Sandra has been the clinical manager in critical care for 10 years. She has noticed that there has been an increasing level of changes in technology and clinical practice in the past 5 years. This new technology has created a different way of treating patients and has called clinical providers to adjust the way in which they deliver care for those patients. Because of the new technology, patients who are more seriously ill are now receiving higher levels of complex and intense care. At the same time, the demand to reduce the length of stay has accelerated as costs have increased and the revenue margin has tightened. Staff have been reasonably responsive to the demand for change. However, there is a large number of staff members who are finding it difficult to let go of past practices and patterns of clinical behavior. At the same time, there is a large number of staff members who are eager to embrace the challenges of new practices and to incorporate them more quickly on the service. Sandra notes that this diversity of behavior is present in the medical staff as well. Shes finding it hard to determine whether she needs to take a decisive lead and direct the staff to address these new changes or if she should take the additional time required to engage them in dialogue and group process so that together they might determine the best methods of action. Time is of the essence, yet all must be involved. A group of the critical care staff has been meeting informally over lunch to talk about some of the issues in the service and to discuss matters of concern with regard to changing practice and new patient care demands. They have come up with many creative suggestions and are eager to begin implementing them as soon as possible. Sandra appreciates their contribution but is beginning to feel as though shes losing control and now is no longer the source of providing direction in her department. Administration, using a future-search approach, has developed a new strategic plan and set of goals and objectives for the health system. Each department has fully participated in the development of the strategic process and now must begin to incorporate the strategic goals into the operation and activity of the department. Every department must give evidence of advancing the strategic goals of the organization, a part of which is departmental competition for advancing quality and service excellence. Sandra must begin to build this initiative in her department. She is feeling challenged and is unsure how to manage all of this work and still implement new sets of priorities and actions in her department.

1: Using quantum examples from the principles outlined in this chapter, review Sandras leadership case study and respond to the following questions that reflect leadership in a quantum age.

• What are three elements of complexity that can be identified in Sandras circumstances?
• Is there conflict or resonance between the organizations method of creating a vision and direction and Sandras obligations to do the same in her department?
• How certain does Sandra need to become about her issues and responses to them before she undertakes action?
• Does Sandra have issues around controlling information, the content of work, the distribution of power, and the management of personal and institutional anxiety?
• What are the paradoxes Sandra is now confronting in the course of providing clinical care and doing the business of the department?
• Sandra must act on multiple levels. What are those multiple circumstances and levels of action that must occur in order for the unit to continue to grow and to thrive?
• What is the emerging power of the informal system? Has the core group changed the dynamics of leadership and the movement of change?
• What is the relationship between the larger organization (larger, complex system) and the department (smaller complex system), and how is the tension and resonance between them now managed differently?
• What are the elements of competition and collaboration that are reflected in the departmental goals and staff activities?

(Case Study from Quantum Leadership 3rd Edition)