March 27, 2023

Key Leadership Competencies: Complexity Fit

Leadership Development

Reading Time: 9 minutes

Forced to evolve or else, this is a time of intense transformation for healthcare leaders. As you navigate the current healthcare environment, you’ve likely noticed many established “best practices” that worked well once upon a time (or at the health system across town) often fail to produce significant or sustainable improvements in your organization. 

In our experience coaching healthcare leaders, we’ve found it takes an expanded set of leadership competencies to drive meaningful transformation at the speed our industry is changing. To that end, we’ve identified one mindset shift we call “Complexity Fit” as vital for leading well in current conditions. That mindset is the focus of this post — the third installment in our Leadership Competencies series.

What’s a Complexity Fit healthcare leader?

Put simply, Complexity Fit leaders are particularly effective in uncovering and advancing solutions in complex environments, where conditions are unpredictable and answers are elusive, which is the norm today. You’re a Complexity Fit leader if you display the following traits:

  • You’re mindful that habitual approaches can’t necessarily solve new problems as conditions shift and crises emerge.
  • You’re readily adaptable to match the needs of changing conditions.
  • You cultivate a systems mindset and encourage diverse perspectives in search of solutions to new problems.

Without Complexity Fitness, there’s often a mismatch between leadership and context. Put another way, we might operate and make decisions based on perceptions that don’t match reality.

Allow me to explain, starting with the different ways leaders make sense of their world, informing the mindsets they hold about leading.

Cynefin framework: A leader’s sense-making tool for better decision-making

To help understand what mental pitfalls might be hindering your impact as a leader, the Cynefin framework for decision-making is useful. Pronounced ky-nev-in, the framework is a “sense-making device,” that helps leaders parse out the various contexts they might find themselves in. It divides reality into predictable and unpredictable worlds, which is helpful because those worlds play by different rules. If leaders can see their context with greater clarity and become familiar with which rules to play by, they can better match the way they are operating to the context they are in. Cynefin can help leaders discern a good path forward.

This framework isn’t some unproven, newfangled theory. Rather, it has been used by governments around the world to counter terrorism and formulate policy, by pharma giants to develop new products, and by entrepreneurs looking to innovate and avoid trouble. It’s useful.

Cynefin can help you make better sense of situations, events, or what’s going on in your entire organization. It is a scalable tool. In real life you’re not going to find a clear demarcation between one domain or another, but you can get an overall sense of what things are like for you. What you’re facing will align with one of the contexts in the table below, falling somewhere from Clear to Chaotic. At the bottom of the table we point out keywords about how a leader best shows up for whatever domain is at play.

Why these distinctions matter: One approach that’s wildly successful for one of the above domains could be disastrous for others. That’s where leaders can get tripped up and end up with bigger problems than they started with. (See: “A Cautionary Tale” below.)

Complicated and Complex

We’ll narrow our discussion to two domains: Complicated and Complex. As executive coaches, we often see healthcare leaders getting these two mixed up.

Think of the Complicated domain as a machine, and Complex domain as a living, breathing, evolving organism. 

A few examples:

  • Electronic medical records are Complicated. How humans use those records is Complex.
  • A clinical protocol is Complicated. How humans apply that protocol to a real patient is Complex. Patient responses and the results of that application are also Complex.
  • A single community-based hospital may be more Complicated and less Complex than a national, 125 hospital-based, healthcare enterprise, which would be more complex than complicated.

David Snowden and Mary Boone, researchers writing for the Harvard Business Review, explain it like this:

“In a complicated context, at least one right answer exists. In a complex context, however, right answers can’t be ferreted out. It’s like the difference between, say, a Ferrari and the Brazilian rainforest.

Ferraris are complicated machines, but an expert mechanic can take one apart and reassemble it without changing a thing. The car is static, and the whole is the sum of its parts.

The rainforest, on the other hand, is in constant flux — a species becomes extinct, weather patterns change, an agricultural project reroutes a water source — and the whole is far more than the sum of its parts. This is the realm of ‘unknown unknowns,’ and it is the domain to which much of contemporary business has shifted.”

