How to deal with ‘wicked problems’

Editor’s note: One in a series of monthly columns examining leadership in health care from CHLNet, representing more than 40 health organizations.

In November 2020, Dr. Johny Van Aerde shared his insights with a Canadian Health Leadership Network (CHLNet) member partners group on a panarchy model and how the pandemic was impacting health-care systems. As part of his presentation, he talked about how the pandemic had morphed into a syndemic, that is: “A network of health problems, (especially) ones that share common social underpinnings and cause an increased public health burden on a community.”

A syndemic creates “wicked problems,” a “class of social system problems which are ill-formulated, where the information is confusing, where there are many clients and decision-makers with conflicting values, and where the ramifications in the whole system are thoroughly confusing.” Wicked problems require a “systems” lens to understand and potentially address them. Systems leadership has been coined as a phrase to explain the dynamics of such leadership and is often described in the literature as complex leadership, or complex adaptive system leadership.

Health care is considered one of the most complex systems humankind has created. Therefore, as we seek solutions in dealing with the syndemic and, indeed, the nature of most social problems – including climate change and its relationship to health care, diversity and the need for more equity and inclusion in health care, the interface between health care and the economy, and the “great resignation” challenge within health-care workforces – it is important for members of  CHLNet and their societal partners to explore the dynamics of that form of leadership.

This month’s three articles illuminate interesting perspectives and approaches to systems leadership – and, by extension, to leaders who strive to operationalize what Van Aerde called the Release and Renewal phases of the panarchy model.

Reference 1 defines complexity leadership as a form of systems leadership and explains how different approaches to the pandemic in different countries explains their success or lack of it.

Reference 2 shows how principles of systems leadership, many consistent with the content of Reference 1, were employed in a practical example– i.e., from paramedicine in Ontario.

Reference 3 defines what systems leadership is, and how programs within the United Kingdom and the Health Education and Training Institute (HET) in New South Wales, Australia have been designed and delivered to generate it.

LEADS Link:

The five LEADS domains – Lead Self, Engage Others, Achieve Results, Develop Coalitions, and Systems Transformation – are all conceptualized from a systems perspective similar to those profiled in the three references. All three highlight the relationality perspective of LEADS – i.e., Engage Others and Develop Coalitions; the personal and systems change perspective of Lead Self and Systems Transformation; and the direction, alignment and results measurement focus of Achieve Results.

Reference 1: Complexity Leadership and Followership: Changed Leadership in a Changed World. Journal of Change Management.

Summary: This article, although entitled “complexity leadership,” explains system leadership from the complexity lens and argues that people no longer question whether we are in complexity; that reality has been made explicitly clear by the pandemic. The author argues that what leaders want to know now is what do we do about it, and how does it change how we need to lead? To answer these questions, the article uses COVID-19 as an example to show how understanding complexity leadership theory as “generative emergence” can help leaders better understand how to lead differently in times of crisis and through complexity. Doing so requires research and practice to focus on developing leaders and followers who can respond by adapting, rather than denying or retreating, in the face of complexity pressures.

Reference 2: Building integrated, adaptive and responsive healthcare systems–lessons from paramedicine in Ontario, Canada. BMC Health Services Research.

Summary: This article provides insights on how systems leadership shaped the evolution of the paramedicine system in Ontario over the past 10 years. To show this, first the authors argue that being responsive and adaptive to local population needs is a key principle of integrated care. Traditional top-down approaches to health-system governance have proven ineffective. They then contend there is a need for more guidance on taking flexible, complexity-aware approaches to governance that foster integration and adaptability in the health system. By studying grassroots local programs, the authors provide insight into how health governance can ensure that health systems are more integrated, adaptive and responsive. Governance strategies include supporting networks of local organizational relationships; considering the role of a functionally flexible health workforce; promoting a shared vision and framework for collaboration; and enabling distributed local control and experimentation.

Reference 3: Systems Leadership Enablement of Collaborative Healthcare Practices. International Practice Development in Health and Social Care. International Practice Development in Health and Social Care.

Summary: This chapter from the 2021 book International Practice Development in Health and Social Care focuses on work undertaken in the United Kingdom (U.K.) and Australia on leading system change by utilizing practice development principles and approaches. The purpose is to share approaches and outcomes to inform contemporary education and workforce development strategies essential to shaping health-system reform. Reform requires people to be enablers of system change for improvement in people-centred care or relationship-centred organizational contexts. Examples of reforms are described within the chapter to support the reader in contextualizing how practice improvement was implemented.

CHLNet is a social enterprise of 40+ organizations called “network partners” who gather around health leadership. Part of its mandate is to share emerging leadership practices for 21s century care. Visit www.chlnet.ca to learn more.