Руководителям здравоохранения необходимо научиться управлять накопленной сложностью систем

The Complexity Challenge Healthcare has never been simple, nor should it be. Our work requires us to navigate evolving science and technologies, diverse patient needs, regulatory oversight, workforce challenges and financial pressures. Complexity is a natural consequence of the mission we serve. The challenge for healthcare leaders today is not complexity itself. It is managing the growing accumulation of complexity that can make it harder for patients to receive care and for caregivers to provide it. Over time, healthcare organizations have built impressive capabilities in quality improvement, patient safety, care coordination, compliance, technology and performance management. Each advancement was designed to improve outcomes and strengthen accountability. Yet complexity is cumulative. New requirements are often added while few are removed. Processes, reports, committees, approvals and decision pathways multiply. What begins as a thoughtful response to a problem can eventually create barriers to getting work done. The question is not whether healthcare should be complex. It will be. The question is whether we are shaping complexity or allowing it to shape us. Complexity as a Leadership Discipline A new challenge for today’s leaders is being able to distinguish the impact of both the external and internal complexities of our ever-changing landscape. External complexity arises from factors largely outside an organization’s control: patient needs, clinical variation, regulatory requirements, reimbursement models and changing community expectations. This complexity is inherent to healthcare and necessary to achieving our mission. Internal complexity is different. It is created by how organizations respond to those external demands. It can appear as duplicative documentation, excessive approvals, overlapping committees, redundant reporting or processes that have outlived their original purpose. Leaders cannot eliminate external complexity. They can, however, determine how much internal complexity they add as a response. Research increasingly shows that complexity affects patients as well as caregivers. A 2025 review published in Health Affairs Scholar highlighted the administrative burdens patients face as they navigate appointments, insurance requirements, communications and other aspects of receiving care. Complexity is often experienced most directly by the people we serve. Research also suggests organizations may unintentionally contribute to that burden. A recent study published in The Permanente Journal found significant variation in how healthcare organizations interpret and operationalize regulatory requirements, creating additional work for physicians and care teams. These findings reinforce an important leadership lesson: Not all complexity originates outside the organization. Some of it is created by the systems and processes we build ourselves. The Leadership Opportunity Effective leadership within organizations requires more than addition. It requires disciplined focus with a willingness to subtract, not add, to the work. Practicing simplicity is an often-neglected leadership discipline. Leaders within organizations should routinely ask: - Does this process still serve its intended outcome? - Are we measuring what matters most? - Are our governance structures helping decisions move faster or slowing them down? - What burden do our systems create for patients, clinicians and other members of the workforce? - What can we stop doing? The last question may be the most important. Without intentional efforts to retire outdated practices, organizations can accumulate complexity faster than they create value. Healthcare will always be complex. The goal is not to eliminate complexity, but to ensure it remains in service of the mission. Leaders can begin by embracing several principles: - Listen to the front line. Those doing the work often recognize unnecessary obstacles before leaders do. - Distinguish between external and internal complexity. Focus energy on reducing the burdens that organizations control. - Institutionalize simplification. Regularly review policies, procedures and processes to determine what can be eliminated, consolidated or streamlined. - Recognize that simplicity and excellence are not competing goals. High-performing organizations maintain rigorous standards while reducing unnecessary obstacles. Healthcare’s future will demand adaptability, innovation and resilience. Achieving that future will require leaders to view complexity management not as an operational exercise, but as a core leadership discipline. The healthcare leaders who succeed will be those who can distinguish between the complexity required to fulfill the mission and the complexity that has simply accumulated over time—and who act to simplify accordingly.  Deborah J. Bowen, FACHE, CAE, is president and CEO of the American College of Healthcare Executives ([email protected]).