One of the many necessary leadership competencies of the 21st century is discerning the difference between Complicated and Complex situations. They each demand different behaviors and actions from leaders. Leaders are so familiar with the Complicated way of making sense of things, that shifting to a less familiar way is challenging for nearly everyone.

For example, maybe you find yourself or your team struggling to find the right solution to something. If the answer escapes you, it may be that one does not exist. Elusive answers to problems are a consequence of Complexity. In Complicated scenarios, right answers can be found. But in Complex situations, they are not available, because they don’t exist.

I’ve seen executive teams get completely bogged down because they were on the hunt for elusive “right” answers to all of their challenges. When offered the possibility that in healthcare today, because it’s complex, the right answer may not exist, but many possible good ones do, the team was able to pick a handful of possible good solutions and try them out. That helped them make quicker decisions, and gain some movement.

To meet Complexity, leaders need to be fit for Complexity. That means, be able to behave and act in ways that are better suited to Complex environments. Some of the common things about Complex environments to pay attention to are:

  1. The cause-effect relationships are obscured. This includes history being able to inform the present. That’s why our past experiences aren’t as useful as they once were for us, and why leaders must be mindful that habitual approaches can’t necessarily solve new problems. In Complex contexts, conditions shift and crises emerge. Problems are always new and we won’t always be aware of what will follow, or where they came from.
  2. Uncertainty is high. Complex situations are infused with uncertainty that cannot be reduced, no matter what we try. It’s one reason why there’s a premium on adaptability in Complex environments and why leaders must be readily adaptable to match the needs of changing, uncertain, conditions.
  3. Rightness isn’t available. Complex systems are so interconnected, dynamic and volatile that no one of us can get our heads wrapped around what is really going on. As mentioned in the example above, right answers are elusive. We must take advantage of our collective abilities to derive the best sense of reality that we can. It takes many to identify the most useful approaches for moving forward. That’s why leaders must cultivate a systems mindset and encourage diverse perspectives in search of solutions to new problems
A cautionary tale: How to break things

Things can go sideways when we confuse the Complicated with the Complex.

Years ago, a string of shark attacks left tourists dead or injured in Hawaii. Local authorities feared tourists would stay away if sharks weren’t controlled. Legislators approached the problem as a Complicated issue, with clear cause-and-effect, and predictable outcomes based on specific actions. They invested $150,000 in a shark population control program, designed to kill off tiger sharks. The plan was wildly successful in meeting that objective.

A couple of years later, local fisheries began to suffer from a sharp decline in fish. The local fishing industry conducted studies to understand where all the fish had gone. Those studies found that by eliminating apex predators (tiger sharks), medium-sized predators increased substantially and preyed on smaller fish. The smaller fish were those we prefer to consume.

By attempting to solve a tourism problem — shark attacks — with a Complicated mindset, Hawaiian authorities had unwittingly decimated its fishing industry. Ecosystems, of course, are Complex, not Complicated. Leaders must meet Complexity with Complexity (meaning with actions and behaviors that are fit to Complexity). It’s called The Law of Requisite Complexity. If we break that law, things go sideways.

Can you think of a situation that you’ve been part of where leaders applied a solution that created unforeseen problems? It’s possible that the solution was derived from a Complicated mindset to solve a Complex problem.

In Complex environments, adaptability beats efficiency

For the past century, efficiency has been a main goal of organizations. And yet, we’ve learned over time how high degrees of efficiency can prevent us from being nimble and adaptable. 

The pandemic was a great example of this. Supply chains spent decades maximizing efficiencies: consolidating, streamlining, getting rid of waste, favoring single suppliers and on-time inventory. And it broke precisely for those reasons. Efficiency was so high, it made organizations brittle. We weren’t able to adapt fast enough, and when complexity hit, it broke us.

The pandemic was just one example of the complexity that happens every day and will happen more frequently now that we operate in a Complex environment. We will never return to the 20th century when efficiency was king. To lead well, healthcare leaders and the organizations they lead desperately need to become more adaptable. Efficiency matters, but in Complexity, adaptability matters more.

