Telemedicine and Complex Systems: Leadership in Healthcare Transformation

Introduction: Telemedicine as Transformative Practice

One of the most profound changes I have experienced in my nursing practice is the implementation of remote digitally supported medicine, commonly referred to as telemedicine. Although the changes that support the eventual universal application of telemedicine have occurred in bits and pieces, taken together, these changes have the potential to transform medical practice. Already, hospitals are equipped to let parents of premature or acutely ill babies observe their infants and the care that they receive from their own homes at all hours of the day and night. This enables the parents and practitioners to engage in close communication about the infant's care and to establish trust to reduce parental anxiety and induce confidence in the provision of care.

Telemonitoring also fosters high levels of adherence to medication and health regimens by using mobile phone technology to communicate via text messages. This version of telemedicine increases the quality of care that patients living in remote areas can receive and also reduces the cost of care by reducing the frequency of trips to centralized medical facilities. These practical applications demonstrate that telemedicine is not merely a theoretical advance but a present reality reshaping how healthcare is delivered.

Disruptive Technology and Emergence in Medicine

Digital mobile devices and the platforms on which they operate have been described as disruptive technology because they disrupted the existing technological systems and practices. In their study of complexity, Snowden and Boone (2007) argue that in a dynamic system, "the whole is greater than the sum of its parts, and solutions can't be imposed, rather, they arise from the circumstances" (p. 3). This phenomenon, called emergence, is what made it possible for physicians to utilize videotelephony to communicate with parents of premature babies while providing care in the newborn intensive care units (NICU).

As a leader in nursing, I believe it is crucial to remember this point made by Snowden and Boone (2007): "best practice is, by definition, past practice...since hindsight no longer leads to foresight after a shift in context, a corresponding change in management style may be called for" (p. 4). In complex contexts, best practices may not hold solutions as they reference backward and are not forward-facing. This adage is fundamental to financial investing and seems to warrant greater consideration for science and technology. While patterns are important, they can—as we have learned through chaos theory—shift radically through unseen or unanticipated stimuli that may, initially at least, be considered too remote to be influential (Stacey, 2010).

Complexity Frameworks and Leadership Paradigms

Change in the medical sector requires not only disruptive technology but strategic and transformational leadership that moves the field forward. It is helpful to use the framework provided by Snowden and Boone (2007) in which three types of systems are considered: ordered systems, chaotic systems, and complex systems. Business people are accustomed to thinking about ordered systems, such as supply chains and production lines. Scientists are accustomed to thinking about chaotic systems in which constraints do not function or exist.

Yet, technological advances require leaders to think in terms of complex systems, which are a medley of other systems, perhaps some of which have not yet even been conceptualized. While this feels daunting, it is also freeing as it promotes creative, divergent thinking to dominate. And it is unconventional thinking that reveals and constructs new paradigms, which is precisely the foundation for complex, integrated technological advances like telemedicine in all its many versions.