We are deepening our understanding of the operation of a complex world and the structures and processes that demonstrate its interactions. The introduction in the United States of concepts associated with complex adaptive systems has radically changed our understanding of human dynamics and the organizations and structures that support and advance them. Traditional industrial and linear notions of structure, culture, and leadership have essentially been eclipsed by the deeper richness of the levels of understanding of how people live, relate, interact, and work in highly complex systems.

As a result of this deeper understanding gleaned from the translation of complex adaptive systems into human organizations and relationships, much conflict and confusion with traditional structures and approaches to aligning, understanding, and applying developed processes to human dynamics have emerged in our traditional organizational constructs. The architecture, structure of work, characteristics of interaction, management and leadership capacities, and relational dynamics that developed over the full course of the 20th century have become less relevant and viable, and increasingly lacking in effectiveness. The more linear two-dimensional, vertical, hierarchical models and mechanisms of structuring work and relationships that were developed throughout the 20th century have become nonrelevant in a 21st-century social context.

The growing digital reality that increasingly defines and influences contemporary human experience has substantially changed the rules of the game with regard to human dynamics, interaction, and work. In the industrial age, models of work were fixed, finite, functional, and institutional. Twenty-first–century work and workplaces are characterized by structures and processes that are more fluid, flexible, focused, portable, and mobile. The portability and mobility of human life, relationships, interactions, and dynamics have altered our understanding of the operation of systems structures, processes, relationships, and leadership. This deepening understanding of the complexity that characterizes life at both the universal and subatomic levels has redefined the parameters within which human interaction unfolds and progresses.

Our understanding of complex adaptive systems leads us to raise questions about our ability to predict and adapt these forces for good use and their implications and actions in human dynamics and on human organization and work. Our awareness is now informed by such wide-ranging complexity characteristics as follows:

All of these characteristics, elements, and forces are acting constantly and consistently and are reflected in human experience and call us as leaders to a deeper understanding of their actions and operations as we more clearly develop mechanisms for engaging environmental dynamism, transformation, change, innovation, and leadership. Whatever approaches are undertaken by organizational leaders must now reflect the clear and abiding understanding of the normative action of these universal forces operating as both the backdrop of human action and the context that gives such action impetus, clarity, understanding, and veracity.

Societal and professional leaders must now make, as a part of their work obligations, the translation of these emerging realities into mechanisms, toolsets, and frames of reference that guide those we lead. This leadership must be expressed in ways that help those we lead reflect on their own responses and patterns of behavior and have a deeper understanding of the forces that can both enable or disable their best efforts. This is especially true as health professionals are challenged with fundamentally transforming the health care system that clearly represents the same many characteristics of complexity, and demands our deepening understanding of health care professionals’ actions and influences on the relevance and effectiveness of the health system. In addition to the growing translation of the attributes of complexity to health care are the political and economic challenges codified in the Patient Protection and Affordable Care Act of 2010 (PPACA), which represents a substantive recalibration from a volume-based economic and delivery model for American health care to one that is grounded in a value-based, effectiveness-delineated health script attempting to advance the nation’s health and provide a level of universal access.

Traditional and historic industrial-grounded approaches to transforming American health care simply can’t succeed. Much of the historic industrial and linear thinking and models are no longer relevant, neither to the times nor the demand. Furthermore, the firmly entrenched digital infrastructure of social and human experience with all of its implications now demands entirely fresh thinking, innovations, and models disciplined by experimentation and testing in a wide variety of social and systems approaches.

Clearly, it is leaders who must understand this sea change within the health system in the broader social culture. Leaders must suspend attachment to traditional grounding in their leadership learning and experience and become increasingly available to approaches that may at first appear counterintuitive and even uncomfortable. Traditional attachment to historic transactional and even transformational models developed within an industrial/postindustrial paradigm must be suspended in a way that increases availability to a richer level of understanding of complexity leadership and its application to the challenges of the time.

This textbook serves as both a challenge and a bridge to nursing and health care leaders as they grapple with the need for changing structures, approaches, and skills necessary to support sustainable health transformation. Practice frequently changes; principle rarely does. The foundational and sustainable principles in caring so central to the nurse’s role do not themselves change, yet, the expression of caring and its applications are necessarily constantly refined and altered to reflect the contemporary character of their expression. With all of the necessary incorporation, translation, and application of complex adaptive systems to health care, there is a strong need for a principle-based, theoretically grounded set of tools for transforming the culture of care in contemporary health care systems. There is a crying need for translational and practical strategies for living the shift to value-grounded caring throughout the health care system. While our understanding of systems and applications may be more deeply evolving, along with it comes a greater demand for intentional reflection and articulation of the living of caring values that sustains the focus on essential human relatedness and the need for refining and developing the enterprise in a way that demonstrates value for caring by translating it within a complex adaptive frame. Engaging stakeholders in the essential partnerships for caring creates both the urge and the obligation to align the contemporary complex culture with the principles and patterns of human caring that will both hominize it and sustain it. To do so creates a culture responsive to the environmental demands and shifts of the time, the converging forces of a complex adaptive milieu, and a community of careers guided by principles and practices that reflect the unique health needs of individuals and the collective sustainable health requisites of the human community.

The authors’ approach to creating a transforming culture through use of foundations laid in the theoretical development of Nursing as Caring offers a solid foundation upon which to recalibrate and reconfigure toward a caring organizational health system. The use of the Dance of Caring Persons, grounded in value-based principles, serves as an effective vehicle for guiding and refining organizational and human systems in a way that grounds the further work of transforming health care systems in sustaining values of caring. While many of the beliefs, elements, and attitudes in the Dance of Caring Persons will need continuous further refinement as they are translated into complex adaptive systems, the fact that the approach requires the engagement of all organizational constituencies in the process of care transformation ensures continuing relevance and adaptation.

The increasing recognition and intentional articulation of the core values of respect for persons and sincere appreciation for the community of contribution of all participants in the health care systems’ effectiveness are essential. This work will need collaboration from patients, families, nurses, physicians, and other health professionals, as well as administrators and managers in conjunction with the systems and models within which they operate as an essential construct for a sustaining transformation. Grounding that transformation in values and principles of caring ensures that the system and approaches will be open and responsive and that the essential elements of care will remain at the core of the collective conversation of service transformation. How systems respond to environmental changes and economic and resource challenges associated with human action, and how personal and collective human caring responses are calibrated, are addressed and will help maintain the caring-centric focus of both human design and response. In this way the authors and those who respond to their work will demonstrate the fundamental and essential core of our human existence and sustenance—the continuing capacity to love and care for each other.