Cynefin - or what sort of problem is it?

I would not give a fig for the simplicity this side of complexity, but I would give my life for the simplicity on the other side of complexity.

 - Oliver Wendell Holmes

This month, the national news covered the treatment of a child at Great Ormond Street with an intractable bacterial infection using a highly novel bacteriophage infusion. As a non-expert it seemed an amazing feat and like many, I hope it offers some optimism in the worrying sphere of antimicrobial resistance. Irrespective of its potential, such a new therapeutic approach is an example of the remarkable and relentless ability of the medical and scientific communities to address complicated problems. Medical research has moved over my career to a highly organised, highly professional industry delivering immeasurable benefits. In parallel, the clinical community has excelled in applying complicated procedures and therapies safely for patients thereby turning pioneering approaches into routine. This works well for complicated problems, but we are increasingly facing challenges which are complex, not complicated and these require a different mindset. We have to ask ourselves how well prepared we are for this shift?

The growth in complex problems does not mean that simple and complicated problems have disappeared. The point is that each requires a different approach and, therefore, the modern leader needs a good theoretical understanding to select the most appropriate strategy. Snowden’s Cynefin conceptual framework[1]  published in 1999 brings clarity to these distinctions and helps to define the necessary approaches while emphasising the dangers of misunderstanding the nature of the challenge.

Cynefin divides contexts into predictable and unpredictable with the former further divided into obvious (simple) and complicated. Training with experience makes seasoned clinicians excellent at manging the complicated and delegating the obvious. Complicated problems require a high level of expertise and judgement, not vested in the non-specialist, to ‘figure it out’. That process boils down to sensing the nature of the problem, expert analysis and judgement to determine the appropriate response. Bone marrow and liver transplantation are good clinical examples of ‘complicated’.

Both are very clever, very intricate, but experts know how to do them and understand cause and effect and complications – in short, they are predictable, complicated Cynefin systems.

Complex challenges sit in the ‘unpredictable’ half of Snowden’s framework. Complex problems have no well tried and tested solution, cause and effect can only be determined in hindsight and resolution cannot be resolved by a single expert or expert team. A collaborative approach is required and as there is little precedent, experimentation with regular review is required. Even then, it has to be accepted that the ideal solution cannot be guaranteed. Take obesity as an example – it has neither a simple nor a complicated solution. It requires the collective effort and brains of many disciplines within health but also with agencies outside health such as the food industry and education and even then, success is not guaranteed. As if this were not enough of a challenge, those attempting to address the problem are not helped by the daily diet (excuse the pun) of simple solutions from those who fail to understand complexity!

I have emphasised before the value that the action logic approach brings to leadership and the seminal work of David Rooke and others[2] . Leading through complexity requires higher level action logics – at a minimum individualist and ideally strategist whereas, globally, the evidence demonstrates that a large majority of the adult population resides below at expert or achiever. The good news is that appropriately tailored development can help individuals to develop beyond the expert and achiever levels and the new flagship FMLM programme Tomorrow's Strategic Leader has done just that.

Designed and delivered in 2018/19 by FMLM with strong support from the Royal College of Surgeons of England, the Dinwoodie Charitable Company and the Royal College of Anaesthetists, 14 highly committed emerging leaders from a range of disciplines (and most shortly before or after CCT) embarked on Tomorrow’s Strategic Leader, a 15-month leadership development programme. The 14 participants’ action logics were measured at the start of the programme and again twelve months later and the results showed a significant, positive qualitative and quantitative (average 10%) shift in leadership ability. The inference is clear, the commitment of this pilot cohort has rewarded them with greater ability to lead in the increasingly complex environment of contemporary healthcare. This is an exciting finding and we plan to research further to understand the specifics of what helps to bring about this shift and understand more about the differential attainment. We are confident that this approach has much to offer and are about to launch the second Tomorrow's Strategic Leader programme, so watch this space!

[1] Snowden, D. (2010) The Cynefin Framework. Available at: https://www.youtube.com/watch?v=N7oz366X0-8

[2] Rooke, D. (2018) “Transformational leadership capabilities for medical leaders”, BMJ Leader; 2:3-6. 

Rooke, D. and Torbert, W. (2005) “Seven transformations of leadership”, Harvard Business Review, April.