Background - VHA Inc., a nationwide alliance of over 1,850 hospitals and health care organizations, is dedicated to supporting efforts by its members to improve their performance and to advance the health of the communities and patients they serve. Among the many programs and services aimed at these objectives is a concentrated effort to uncover promising new leadership and health care delivery concepts. In this regard, VHA has been working intensively to introduce interested leaders from VHA organizations to the science of complexity and the profound implications of this emerging science for management, health care delivery and even our very conception of human organizations. This work is primarily accomplished through Complexity and Leadership Learning Networks comprised of senior executives, physician and nursing leaders. The first of four networks was organized in 1995, the most recent in 1998. It is anticipated that new networks will be formed as interest grows. Other vehicles include conferences, courses, and written educational and case study material disseminated to VHA members.

Learning Networks - Purpose - The overall purpose of the Learning Network approach is to advance the leadership and management of health care organizations and the provision of health and medical care. The Learning Network members pursue this aim together by:

• gaining a solid grounding in the science of complexity;
• exploring the implications of this emerging science for leadership, management and health care;
• identifying how complexity concepts and related methods can used to discover fresh approaches to real, challenging organizational issues faced by health care organizations and their leaders;
• stimulating and supporting the use of these new approaches in their organizations, putting the theory into action;
• learning from and sharing the results of their application efforts.

Network Membership - Membership on the Leadership Learning Networks is drawn primarily from VHA members organizations. The four Networks are comprised of a diverse mix of CEOs, physicians leaders, and nursing and other senior executives who have a record of progressive management thinking. The network members are intellectually curious, like to put new ideas into practice quickly, and are able to deal with the ambiguity associated with emerging concepts. Each network contains from 25 to 30 individuals. In many cases a VHA member organization is represented by two or three individuals.

Learning & Development Process - The following is the general approach taken by each Network to the work described above:

• Early Leadership Learning Network sessions focus on the basics of complexity. Subsequent sessions build on this base while devoting growing attention to the use of complexity concepts on important organizational issues. External faculty who are complexity scientists or prominent organizational theorists serve as resource partners in this learning process.
• As members gain confidence in their new complexity knowledge and begin to use "complexity thinking" in their work, the network becomes a place to bring challenging new ideas and seek counsel from other members and to share lessons learned.
• Membership on the Networks is kept relatively low so members come to know each other well and are comfortable sharing their questions, experiences, and difficulties with using complexity approaches in their organizations. The supportive environment which the groups create encourages risk taking, experimentation and working in open ways - all of which complexity science suggests.
• Each group meets approximately three times each year in 1 1/2 to 2 day working sessions. In 1998 we added the capability to work in online, electronic environments .
• Among the issues being addressed by the Networks are: how to effectively introduce complexity concepts and approaches in an organization; quality improvement; planning when the future is unknowable; building and leading health care systems; fostering more naturally adaptable and creative organizations; and community health care improvement. These topics are addressed by individual Networks and also by special task forces which are formed by members from all of the Networks with a special interest in a given issue.

Some Early Accomplishments - Among the early accomplishments of VHA’s Complexity and Leadership Initiative are:

• Growing interest among VHA member leaders evidenced by participation on Leadership Learning Networks and attendance at educational offerings
• Genuine working partnerships with some of the North America’s leading complexity scientists and organizational theorists
• Sponsorship of the first ever conference on complexity and health care in December, 1997
• Publication of several articles by VHA staff and members of the Leadership Learning Networks which are helping to bring a complexity perspective into management and health care
• Publication of Edgeware: Complexity Resources for Health Care Leaders - a field guide to help leaders disseminate and use complexity concepts in their organizations
• And most importantly, encouraging progress by members of the Leadership Learning Networks in using complexity perspectives and concepts to uncover and use fresh, promising approaches to challenging organizational issues
• Introduction of this website - Edgeplace

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