Globalization is a process changing the nature of human interaction across many spheres, economic, political, social, environmental. As borders across geography drop and lower, there is less isolation and more sharing of wealth, ideas, information and trust. As a result, there tends to be less inequality and inequity and more security in the systems that are designed. Consequently, there is a force and direction for change of sick care towards more health and wellness; from hierarchical structures to hybrid social networks….

From acute illness focus to community based chronic condition management… from solving discrete problems to managing polarity and complexity of change dilemmas… and from managing resources to asset mapping of value-added outcomes. When we examine continuity, we must look beyond locations of acute care to recovering, long term care TO the interacting factors causing chronic illness, risk and vulnerability such as: behavioral, biomedical, social-spiritual, environmental and political-legal factors. Examining such systems requires continual feedback and benchmarking about similar patients, collaborative, innovative and diverse problem solving, and aggregate and individual patient data of outcomes… from Evidence Based Practice (EBP) to Practice Based Evidence (PBE).

Complex adaptive systems allow us to move from a positional control to a decisional control. From one of hierarchical, reductionist, vertical and directiveness to one that is relational, wholistic, user driven and value-centric. Innovation is always driven from the point of the “real power” which is the point of service, the bedside, the individual patient-provider interaction. Thus, the leader’s role is to create alignment between personal and organizational goals, which requires engagement and personal ownership with mutually advantageous goals and gains. It requires differences and dialogue which are necessary for sustainable human interaction. Innovation leads to an irreversible change in the way we do things with both creative destruction and discomfort. It leads to transformation that nurtures both the individual and the group to co-design better patient centered outcomes.