. We need to learn the lessons from this crisis, share our new insights and build them into our future way of working.

“Over and over again is that when leaders are faced with complexity they go to an order response”

Future blogs based on this conversation with Mary Uhl-Bien will explore:

If you're interested in how to enable the spread and adoption of innovations in healthcare, there are previous blogs and further blogs to follow. Please do subscribe to this blog and follow @DianeKetley @HorizonsNHS, #nhsspread.


Further information and reading

NHS Horizons' work on spread and adoption of innovation, and forthcoming online publication, is informed by Mary’s work. We identify the need for a new mindset with an increased understanding of complexity and interdependencies, the need to create a pull of innovation alongside the traditional push approach with attention to relationships and the impact of asking people to change their routines and behaviour. 

For more information on the Q community follow @theQCommunity.

M. Uhl-Bien. How 'Adaptive Spaces' enable innovation in healthcare and beyond. 2019. Q community webinar.

COVID-19: Safety-II in action and zoom outcomes. 2020. Q community webinar.

M J Arena, M Uhl-Bien. Complexity Leadership Theory: Shifting from Human Capital to Social Capital in People + Strategy, 2016 – open access

M Arena, R Cross, J Sims, M Uhl-Bien. How to Catalyse Innovation in Your Organisation in Sloan Management Review, 2017 

Professor Mary Uhl-Bien, Ph.D. is BNSF Railway Endowed Professor of Leadership at Neeley School of Business at TCU, Texas, USA.