Antioch University AURA - Antioch University Repository and Archive Student & Alumni Scholarship, including Dissertations & Theses Dissertations & Theses 2012 Facilitating Emergence: Complex, Adaptive Systems Theory and the Shape of Change Peter Martin Dickens Antioch University - PhD Program in Leadership and Change Follow this and additional works at: http://aura.antioch.edu/etds Part of the Health and Medical Administration Commons, Leadership Studies Commons, and the Organizational Behavior and Theory Commons Recommended Citation Dickens, Peter Martin, "Facilitating Emergence: Complex, Adaptive Systems Theory and the Shape of Change" (2012). Dissertations & Theses. 114. http://aura.antioch.edu/etds/114 This Dissertation is brought to you for free and open access by the Student & Alumni Scholarship, including Dissertations & Theses at AURA - Antioch University Repository and Archive. It has been accepted for inclusion in Dissertations & Theses by an authorized administrator of AURA - Antioch University Repository and Archive. For more information, please contact [email protected], [email protected]. FACILITATING EMERGENCE: COMPLEX, ADAPTIVE SYSTEMS THEORY AND THE SHAPE OF CHANGE PETER MARTIN DICKENS A DISSERTATION Submitted to the Ph.D. in Leadership and Change Program of Antioch University in partial fulfillment of the requirements for the degree of Doctor of Philosophy March, 2012 This is to certify that the Dissertation entitled: FACILITATING EMERGENCE IN A HOSPITAL SETTING: COMPLEX, ADAPTIVE SYSTEMS THEORY AND THE SHAPE OF CHANGE prepared by Peter Martin Dickens is approved in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Leadership and Change. Approved by: ________________________________________________________________________ Jon Wergin, Ph.D., Chair date ________________________________________________________________________ Carol Baron, Ph.D., Committee Member date ________________________________________________________________________ Curt Lindberg, D.Man. Committee Member date ________________________________________________________________________ Glenda Eoyang, Ph.D., External Reader date Copyright 2012 Peter Martin Dickens All rights reserved Acknowledgements Like most of my life, the journey to this dissertation has been one of discontinuous change. A friend once told me I have a habit of committing financial suicide by jumping off the tops of very steep learning curves. Looking back, that is certainly true. Why else would someone commit to the cost of a doctorate at the age of 55? Further, as a Canadian pursuing a doctorate at a private American university, I had no available financial support on either side of the border. Such is the risk of developing a passion for things and simply feeling a call that demands you take action, no matter how risky. In regard to that risk, I need to begin and end by acknowledging the incredible support of my wife, companion, and dialogue partner, Marion. Without her unfailing commitment, this doctorate would never have been completed. I returned to university later in life and completed my master’s degree when I was 51, in theological studies no less. In pursuing that degree, another deep passion, I discovered my inner academic and found that I really wanted to pursue more. In that leg of my journey, I was deeply grateful to Ken White, CEO of Trillium Health Centre near Toronto, to whom my thesis was dedicated. It was his support that enabled me to complete my master’s degree. More importantly, he offered me the largest canvas I could ever imagine for exploring the concept of complex, adaptive systems (CAS) within an organizational setting. I joined Trillium as the vice president of organization development at the time when Trillium was formed from the forced merger of two hospitals. Conscious experimentation with CAS theory enabled us to move relatively quickly in forging a unified culture and commitment to quality patient care. It was during this time I first encountered the work of Brenda Zimmerman and Curt Lindberg through their involvement in a large-scale CAS study with the Volunteer Hospital Association. Brenda has become a mentor to me and was central in the deeper development of some of my ideas i during one of my major papers for this doctorate. Curt has been an invaluable member of my dissertation committee. I am deeply indebted to the faculty at Antioch University as well as my classmates. Special mention must go to Dr. Kori Diehl and Dr. Linda Lyshall, as well as Peggy Mark, Michael Guillot, and Chuck Powell who all contributed to the development of the survey that is central to this study. I have come to admire, respect, and truly love my dissertation chair, Jon Wergin. From the time spent at his river house in Virginia, thinking