Resilient leadership: Exploring the most

appropriate leadership style for resilient

organizations within the health care sector

Eric Arne Lofquist

15 August 2016

Leading resilient organizations

Resilient organizations

•Complex dynamic-adaptive socio-technical systems in

high risk environments where safety is a priority.

• Civil aviation

• Maritime (Aircraft carrier operations)

• Off-shore

• Health care

Resilience Engineering (2006)

•Resilience Engineering is a multi-disciplinary, theoretical

approach for designing and managing complex, dynamic-

adaptive socio-technical systems, and has become

recognized as an alternative to traditional approaches to

safety management (Hollnagel, Braithwaite & Wears,

2013).

Key concepts• Systems understanding

• Complexity/bounded rationality

• Dynamic-adaptive behaviour

• Performance improvements• Resilience

• Single vs. Double-loop learning (Safety I vs. Safety II)

• Mindfulness (sensemaking)

• Culture (Just Culture)

• System inertia• Quality (continual improvement vs. adaptation)

• Control-based management (Rules, regulations, procedures, processes, targets, etc.)

• Compliance

Research problem

•There currently exists an organizational mismatch

between creating a supportive environment to promote

“resilient traits or qualities” and management

(leadership) mechanisms.

• Lack of understanding of complex, dynamic-adaptive behavior

in socio-technical systems.

• Control-based management mechanisms.

• Reliance on rules, regulations, procedures, compliance, etc.

• Gaps.

Improvement through resilience

•Resilience – the ability of a system to absorb stress and

handle unexpected/unplanned changes in the environment

without collapsing/failing.

•Ability to learn from success vice «trial and error

learning».

•To detect changes through mindfulness/sensemaking.

•Ability to adapt to changes in the system «on the fly».

• Flexibility to deviate when appropriate (without fear).

Research questions

•What do leaders need to understand about the

nature of complex, dynamic-adaptive socio-

technical systems to create a resilient

organization to improve safety performance?

•What leadership styles are best suited to promote

resilient behavior on both the structural and

individual levels?

Organizational leadership

• Theory X/Theory Y

• Transactional/transformational/charismatic leadership

• Leader Member Exchange (LMX)

• Shared/Distributed/Collective leadership

• Self/Super leadership

• Authentic leadership

• Adaptive leadership

• Entrepreneurial leadership

• Ethical leadership

Clinical microsystems (Health care)

•Micro system - small, organized groups of providers and

staff caring for a defined population of patients

• Emergency rooms, trauma centers, primary care clinics,

neonatal intensive care units, renal dialysis units,

diabetes care clinics, etc. (Mohr & Batalden, 2002).

•Meso system

•Macro system

•Global system

Leadership

Style

Attitudes

Self-efficacy

Ownership

Commitment

Satisfaction

Empowerment

Social capital

Resilient

behaviorsSafety

performance

Culture? Individual

traits

Conceptual model

Sabbatical

• 16 Jun 2016 – Helse Vest & Haukeland sykehus

• 15-17 Aug 2016 – Resilient Health Care Net workshop –

Middelfart, Denmark.

•Aug 2016 – Focus group meeting Helse Vest/Haukeland

• 12-16 Sep 2016 Jacksonville, Fla

• 18-31 Oct 2016 Michigan State University/Ohio State

University/Buffalo, New York

•Dec 2016 Sydney, Australia

Resilience literature

• Resilience Engineering: Concepts and Precepts (Hollnagel, Woods & Leveson,

2006)

• Resilience Engineering Perspectives, Vol. 1 (Hollnagel, Nemeth & Dekker, 2008).

• Resilience Engineering in Practice: A guidebook (Hollnagel, Pariès, Woods &

Wreathall, 2011).

• Resilient Health Care Vol. 1 (Hollnagel, Braithwaite & Wears, 2013).

• Safety-I and Safety-II (Hollnagel, 2014).

• Resilient Health Care Vol. 2 (Wears, Hollnagel, & Braithwaite, 2015).