Leader as Change Agent in a
Time of Complexity
NURS 560 Fall 2015
Dr. Mileva Saulo Lewis
Professor Emerita
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At the completion of this session,
learners will be able to:
• Compare and contrast theories of change
• Differentiate among models as appropriate for
health behavior change and organizational
change
• Analyze a situation for readiness to change
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Martha Rogers, PhD, RN Science of Unitary Beings
New York University 1967
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Thomas Kuhn
• Paradigm Shift
• From Newtonian Physics – linear, predictable
• Quantum Physics – interrelatedness,
action/reaction, constant movement
– Kuhn, T.S. (1962). The structure of scientific
revolutions. (2nd ed.). Chicago: The University of
Chicago Press.
Science of Unitary Human Beings
Chinn, P. L. & Jacobs, M.K. (1987). Theory and nursing: a systematic approach. St. Louis, MO: Mosby.
Individual
Nursing
Society
Environment
“Man” is an energy field
Endless boundaries
Characterized by:
Unified wholeness
 Openness
 Unidirectionality
 Pattern and organization
 Sentience
Science of humanity
Synergistic wholeness
Life processes are the core of
nursing
Principles of homeodynamics:
• Reciprocity
• Synchrony
• Helicy
• Resonancy
Environment and man
are energy fields
coexisting with the
environment
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Complexity Science
• Paradigm shift from mechanistic dualism to
quantum physics
– Cause and effect only is an incomplete theory
– Quantum physics – subatomic particles are
synchronized, cooperative, and interlinked
• Essential Ingredients – Interconnected
Universal Web of Energy
– Impact of awareness
– Relationship between observer and observed
• Koerner, J. (2009). Insight: The application of
complexity science in decision making. Creative Nursing,
15(4), 165-171.
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“Change agents continue to struggle with
outmoded models, tools, and techniques--ones that were sufficient in slower and
simpler times, but that are counterproductive
when complex adaptation is the only viable
survival strategy”.
Edwin Olson and Glenda Eoyang
Facilitation Organizational Change
(Courtesy Dr. Phyllis Kritek)
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Complexity Science and Adaptive Systems
The Butterfly Effect
 Seemingly small changes large effect on the results
 Groundwork for the mapping of chaos mathematically.
 Small changes in the initial characteristics of an active
system can dramatically affect the long-term behaviour
of that system.
 Referred to as the ‘butterfly effect’.
 If a butterfly flaps its wings somewhere in the world
today, there will be a hurricane somewhere else at some
future point
 Holden, L.M. (2005). Complex adaptive systems: concept analysis. Journal of
Advanced Nursing, 52(6), 651-657
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Change Agents Understand Systems
• Open systems – flows and constraints
– 1972 - Bertlanfy researching international postal system – WW II
– Inputs
– Throughputs
– Outputs
• Social Systems – Seeing the world through interactions - Social groups
– Perceptions that shape social interactions
– Purpose and goals of the system
• Process Systems - Seeing the world from information flow
• Living systems – Seeing the world through the interactions of selfcreating entities
» Senge,P. (1991). The fifth discipline: The art & practice of the learning organization. New
York: Doubleday Currency.
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Small Groups
Relevance and Application of Gerardi to Nursing Practice
Complexity Science and
Healthcare Organizations
• Complex Adaptive Systems
• Dynamic, interdependent activities occurring simultaneously
• Qualities:
–
–
–
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Self-organizing
Patterns emerge over time
Non-linear (future is unpredictable)
Patterns result from personal interactions and relationships
• Organizational effectiveness, quality, clinical outcomes depend on quality
of relationships
• Gerardi, D. (2015). Conflict engagement: a new model for nurses. American Journal Of
Nursing, 115(3), 56-61.
High Performing Primary Care Practices
(Emotional & Social Intelligence)
• Individual Traits & Interpersonal relationships
characterized by:
–
–
–
–
–
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Trust
Mindfulness
Heedfulness
Respect
Social and task relatedness
Diversity
Communication
– Gerardi, 2015
How about a Break
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