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From the Editor

From the Editor

Section Editor(s): Sanford, Kathleen D. DBA, RN, FACHE, FAAN

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Nursing Administration Quarterly: April/June 2020 - Volume 44 - Issue 2 - p 89-90
doi: 10.1097/NAQ.0000000000000416
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Hospitals are the most complex of all human organizations. At least that's what management guru Peter Drucker said decades ago.1 If he was alive today, he would have to change that pronouncement by substituting “health care systems” for “hospitals.” He would also be amazed at how much more complex the industry that's grown up around caring for both the sick and the well (trying to maintain their health) has become.

Nurse executives are very aware of the complexity in our workplace. We navigate and lead in tumultuous environments where systems are not synchronized; incentives are not aligned; gender and professional politics continue to complicate decision-making; and what is best for one group of stakeholders might not be what is perceived to be best for others. We wade through the slush caused by unrelenting and constant change2; adapt to meet new regulations; and invent or adopt new technologies and models of care. We deal with computers that don't always talk to each other; colleagues who are “burned out” because of a growing lack of control; obsolescence of both tools and personal skills; and the need for continual learning. We have so much data about our business that we can't always understand what it means, how it correlates, or how to best utilize it.

I've recently been in several conversations where a manager has dismissed questions from others by saying, “It's far too complex to explain.” I've also heard a variation of this, made in reply to suggested resolutions: “This situation is far too complex for simple answers.” I think both sentences are technically correct. Every issue usually does have multiple and complex causes. Very few of today's problems can be solved with a “magic bullet” or “secret sauce,” as much as we would like to believe they could. Too many people seem to believe that complex conundrums can be solved with simplistic solutions.

The authors in this edition don't suggest simple solutions. However, through an understanding of complexity theory, they are able to share ingredients for a not-so-secret “complexity sauce.” One of these has to do with our model of leadership.

Drucker pointed out that the old style of management, where bosses at the top of a complex organization make most decisions, is not effective. Because the pace of change today requires quicker adaptation, and because we have so much data that can be used to guide our thinking, we can't wait for the time it takes for that data to move up and down a complicated hierarchy. We must empower the front lines to make more decisions, and then to act, for the good of the company and the people we serve. Specifically, Drucker said, the point at which we teach people to think (and act) “will have to be moved further and further down the line.”3

Leadership theories have evolved, and many of us are trying dyad (or even triad) leadership, team leadership, and shared/self-governance models. Drucker would be pleased, but would probably ask what has taken us so long. Please enjoy the following articles on complexity theory and the leadership styles managers will need to adapt, lest we make his other dire prognostication come true: “There is a point of complexity beyond which a business is no longer manageable.”4

If you share this edition with management colleagues (and I hope you will) some may say they don't understand, or don't agree that we need to change our leadership models. To that, feel free to use this quote: “It's just too complex for me to explain to you.”

Thank you for choosing to lead,

—Kathleen D. Sanford, DBA, RN, FACHE, FAAN


Nursing Administration Quarterly

PS: Due to the increased complexity I need to manage in my newest System CNO job, I am “retiring” as the editor-in-chief of NAQ. This has been a labor of love since the founding editor, Barbara Brown, entrusted me with the role. I am thankful for that opportunity, the support of Wolters-Kluwer colleagues (especially our publisher, Beth Guthy), the faithfulness of our editorial board, the hard work of our guest editors, the willingness of our authors to contribute to our combined knowledge, and the competence and kindness of our managing editor, Linda Pickett.


1. Flowers J. Peter Drucker on the Future of Healthcare: It's Late in the Day.'s-late-in-the-day/. Publish-ed January 11, 2015. Accessed December 19, 2019.
2. Sanford K. Leading With Love. Olalla, WA: Vashon Publishing; 1998:17–18.
3. Drucker P. The Manager and the Moron. McKinsey Quarterly. Published 1967. Accessed December 19, 2019.
4. Drucker P. Management: Tasks, Responsibilities and Practices. New York, NY: Harper and Row; 1973:681.
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