Leadership in volatile, uncertain, complex and ambiguous times

By Dr. Tim Rutledge

The acronym “VUCA” was coined in the 1980s to describe conditions or situations that are characterized by volatility, uncertainty, complexity and ambiguity. Initially used in military education, it has taken root in literature on leadership and business strategy over the past two decades.

Formal training and 25 years of practice in emergency medicine have helped to prepare me for VUCA conditions. However, my first immersive experience with a fully VUCA environment was the SARS outbreak in 2003. During that time, I was the Chief of the Emergency Department and Chair of the Medical Advisory Committee at North York General Hospital, which was at the epicentre of the outbreak. It was the most intense period in my 35-year career in health care. Health care professionals scrambled as we tried to understand and contain this new, highly contagious and potentially deadly illness. Decisions were being made, then modified, sometimes hourly. New policies and protocols were developed in response to frequently changing directives from the Ministry of Health. The transformation of our care environments was surreal.

Many of the experiences, emotions and learnings from the SARS outbreak are indelibly etched in my mind. What helped get us through that unprecedented crisis was ample two-way communication, trust, courage, being true to our values, and focusing on what was most important – the respect we had for each other and our patients.

Health care in Canada is becoming an increasingly VUCA world with the convergence of a number of factors. Escalating costs, economic concerns, growth and aging all present urgent imperatives to find solutions to sustain our system. The expectations of patients and families are continually evolving with increasing consumer expectations and the democratization of medicine. Innovations, new technologies and advanced analytics are being developed at an exponential rate.

In Ontario, we are currently entering into the biggest health care system transformation in most of our careers, with the plan to dismantle Local Health Integration Networks and to create more local integrated delivery models referred to as Ontario Health Teams.

As the President and CEO of Unity Health Toronto, I have been involved with the integration of three Catholic hospitals: St. Joseph’s Health Centre, St. Michael’s Hospital and Providence Healthcare. A little over two years into our official integration, I’m sure our staff feel there are elements of VUCA to contend with as we grow together and align our priorities, policies and procedures to meet the challenges we face in health care today and into the future.

Good leadership is extremely important during VUCA times. Without it, organizations are at high risk. One tendency is to adopt a highly cautious approach. However, too much risk aversion in a VUCA environment can lead to organizations being left behind, and possibly even becoming irrelevant.

In VUCA conditions, people can become very anxious and unsure of what to do. It is important for leaders in these situations to communicate well with staff to help them make sense of what is going on. Meaningful engagement of staff in developing strategies to navigate challenges can build trust and lead to greater success. It is also essential in these times for organizations to be well grounded in their mission and values, and to be laser focused on their vision – the lighthouse across the stormy sea.

It is worthwhile breaking down VUCA into its components. VUCA conflates four types of challenges that can call for distinct approaches. As examples, volatility may require strategies to increase organizational resilience, uncertainly often calls for gathering lots of information, and complexity and ambiguity can be approached with hypothesis generation and testing, for example, with Plan-Do-Study-Act cycles.

Above all, leaders should embrace VUCA conditions and look for the opportunities presented by them. They have a Darwinian nature in that they drive innovation. Those that are able to thoughtfully and skillfully navigate VUCA storms will succeed, be stronger, and even thrive.

As we enter into a VUCA world in health care in Ontario, I’m excited about the future. We have recently launched our strategic plan at Unity Health Toronto. Well aligned with the province’s plan for health care transformation, our vision statement is: The Best Care Experiences. Created Together. Grounded in the meaning and purpose in our work, we look forward to collaborating with our system partners, breaking down silos in our system, learning from leaders in other sectors, and partnering with those we serve – our patients, families and our communities. Together we will embrace the challenges ahead and create a better, more integrated and sustainable health care system.

Dr. Tim Rutledge is the President and CEO of Unity Health Toronto, the Catholic health network consisting of St. Joseph’s Health Centre, St. Michael’s Hospital and Providence Healthcare