Leadership in Veterinary Medicine. Clive Elwood
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this book, I will refer to complexity and the leadership challenges this brings. It seems fair to cover some definitions at this point to contextualise this approach.
Complexity science has shed light on human organisations and how and why they form and develop. It is useful to consider the distinctions between simple, complicated, complex, and chaotic systems.
2.2.1 Simple
Easy to conceive and understand with linear cause and effect, such as the response of a snooker ball to being struck by another or following the recipe to bake a cake.
2.2.2 Complicated
Can be understood by breaking down and examining its individual parts. Can be re‐assembled from those parts. An analogue wristwatch, for example, is complicated but ultimately understandable.
2.2.3 Complex
Can only be understood holistically. Meaning is in the relationships and interactions, which are multiple and nonlinear (Snowden and Boone 2007). Complex systems are dynamic, unpredictable, and complexly stable (Marion and Uhl‐Bien 2001). They can be self‐organising around simple rules, e.g. flocks of birds in flight (Snowden and Boone 2007). Complexity is about ‘rich interconnectivity’ in that, ‘when things interact, they change one another in unexpected and irreversible ways’ (Uhl‐bien et al. 2017). Unlike complicated systems, complex systems cannot be divided back to unchanged parts (Levy 1993).
Our patients are complex systems and are in a state of constant disequilibrium that is managed by that process we know as homeostasis and where small deviations trigger feedback loops that can either create a return the old ‘stable’ state or, potentially, a whole new state (emergence). Deviation is allowed and, indeed, encouraged, and ‘failing small’ and reacting is far preferable to ‘failing big’ (Meadows and Wright 2009).
When thinking about human organisations that are complex systems, we must consider our ability to adapt roles and identities, knowledge of past responses, and our agency to change the system from within (Snowden and Boone 2007). Human healthcare systems have been categorised as complex and adaptive/responsive, and I believe the same argument can be readily made for the organisational world of veterinary professionals (Plsek and Greenhalgh 2001). Furthermore, these systems are open to influence and in relationship with the wider world. Rules of complex systems can be understood retrospectively but cannot be applied for the future when new patterns emerge. As Kierkegaard (1844) said, ‘Life must be understood backwards. But then one forgets the other principle: that it must be lived forwards’.
2.2.4 Chaotic
This is the realm of the turbulent, fast‐moving, and unknowable, where relationships are in constant flux. Only acting on this system and reducing some of the fluctuation can bring them into a more manageable and complex state (Snowden and Boone 2007).
2.2.5 Wicked problems
Wicked problems have the following characteristics (Periyakoil 2007; Cleland et al. 2018):
They are complex and unique.
They have innumerable causes associated with multiple, and shifting, social, cultural, and political environments.
Participants have different interpretations of the same issue, unpredictable behaviour, and a lack of agreement on desirable outcomes.
They are difficult to define and resolve and do not lend themselves to the traditional linear mode of problem solving.
The intricacies of understanding are typically retrospective.
Cause and effect, typically, are ‘distant in time and space’.
Solutions are not ‘right’ or ‘wrong’ but ‘good’ or ‘bad’.
A solution that simplifies the issue can move the problem elsewhere.
They cannot be managed without politics.
The Review Committee had the unenviable task of re‐designing the process for selecting the ‘best’ veterinary students. The representatives came from general and specialist practice, industry, charities, and academia, and all had a view of what was needed now. Some wanted the most academically able, and they all agreed that personal and relational characteristics were essential. They also recognised the need for a diverse intake. They knew that the decisions they made now would play out over the course of the next 30 years, and that the world would change over that time in ways they could not predict. A wicked problem, and a thankless task, indeed.
Contextualising the veterinary professions as sitting as part of complex, open, adaptive/responsive system and where many problems are wicked without ‘perfect solutions’ informs the approach to managing the realities, and challenges, of leadership in veterinary medicine.
2.3 What Is a Profession?
The early professions such as medicine and law arose as learned activities in the late Middle Ages and formal professions developed to allow a monopoly over a domain of practise (Adler et al. 2008). Generally speaking, professions are knowledge and/or skill‐based; entry is certified, e.g. by examination, and professional competencies must be maintained. This monopoly gives a right to charge for service and prohibits ‘lay’ persons from practising. With professional status comes an identity that develops before and after training, and a professional community to which we belong. Historically, professional membership has come with a high degree of trust and, generally, professions have been self‐regulating (this has, arguably, diluted as trust in the professions has diminished) and set their own standards of practise.
Morrell (2016) citing Lord Benson in a House of Lords debate in 1992, offers a list of the distinguishing characteristics of a profession:
Ensures fair and open competition, directs the behaviour of its members, sets adequate standards of entry‐level education and continuing competence
Sets ethical rules and professional standards that are higher than those established by the general law and are designed for the benefit of the public and not for private advantage.
Has a membership that is independent in thought and outlook but subordinates its private interests in favour of support for the governing body and observes its rules and standards.
Has disciplinary standards if its rules are not observed, or in the event of bad work.
Provides leadership.
At an institutional level, has an obligation to develop and disseminate a genuine body of knowledge and, at individual level, has the requirement to exercise judgement.
2.4 The History of the Veterinary Profession
Knowledge leadership in veterinary medicine can be traced centuries back, such as through the production of treatise in China c. 2500 BCE. Formally, the veterinary profession was begun through the leadership of Claude Bourgelat who founded Lyon Veterinary School and Alfort School in 1765. This was followed by establishment of the ‘London Veterinary College’ by Charles Vial de St. Bel (a graduate of Lyon) in 1791. The development of veterinary nursing as an independent profession in the United Kingdom continues with milestones such as with the first veterinary nurse to sit on Royal College of Veterinary Surgeons (RCVS) Council and, in 2012, development of a new Code of Professional Conduct including, for the first time, a declaration to be made by Registered Veterinary Nurses on professional registration.
Interactions between humans and animals are complex and multilayered (ranging from practical to psycho‐social to transpersonal)