Tolerance for Imperfection and Ambiguity
Leaders recognized that conditions that stimulate creativity, adaptation and learning were not necessarily smooth and often “quite messy.” “Most of life is change” and leadership learns to “incorporate that so the expectation isn't that stability is the goal.” Leadership expected resistance to change, disagreement and debate.
Having a vision and core values to guide the process was helpful in managing resistance to change. “After a bit, they stopped challenging the message and the vision. They could no longer push back as to the reasonableness and wisdom of doing it.” However, there was an understanding that the impact of constant change on staff in complex environments was still very real and must be expected, along with the recognition that not everyone will be on board. Leadership welcomed debate and discussion. In their experiences with resistance, skepticism, and doubt, the leaders engaged in self-reflection, recognizing “it's okay to look back and say I could have done that better.”
Whether managing major or minor change, the leaders had the experience of acceptance that things would not be perfect right away. One leader said, “this was being created out of whole cloth,” and there was an “understanding that things were going to evolve.” Nurse leaders described fine-tuning and “tweaking as you go and not having the whole thing perfected, but be willing to go with what it is that you know and let some of it evolve and learn as you go.” “The tinkering is what happens when there are small things that need to be done.” Leadership encouraged their staff to “be as creative as they wanted.” “I'm not saying laissez-faire; I'm saying I'm comfortable with some degree of chaos and lack of structure.” One leader referred to this as “trusting the process” and the people.
If it effects change, real change, it's not top down; it's messy where it really happens. The only way to deal with that is to let it see itself, see if it's fighting itself, getting in its own way, or figuring out how to come up with something better. It generally does, and in my experience, you come up with something far more complex and wonderful than I ever could have imagined. Once it becomes an organic thing, you have to get out of the way and say thanks.
Learning From Adversity as Well as From Success: Gratification, Validation, Joy
The nurse leaders described learning from positive and negative experiences with leadership in organizations. In some cases, the learning led to creative, adaptive solutions and positive outcomes in their organizations. In other cases, it led to adaptation by leaving the organization and applying the learning in another setting. Negative experiences with leadership in an organization shaped development as leaders learned what they “would not want to replicate” in a new environment.
When creativity, adaptation, and learning were associated with positive experiences and outcomes, nurse leaders described experiencing gratification, recognition, and appreciation, validation, and joy. As described by one participant, they are “accomplishing work so everybody can leave and feel a sense of accomplishment.” She reflected on the need to “really reflect and derive some joy and pride.” Other participants described the inherent joy in collaborative, creative work. “It's fun to be creative and innovative and to deal with the complexity of the system.” There was a sense of “synergy” when “everything was in the right place in the right balance to have the effect.”
“It was the first time in my life that I felt, even in my cells, that I was in the right place and I was doing the right work and it was going to be respected. I never felt so personally energized and validated.”
Fundamental Structure of Enabling Leadership
Leadership that enables creativity, adaptation, and learning in an organization requires leaders who can read the environment and establish a compelling, if imperfect vision for the future. The vision is grounded in the shared values and mission of the organization and sets the direction. Leadership creates the conditions for creative, adaptive action by valuing diversity and connecting people with diverse perspectives and ideas. Leadership sets expectations for dialogue and debate, as well as for collaboration. There is trust in the process and the people. There is recognition that it can find its way creatively. Under these conditions, learning and adaptation can take place. The best ideas arise, not from formal leaders, but from the people doing the work. New ways of doing business and providing care emerge and stimulate further innovation. When it works well, it is productive, satisfying, gratifying, and validating, providing a basis for joy in the workplace.
Discussion
As they shared their experiences, nurse leaders described, not just the work of leaders, but the leadership dynamic in complex, adaptive healthcare systems that allowed creativity, adaptation, and learning to occur. They described the conditions that engaged the leadership capacity throughout the organization to enable the emergence of positive solutions to organizational challenges. The experiences of the nurse leaders in this study reflect an appreciation for complexity leadership in healthcare and validate the need to balance administrative and adaptive functions to meet many competing demands.
The enabling conditions described by the participants illustrate the value of administrative leadership in recognizing the need for change and setting the vision of where the organization needs to go. Whether described as a “radar” that develops with experience or the ability to be a “signpost reader,”6(p.45) leadership processes cues from the environment and sets the stage for action. Leadership engages in sense making, one of the key processes in complex systems,7 and enlists the organizational capacity to respond while remaining grounded in the mission and core values of the organization.
Key to enabling leadership is the creation of the infrastructure and conditions to enable changes to creatively evolve and emerge. Structures and processes that optimize the rate of information flow, diversity of perspectives, and rich connectivity enhance the ability of people to self-organize and to creatively adapt.8 Solutions may be imperfect as people connect and explore,7 but leadership promotes risk taking, small tests of change, adopting what works, fine tuning, and adjusting, but always with an eye toward the vision. Adaptive leadership is shared as different individuals take the lead at different times to move the process forward or in a slightly new direction. There is courage, willingness to try out new ideas, and tolerance for imperfection.
Nurses at every level of the complex system may engage in administrative, adaptive, and enabling functions as part of the leadership dynamic. However, in the experience of nurse leaders, enabling leadership sets the stage for better outcomes by fostering connection, valuing diversity, and supporting risk taking and accountability. It creates the space for better solutions to pressing patient and system challenges.