Posted by: Tony Shannon | October 31, 2014

FAO Medical Leaders: Cynefin: A Leader’s Framework

 It’s become a complex world…an introduction to Complexity

In our last post on medical leadership we spoke of the need for a framework that aligns medical , management and technical disciplines towards the improved delivery of 21st Century Healthcare.. before we closed by introducing the Cynefin framework.

Before we get into the broad and valuable framework of Cynefin ( which looks at the world from 4 useful perspectives -from simple to complicated to complex to chaos) lets me delve initially into one that deserves particular mention in this exploration, i.e. complexity and the world of Complex Systems

As history has unfolded human civilisation has inexorably moved from a relatively simple hunter gatherer/agrigarian life towards the development of more complicated skills and expertise and we now find ourselves in the complex world of the 21st century.

The word complex is one that is bandied around all the time.. yet what does it mean to you? Have you heard of complex systems science? Well if not, you may be interested as while its relatively new, it’s already pretty useful.

The principles of complex systems..

A complex system is one that;

-is made up of many parts with

-has many interactions between its parts

-cannot be completely understood

-cannot be completely controlled.
…so rather than trying to understand and control the whole system you look for the simple patterns and simple rules that emerge from the system and you harness those then the rest of the system will self-organise…

Certainly from my perspective, that is a perfect description of one of  the places I’ve spent most of my career, i.e. an Emergency Department and I’m eternally grateful for being introduced to the subject by Dr Mark Smith of Washington Hospital Center ED.

Over time I realised that it was also a very good way to explain hospitals.. and local health economies .. and healthcare systems in general too!

Moving beyond clinical practice,  I ventured into further studies, then took on more Leadership and Management roles. Whereupon it was quickly apparent that many/most projects I was involved with fitted the same “Complex System” description. As has any of the management programmes I have been/am involved in. So it became clear to me that Complex Systems have a very good fit with Management science too.

Furthermore, as more of my work became involved with the Information Technology field, over time I began to understand most software quickly moves away from being complicated (its rarely simple) to being complex too, especially if issues of scalability and maintainability are examined. So yet again, I believe there is a good fit between complex systems science and the world of information technology/software engineering. If you would like an example of a complex system in the context of Information Technology… think Internet..

So though I’ve just mentioned 3 differing fields, I can explain that complex systems science applies to just about anything you can think of, from biology to mathematics, ecology to evolution, social science to economics, from military strategy to medicine.

If you have  an interest in that tiny taster in the subject of Complex Systems, I can recommend “Making Thinks Work” by Yaneer Bar Yam of the New England Complex Systems Institute as a very good introductory book on the subject.

That’s all very well.. but how does that fit with..?

For a time I was finding the principles of complex systems of interest and useful to my work while wondering how to reconcile these principles with the rest of my education and knowledge base. While I was wondering how to fit complexity into the rest of my thinking, I got some very useful help from Kate Silvester, a fellow medical doctor who introduced me to looking at complexity within the broader Cynefin framework.

Thankfully this framework is a relatively simple yet effective way to reconcile many of the challenges in the modern world. While it has emerged from the leading work of Dave Snowden from the knowledge management industry I believe it has very widespread applicability. Within this field there are a number of related and valuable schools of thought including work by Ralph Stacey (Agreement & Certainty Matrix) and adaptations by Brenda Zimmerman et al (Edgeware).

Very briefly the Cynefin framework explains the world across 4 key states, from simple to complicated to complex to chaos. Thankfully I find this framework a relatively simple yet effective way to reconcile many of the challenges in the modern world. I hope in spreading the word, this just might help you too…

Chaos-Complex-Complicated-Simple and the Cynefin Framework

After a formal education in medical school, I was armed with the related medical vocabulary. Yet that language is very different to that used by the management and software engineering folk I now work with.

Understanding the differences and commonality in languages and mental frameworks between disciplines is in many ways key to tackling multidisciplinary challenges (e.g. Healthcare reform) today. In the modern world differing folk with differing backgrounds increasingly need to come together to tackle challenges together.

Over time I have found myself looking across these disciplines for some common patterns that span across disciplines and found some common ground that I think may be useful to share.

One of the key aspects of that common ground is that all 3 disciplines can learn from the patterns in the Cynefin framework which is very much a multidisciplinary approach to making sense of the world and aiding leaders with decision making.


You began your education with the basics of reading, writing and arithmetic. While challenging at the time, you likely take these challenges for granted now and might class them as “simple” to do.

Further along your education you most likely will have chosen a path that you enjoyed/preferred for a variety of reasons. While your chosen field may have appeared a “complicated” at the outset, requiring years of study and effort, over time you will have got a very good grasp of the subject. Indeed you may be a master in that field. Those from a scientific background will be familiar with this domain.

Regardless, there is for all of us, stuff that appears more than complicated, complex even, that stretches our ability and it can be hard to explain how, but some how we get through these challenges. Within the complexity, patterns emerge and can be distinguished and harnessed, which may be understood as the art within many disciplines.

At the edge of complex challenges, occasionally lies chaos… a bad day, an organisational mess, a challenge so unwieldy that chaos is the only word that fits..

In brief, the Cynefin principles of how to deal with each of these domains can be summarised as follows..

Simple: Sense, Respond, Categorise (Best practice)

Complicated: Sense, Analyse, Respond (Good practice)

Complex: Probe, Sense, Respond (Emergent Practice)

Chaos: Act, Sense, Respond (Novel Practice)

In our next post we will delve into the common ground between three disciplines, Healthcare, Management and Information Technology, using the Cynefin framework which should help to explain and illustrate its real value.


A Leader’s Framework for Decision Making by David J. Snowden and Mary E. Boone
Harvard Business Review, November 2007

NB This post is adapted from a series of articles in my Book of Thoughts


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