At the heart of getting things done in complex healthcare ecosystems: leadership, strategy, sensemaking and sensegiving

Healthcare delivery organisations are complex. They tend to be resilient and flexible, with a capacity to respond and adjust to the exigencies of external and internal circumstances. If they are not, and are excessively structured, and poorly able to manoeuvre, they risk failure, or delivering poor outcomes to patients. Healthcare systems have been increasingly bureaucratised, and not optimally configured for agility and responsiveness. Most are additionally challenged by resource constraints, workforce shortages, poor change management competencies or excessive pressures to perform, or a combination. Healthcare organisations nevertheless change over time, not always in reaction to top-down prescriptions, but as a response largely to changing clinical practices and new technologies. This chapter examines how leaders behave strategically and make sense of their environments, whichever ecosystem they inhabit - one that is relatively resilient and flexible, or rigid and brittle. This conceptualisation of healthcare organisations represents a heuristic for assessing how leaders strategise, sensemake and sensegive in complex ecosystems, the behaviours of which are central to the work of leadership.