Building your Complexity Fit muscle

In a piece published by the Journal of Evaluation in Clinical Practice, Dr. Carmel Martin argues “the role of adaptive leadership is not to solve problems, but rather to facilitate the necessary adaptive work of the people directly confronting the problems, often in the frontline of healthcare.” That kind of leadership requires a shift in the way most leaders show up. 

But how do you become such a leader? Because Complex problems can’t be solved with a clear, five-step recipe, we can’t leave you with one-size-fits-all guidance for transforming into a Complexity Fit leader overnight.

Awareness of the various mental models is a good and necessary first step. So is acknowledging that your mental map might be at odds with Complex challenges you’re facing today.

You might also find it helpful to contrast modern leadership with previous mental maps that no longer serve you well. Your challenge (and opportunity) is to shift from 20th Century approaches and behaviors to 21st Century as described below.

To help your personal evolution, we can point to five behaviors we commonly see in Complexity Fit leaders:

  1. Embrace constructive conflict.
    Complexity Fit leaders crave constructive conflict, knowing how to create safe environments where a free flow of diverse perspectives and ideas is the norm. They are also adept at extracting the richest and ripest fruit from conflicting interactions. To that end, they see diversity and inclusion as the organization’s lifeblood — a necessary precondition for catalyzing the constructive conflict their organization needs to thrive.
  2. Connect with abundant referent power.
    Complexity Fit leaders continually build and sustain connections with and between people, information, and resources. These internal networks typically reach outside the organization’s boundaries, commonly extending into their communities, regions, nationally and often internationally. While these leaders are connecting in nature, they are not controlling. Rather, they facilitate a remarkably robust flow throughout the network, often by getting out of the way and resisting the temptation to seize control of the flow.
  3. Cultivate a collaborative culture.
    Complexity Fit leaders create environments where individuals can voice their legitimate self-interests and work within those interests to craft solutions that address all expressed legitimate interests. In doing so, new paths emerge from the collaboration, frequently out of opposing positions.
  4. If Collaboration is the mode, Teaming is the platform.
    Complexity Fit leaders ply their unique constellation of skills via teams. They are adept at the repeated creation and sustainment of high-performing teams. These aren’t mere collections of coworkers, but colleagues who have built a deep level of trust derived from mutual vulnerability. They expect conflicting ideas and commit to decisions made by the team.
  5. Practice, feed and encourage creativity.
    Complexity Fit leaders carry a deep sense of empathy for others, the legitimate interests others hold, diverse perspectives and expertise — a rich palette of humanity! From that place of empathy, leaders take advantage of the palette before them to creatively synthesize novel solutions, often from what are deeply entrenched polarities. Seeing contexts through shifting lenses, they can creatively make sense of their environment through multiple frames. Creativity is grown by being curious, relentlessly seeking to learn, challenging conventional thinking, rewarding risk, becoming proficient at experimenting, and creating a culture filled with the energy of possibility thinking. 

As you seek to grow new behaviors, our recommendation is not to attempt it alone. Expert coaching focused on behavioral transformation is key to accelerating your development, exposing blind spots, minimizing your growing pains, and helping you avoid costly errors. 

Could you figure this out on your own? Sure. But for mere mortals, as most of us are, it takes decades of stumbling around before we figure it out. In a Complex world, time is a rare luxury. MEDI Leadership coaches are happy to have a conversation and help shed light on next steps that make most sense for you.

Healthcare urgently needs a new breed of leaders. Investing in your own transformation  — and the transformation of leaders working alongside you — might be the most impactful investment you will make in your organization, your cause, and your own career.


These are turbulent times in healthcare. Today’s leaders need an expanded set of competencies to manage growing ambiguity, uncertainty, and risk. MEDI’s new blog series is a masterclass in Leadership Competencies we’ve found most critical for driving meaningful transformation in 2023 and beyond. 

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About the author

Michael S. Hein, MD, MHCM, ACC

Michael S. Hein, MD, MHCM, ACC has over 20 years of healthcare leadership experience in multi-specialty practice, large integrated health systems, academic medicine, and start-up companies. He has extensive clinical leadership experience and deep knowledge in transformational change.

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