January 14, 2015 M Scholarly Discussion 2.1 Understanding the parts of a complex system, or the Complex Theory, and how systems work together within an organization enables us to see how they can affect the patients care and eventual outcome. Choosing from the category of staff, the questions I would ask are as follows: does the institution allow for input and critical thinking from their nursing staff? As stated in Edgeware Tales, Unleashing People Potential, When Trouble Makers Become Superstars (1998), the nurse manager Janet has become “stagnated” in her “environment of command/control culture”. Janet’s personality is one of a “free thinker, she couldn’t accept a decision just because she was told to she needed to understand the decision”. Janet, “recognized what was not working rather than pretending it did”. Not all personalities are able to work and thrive in an atmosphere of conformity. The next important question to ask would be the status of morale. If the health care team members are unhappy and frustrated due to stringent policies, procedures and other limitations the patient outcome will be reflective of this. Edgeware Tales, Unleashing People Potential, When Trouble Makers Become Superstars (1998), “there seemed no opportunities to be creative, no reason to be innovative”. “Something was missing in Janet, something essential had become dormant - her passion”. Within a system of complexity leadership, there is the theory of distributed leadership. Crowell (2009), “a process that includes accountability and contributions from nurses at all levels, share governance. By allowing the nursing staff to have autonomy the system would foster emergence. The type of leadership of an organization sets the tone for the entire system. Knowing what is important to the governing body will greatly impact on the culture of the institution. The two questions to be addressed are as follows: have the leaders created an environment that produces quality care, and are they supportive of the staff. In the article by Patricia R. Ebright, RN, DNS, CNS, ADA Periodicals (2010), Ms. Ebright states “Healthy work environments that support and foster excellence in patient care focus on designing processes to eliminate actual and potential system gaps”. ( Weick & Suttcliffe, 2007). Organizations that maintain the necessary resources and supplies provide for a working environment that is reliable and efficient. Having equipment, supplies and any ancillary help when needed eliminates distractions that take away from patient care and safety. Allowing for a positive patient outcome and a staff that is trusting of their leadership. Edgeware, A Leap into Uncertainly (2001), The Subject of Complexity, Tom Irons, president of HealthEast, made the complexity theory his priority in the change of leadership at HealthEast. Mr Irons goes on to say, “it's built around managing care rather than costs, with the business structure evolving to accommodate function”. "You know, that trust we built was key," Crowell, D.M. (2011). Complexity leadership: Nursing's role in health care delivery. Philadelphia, PA.: F.A. Davis Company.
Zimmerman, B., Lindberg, C., & Plsek, P. (1998) Edgeware – lessons from complexity science for healthcare leaders. Plexus Institute. * Primer (p. 3 - 20) * Principles (p. 23 - 44) * Tales (p. 49 - 127)

* Ebright, P.R. (2010). The Complex Work of RNs: Implications for Healthy Work Environments The Online Journal of Issues in Nursing, 15 (1), Retrieved from