through the research possibilities to the constant encouragement, guidance, and support, he has been integral to this process. Dr. Carol Baron, who guided me, a complete neophyte, through the intricacies of scale development central to this study has also been a source of support, humor, and deep wisdom. I am grateful to all the staff, physicians, and managers at my research site who have been wonderful sources of very rich data. I am particularly thankful to my friend, Marla Fryers, who was unstinting in her support. Finally, I acknowledge my family: my daughters, Lindsey, Shannon, Danielle, and Tamara, as well as my son-in-law, Tolga. They all deserve thanks for their slightly confused good humor whenever I tried to explain my research. The last word of thanks goes to Marion, who has made it all possible. When I was recovering from cancer, she asked me what was on my “bucket list” and a Ph.D. was at the top of the list. From that moment on, she made enormous financial and personal sacrifices and never flinched in her encouragement. The unique philosophy of Antioch encourages spouses to participate actively in each of the residencies. Marion was a regular attendee and became an honorary member of Cohort 7. This arrangement ensured she was deeply familiar with the ii content and structure of the program, which made her a superb coach and accountability partner. This whole thing would never have been possible without her. It’s your turn now, my love. Gloria Dei iii Abstract This study used Principal Component Analysis to examine factors that facilitate emergent change in an organization. As organizational life becomes more complex, today’s dominant management paradigms no longer suffice. This is particularly true in a health care setting where multiple sources of disease interacting with each other meet with often-competing organizational priorities and accountabilities in a highly complex world. This study identifies new ways of approaching complexity by embracing the capacity of complex systems to find their own form of order and coherence. Based on a review of the literature, interviews with hospital CEOs, and my organization development practice experience in the health care sector, I identified nine constructs of interest: a strategic framework; organizational culture; work structures; CEO and executive team; leadership culture; quality control systems; accountability framework; learning structures; and feedback processes. One hundred and sixty-two senior leaders, managers, and staff at a hospital in Toronto, Canada, who had completed an eight-week leadership program, completed an Emergence Survey© based on the nine constructs of interest. The survey included Likert items representing the nine constructs, as well as opportunities to provide narrative feedback. In the initial analysis of the survey results, the items taken as a whole would not converge on a clear set of components. It was also clear that the mean for most of the items was very high. I theorized that the size of the sample and possibility that they were a favorably biased convenience sample because they had self-selected as leaders may have contributed to the lack of convergence and high mean. I then theorized three clusters of constructs, based on what appeared to be natural affinities. At that point I facilitated two focus groups with people who were among the survey group. Both focus groups affirmed the importance of each of the factors in improving organizational performance indicators such as patient satisfaction, staff iv engagement, and quality. I then completed a principal component analysis of each of the three clusters of constructs. From this analysis, seven components emerged. Five of these, executive engagement, safe-fail culture, collaborative decision-processes, a collaborative quality, and intentional learning processes had reliability >.70; culture of experimentation and purposeful orientation had reliability < .70. The electronic version of this Dissertation is at OhioLink ETD Center, www.ohiolink.edu/etd v TABLE OF CONTENTS Acknowledgments i Abstract iv Table of Contents v List of Tables viii Chapter I: Introduction 1 Statement of the Problem 1 Locating the Researcher 7 Rationale for Studying the Problem 10 Statement of Purpose 13 Literature/Research Background 13 Research Questions 15 Methodology 15 Summary 16 Chapter II: Literature Review 17 Introduction 17 Setting the Context: Health Care 17 The Specific Context for This Study: The Ontario Hospital System 21 Introduction to Complexity Science 24 Schools of Thought in the Current Literature 29 Making the Shift to New Metaphors 34 Organizational Ecocycles and Resilience 38 Accepting Complexity for What It Is 45 Broad Definitions of Complex, Adaptive