The problem: We rely on health care organizations to improve patient care quality and reduce medical errors, but their record has been mixed, with some breakthrough success but also substantial room for improvement.

The proposals: Under two Pioneer Portfolio grants, the Plexus Institute is trying to help hospitals and other institutions improve how they deal with some of health care's most intractable problems, from reducing hospital-acquired infections to improving the quality of care. Their approach: Introduce health care leaders to different operational concepts, including complexity science and positive deviance.

Grantee perspective: Life is largely about relationships; they're at the root of how individuals and families grow and evolve. Each relationship, each family, is uniquely different, evolving in a nonlinear way, with each person playing a role. The same is true in the natural world. Take an ant colony; individual ants follow a small repertoire of behaviors, resulting in an elaborate physical architecture and exact temperature regulation. Conversely, health care organizations, like many organizations built by humans, function based on a top-down, command-and-control approach.

A former hospital corporation executive, Curt Lindberg believes health care leaders could improve patient care and quality by looking at their organizations—and the people in them and affected by them—differently. Lindberg believes complexity science-the discipline that explains how living systems self-organize, evolve and adapt-offers insights to help health care and business leaders better understand human physiology and human organizations.

"Complexity points our attention to the notion that every organization, family, person is different," Lindberg says, adding that patterns of behavior differ based on individuals' relationships to one another, to an organization. "You need to work with the patterns, the history and behavior of an organization to get things to change-and for that change to last," Lindberg says.

Case in point: When looking to reduce pernicious methicillin-resistant staphylococcus aureus (MRSA) infections, the VA Pittsburgh Health System approached things differently. MRSA is one of today's fastest spreading pathogens; the United States is second only to Japan in terms of MRSA infection rates. Positive deviance (PD) principles provided a useful framework for combating the disease. PD holds that, in most communities, there are individuals or groups whose uncommon behaviors or practices allow them to find better solutions to seemingly intractable problems than peers who have access to the same resources. Following this logic, VA leaders listened to workers at all levels of the organization. An astute housekeeper named Eddie, says Lindberg, observed infection-control patterns became lax at certain times and highlighted this to leaders. The housekeeper ultimately led unit briefings with physicians, nurses and others. Changes made at the VA facility have cut cases of MRSA by 75 percent. That trend has been sustained for three years. Now, Plexus is working with six other hospitals to apply PD strategies to drive individual and organization change and reduce MRSA rates.

"They certainly have stirred things up," notes Rosemary Gibson, M.Sc., RWJF senior program officer, of Lindberg and his Plexus colleagues. And organizations and institutions are taking note. Several nursing schools, including University of Kansas, College of New Jersey, Duke University, as well as the American Association of the Colleges of Nursing, have integrated complexity science into their curricula.

RWJF Perspective: "Our health care system has many cracks and is not what we want for our families and ourselves," says Gibson. "We need different approaches to fill the cracks, approaches that use the untapped motivation and knowledge of people at all levels of health care organizations." The top-down way of doing business and getting employee "buy-in" will not work to create sustained improvements in quality.

"The Plexus Institute is inviting health care leaders to lead differently to transform health care," Gibson says.