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Featured Article: Leadership in Complexity - Succeeding in the Setting of Unknown Unknowns

 , May 16, 2018

Jean S. Kutner, MD, MSPH is professor of medicine at the University of Colorado School of Medicine and chief medical officer at University of Colorado Hospital.

Our environment in academic medicine has become more complex,volatile, and unpredictable, with both external and internal forces driving
complexity. As such, the skills for leadership have changed, requiring more adaptive thinking and abilities. Complexity is the domain of unknown unknowns. That is, cause and effect cannot be known in advance; interactions among system elements are nonlinear and tightly coupled such that small changes can produce disproportionately large effects. Solutions emerge from the dynamics within the system and cannot be imposed from outside with predictable results.

Traditional leadership relies on alignment and control with change efforts driven from the top down, with the assumption that a future state is
knowable. The traditional job of the leader is to focus on the gap and steps required to close it by employing vision, strategy, critical steps and milestones, bringing to bear analysis, experts, and data. In the setting of complexity, the job of the leader is to mind the system rather than mind the gap. The leader sets boundaries and charts a direction, but not a destination, focusing on possibilities rather than probabilities, encouraging and fostering experimentation.

Our role as a change leader in the setting of complexity is to help others make sense of what is going on around them, allowing emergence
rather than defining solutions a priori.

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