No one doubts that health care is becoming increasingly complex. Across all components of the delivery system and to every level of service, the intensity and number of relationships and interactions across the health care continuum have expanded exponentially. While this understanding is now universally accepted, there are many challenges associated with understanding its impact and ensuring the growing degree of efficiency, effectiveness, and efficacy in the appropriate delivery of health care. This growing level of complexity creates challenges to existing health care leadership since most of us were grounded, both by education and by experience, in the functional and linear context of industrial age medicine. The notion that the fundamentals of our learning and practice have now radically shifted into an emerging new context exemplified by multifocal, nonlinear, relationship-based, evidence-grounded, and value-based service constructs is, at times, overwhelming to contemporary leaders.
The issue for most leaders is how to translate these significant transformations in our understanding of sustainable health service. Ultimately, leadership must be able to take these emerging complexity-based concepts and make them work in the practice environment. Adding a degree of difficulty is the fact that translation and application often must unfold at the same time as we deepen our understanding of the implications of complexity concepts on the practice environment and action. Increasing the complexity of translation and application is the fact that no template exists currently that can adequately serve as a framework or map that can guide action. Most contemporary health care leaders must write the script as they live it, experimenting, risking, innovating, and changing existing models, testing and evaluating in process. The hope is that leaders will document their experiments and experiences in creating strategies as they become complex adaptive and responsive health systems, and through such sharing, models can emerge that are both effective and replicable.
This issue provides a broad cross section of articles from a variety of authors who are in the midst of their own discernment and adaptation to newer realities and emerging complexities in health care. Each of our authors addresses a different and unique element of contemporary challenges and opportunity in health system design, structure, and delivery. Also, implications for nurses and other practitioners in a transdisciplinary perspective are represented in this issue, and the special focus of our "on-the-scene" authors lend some new insights on transforming health service delivery within a large complex health system.
Increasingly, leaders must understand that much of the leadership capacity gained in traditional leadership programs emphasizing styles, behaviors, and transformational skill sets is inadequate to the contemporary environment and complexity models of service delivery unfolding under the auspices of the Patient Protection and Affordable Care Act. The inexorable movement to value-based service and payment, accountable care approaches, implementing the triple aim (price, quality, and service excellence), must all converge to move the health care delivery system to a stronger primary care foundation and more effective health-driven script for service and care.
Of course, while not always as clearly and broadly acknowledged as it should be, nursing will form the centerpiece of these major reforms. Nursing will provide leadership in coordinating, integrating, and facilitating clinical systems, operations, and practices. These will be essential to ensure that the products of reform, strong primary and preventive care, an effective and high-quality continuum of clinical services, and the net aggregate increase in our nation's health status, can be both achieved and sustained. It is to this end we hope this issue will contribute. It is our hope that as we continue to grow, collect, and aggregate experience and evidence of successful approaches to advancing our nation's health, we will serve to contribute to a growing body of knowledge that reinforces nursing's critical centrality to the health of our nation evidenced in our capacity to demonstrate successful models of sustainable health.
-Tim Porter-O'Grady, DM, EdD, APRN,
FAAN, FACCWS
Guest Editor