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Reflections on Hope for Healthcare:  Leaders Create From Chaos

In recent weeks I have had some interesting conversations with some of the physicians I’m coaching around the events of September 11th.  These discussions have inspired me to reflect on the chaos and complexity of the healthcare industry as simply a reflection of the complexity of all kinds of global issues faced by leaders today. 

As physician leaders it’s easy to become discouraged when we are continuously bombarded by the demands of our leadership roles.  While chaos is all around us and complexity seems to be increasing in all aspects of our lives – personal, career, community, nationally, and globally, I encourage my clients to experiment with a new perspective that offers hope for the future and the possibility of effecting change and work with them to develop the skills of transformative leaders.

Chaos – A Precursor to Creativity

According to Chaos Theory, systems in chaos, like our healthcare systems, have three characteristics:

  • Uncertainty (unpredictability, which is not the same as randomness),

  • Subtlety – a pattern of interconnectedness that is difficult if not impossible for many to see and

  • Creativity - multiple options exist (unlike problem solving -where there is one best solution)

As chaos increases, systems must eventually do either one of two things - disintegrate into utter disorganization with complete dispersal of energy, or reorganize at a higher level, the nature of which is unpredictable until it happens. 

The edge of chaos is where creativity occurs because there is enough tension created between dissatisfaction with, or failure of existing systems, and the desire (yearning) for a new way to stimulate the necessary changes and support the efforts to make it happen.  Without the creative tension, change will not occur.  However, if there is too much chaos, the elasticity of the tension is overcome and the system breaks down completely like the snapping of an overstretched rubber band.

Chaos in Healthcare

It’s all too easy to find examples of this phenomenon in healthcare systems both large and small.  A sure sign of a system in chaos is a history of successive reorganizations under a parade of CEOs over a few short years.  With each reorganization, the system becomes more and more unstable as employee morale falls, leaders lose touch with their constituents, the organization loses credibility in the community and the system falls into the “doom loop”.  As revenues fall, resources become more limited until eventually the system passes the point where recovery is possible.  At that time, it may fail completely, close down or be absorbed by a larger system.  However, if at some point in the process, a new leader who understands how to manage the creative tension at the edge of chaos comes aboard before it’s too late, he or she may lead the organization through a transformative process into a stronger, more vibrant organization than ever before.

A Challenging Role for Healthcare Leaders

In my view, healthcare as an industry and many of the systems within it are at the edge of chaos today. As leaders in healthcare, our role is to create and maintain the space in which people can grow and organizations can transform.  A leader’s job is to maintain the pressure necessary to keep the work going, yet offer the safety of a resting place for the followers in the face of overwhelm.  My questions are these:

§         Are there enough of us - a critical mass of physicians who are willing to step up and ask, "What am I willing to notice in my world?"  And, "What am I willing to do about it?" (Wheatley, MJ, Turning to one another: Simple conversations to restore hope to the future. 2002, San Francisco : Berrett-Koehler.)

§         Are we too late – will our healthcare system go the way of the dinosaurs, or are there enough physician leaders and other healthcare leaders who understand what it takes to create an environment conducive to transformative change?

§         Who will hold the leaders?  The answer to this question I believe lies in creating, nurturing and supportive communities such as Creative Strategies for Physician Leadership where physician can hold and support each other and develop through training and coaching to help them learn the new skills required of transformative leaders.

Adopting a New Perspective

In a recent course I took called Exploring the Spirit Beyond Work Through Islamic Mysticism, I learned to look for paradoxes in the midst of complexity and chaos because paradox is the source of creative solutions.  Within paradoxes lie the seeds of change.  The greater the complexity and chaos of a given situation, the greater is the opportunity for creative thinking that will lead to innovative, transformative solutions. 

To tap into the creativity at the edge of chaos, a leader must learn to let go of positions that insist on either/or (good vs. evil, life vs. death, my way vs. your way), and look for possibilities that support both/and, and ultimately seek solutions that transcend and include with the idea being that the whole is greater than the sum of its parts.

Hope for the Future

Healthcare leaders must seek commonalities which support the interconnectedness of the world such as transpersonal values -values that transcend medical specialty, individual interests, race, gender, culture and are held by all humankind - love, safety, respect, dignity, sacredness of life.  Physician leaders must, as Wheatley suggests (2002), begin turning to one another in simple conversation to discover what these values are, to start talking about them and to begin questioning when, where and why they are not being honored.

We as physician leaders have the unique opportunity (duty?) to model this behavior and because we are in positions of leadership, both formal and informal, have far-reaching influence.  Consequently, we have the leverage to actually effect positive change.  This is the belief that gives me a sense of hope for the future of healthcare and in a broader sense greater hope for humanity.

As a coach, I encourage and support my clients to take that first critical step - to embrace complexity and chaos as a source of creativity and to develop the skills required of transformative leaders.  I invite you to reflect on how you might creatively address the issues facing your organization, your local medical community and the worldwide community as a whole.  Each journey, no matter how long, begins with the first step.  

Comments provided by:

Jane L. Thilo, MD, MS
Business Consultant & Executive Coach
Developing capable leaders for turbulent times

 Dr. Thilo specializes in working with physician leaders and other senior level executives aspiring to build competency in the skills required to lead organizations in the chaos and complexity of today’s business environment.


Francine R. Gaillour, MD, MBA, FACPE
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Francine R. Gaillour, MD   ©2006 Ki Health, Inc.