LEAD 6021 Module 3 Leadership Principles Applied to a Case Example

Ninety-Eight Percent Completion, No Change at the Bedside: Applying Complexity Leadership to a Sepsis Alert Rollout and the Two Units That Solved It Themselves

Student Name

American College of Education

LEAD6021: Leadership Seminar

Module 3 Assignment

Instructor Name

October 26, 2026

Introduction

Last spring my composite Michigan community hospital added a sepsis early-warning alert to its electronic health record. When a patient's vital signs and laboratory values met screening criteria, the nurse's screen displayed an alert and asked for a bedside assessment and a call to the provider within 30 minutes. My department built and delivered the required training. By every measure we controlled, the rollout succeeded; by the measure that mattered, it did not. This paper uses complexity leadership theory to explain what happened and what leadership the situation actually required.

The Case

My department produced a 25-minute online module and a one-page reference card. Within six weeks, 98% of 900 nurses had completed the module. Three months after launch, however, the quality department's audit found that nurses documented the required assessment within 30 minutes for only 41% of alerts, about the same as the screening compliance before the alert existed. Nurses told auditors that the alert fired too often, that many alerts concerned patients they were already watching and that the call to the provider felt redundant when the provider had seen the same values.

Two medical units were exceptions, with compliance above 80%. On both, charge nurses had begun gathering staff for two minutes as each shift opened, reading off the patients flagged by the alert since the day before and settling who would go back and check each one. Nobody in my department or in nursing administration had designed that huddle; staff invented it.

The Theory

Uhl-Bien et al. (2007) proposed complexity leadership theory for organizations whose main work depends on knowledge and adaptation. They described three entangled leadership functions. Administrative leadership covers the official machinery: plans, schedules, policies and the assignment of tasks. Adaptive leadership is an emergent, informal dynamic in which people interacting across the organization generate new solutions. Enabling leadership sits between the two, clearing room for adaptive work and brokering the friction when new practices rub against official procedures.

The theory rests on the idea that organizations behave as complex adaptive systems. Plsek and Greenhalgh (2001) argued that health care fits this description: its many actors, from nurses to pharmacists to patients, can each choose how to act, no plan can fully forecast what they will do, and whatever one of them does reshapes the ground under the rest. In such systems, they argued, a few simple rules and minimum specifications often work better than detailed plans imposed from above.

Administrative Leadership: What My Department Did

Our training was administrative leadership done well. It defined the task, standardized the message, tracked completion and reported 98% to the chief nursing officer. Administrative leadership is necessary; the hospital needed a policy and every nurse needed to know what the alert meant. But completion rates measure the reach of a message, not a change in practice, and the problem nurses faced was not a lack of information. They knew what the alert asked of them. What they lacked was a workable way to fit 30-minute reassessments into a shift where alerts arrived in clusters and often duplicated what they were already doing.

Adaptive Leadership: What the Two Units Did

The shift huddle on the two medical units is adaptive leadership in the theory's sense. It emerged from interaction among charge nurses and staff, solved a problem the formal plan had not anticipated and spread informally from one unit to the next when a charge nurse who worked on both units carried it with her. It also changed the meaning of the alert: instead of an interruption to one nurse, it became a shared list the team reviewed together. No one held formal authority for the huddle, which is exactly why the formal system did not see it. Asked why she had begun it, one charge nurse told me the alerts had become noise and the huddle turned the noise back into a list.

Enabling Leadership: What Was Missing

Between the administrative training and the adaptive huddle, the missing function was enabling leadership. No one connected the two units' solution to the rest of the hospital, no one fed staff complaints about alert frequency back to the informatics team and no one created space for other units to test their own versions. Weberg (2012) argued that health care organizations are held back by leader-centered, linear practices and that complexity leadership, which treats leadership as an ongoing process of collaboration and systems thinking, holds promise for both cost and quality. My department behaved in the linear way: design, deliver, measure completion, move on.

Why We Missed It

It is worth asking why a department devoted to education did not see the adaptive solution until the audit forced the question. Part of the answer is what we measured. Completion rates arrive automatically from the learning system; bedside compliance had to be requested from another department, and we never asked for it. Part of the answer is how we defined our job. We saw ourselves as the people who teach what the hospital decides, which made staff inventions invisible to us unless someone reported them. And part of it is time pressure: the alert's launch date was fixed by the vendor contract, so the training was built to meet a deadline rather than to fit the way nurses actually work. None of these reasons is unusual, and each is a habit of administrative leadership that crowds out the other two functions when no one is watching for them.

What Enabling Leadership Would Look Like

Applying the theory suggests four actions, and my department has begun them. First, we invited the two units' charge nurses to describe their huddle at the nursing leadership council, presented as their work rather than ours. Second, instead of a new mandatory module, we offered a minimum specification, following Plsek and Greenhalgh (2001): every unit agrees once per shift on who will reassess alerted patients, and each unit decides how. Third, we collected nurses' examples of redundant alerts and brought them to the informatics committee, which has since tightened one screening criterion. Fourth, we now track bedside compliance by unit every month and share it with charge nurses, not only with administrators.

Early Results and Limits

Four months after these changes, seven of twelve inpatient units have adopted some version of a shift review, and hospital-wide documented reassessment within 30 minutes has risen to 63%. The improvement cannot be attributed to any single action, and the tightened alert criterion alone may account for part of it by reducing redundant alerts. Complexity leadership theory is also difficult to test directly; it explains this case well in hindsight, which is a weaker claim than predicting it. The next audit will compare units that adopted a shift review with those that did not, which is the closest test the hospital can run.

Conclusion

The sepsis alert rollout showed my department doing one leadership function well and missing the others. Administrative leadership delivered a message to 900 nurses; adaptive leadership on two units solved the real problem; and the enabling leadership that would have linked them was absent until we looked for it. For a professional development department, the lesson is uncomfortable but useful: our most important work may be noticing and spreading what staff invent, not only teaching what administrators decide.

References

Plsek, P. E., & Greenhalgh, T. (2001). The challenge of complexity in health care. BMJ, 323(7313), 625-628. https://doi.org/10.1136/bmj.323.7313.625

Uhl-Bien, M., Marion, R., & McKelvey, B. (2007). Complexity leadership theory: Shifting leadership from the industrial age to the knowledge era. The Leadership Quarterly, 18(4), 298-318. https://doi.org/10.1016/j.leaqua.2007.04.002

Weberg, D. (2012). Complexity leadership: A healthcare imperative. Nursing Forum, 47(4), 268-277. https://doi.org/10.1111/j.1744-6198.2012.00276.x