Adaptive leadership and the practice of medicine: a complexity-based approach to reframing the doctor-patient relationship.

RATIONALE, AIMS AND OBJECTIVES This paper applies the concepts of 'adaptive leadership', as developed by Ron Heifetz, MD, to the practice of medicine. METHODS Literature review and theory development. RESULTS Patients are complex adaptive systems facing both adaptive and technical health challenges. Technical health challenges are amenable to the simple or complicated expert-mediated technical interventions that are common in modern medicine, but complex adaptive challenges can only be addressed by patients doing the adaptive work to learn new attitudes, beliefs and behaviours. In medicine, we often make the mistake of offering technical interventions in lieu of supporting patients' adaptive work. This error can result in poor clinical outcomes and wasted resources. Expecting simple or complicated technical 'solutions' to resolve complex adaptive health challenges is a failure of adaptive leadership and violates Ashby's law of requisite variety. Adaptive leadership behaviours correspond to and complement doctor practices that have been shown to improve health outcomes and doctor-patient communication. CONCLUSIONS Adopting an adaptive leadership framework in the practice of medicine will require adaptive work on our part, but it promises to improve the doctor-patient relationship, increase our effectiveness as healers and reduce unnecessary health care utilization.

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