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First Advisor

Alan Bateau


This research is an ethnographic portrayal of nursing and hospital management during times of change. It examines management's responses to change through spontaneous reorganizations and regroupings. The objective is not only to discover new insights into nursing and hospital management, but also to provide new perspectives in understanding change within hospital cultures. The study uses the unorthodox approach of studying up that understands the culture from the leaders' perspectives. This research is notable for its application of complexity theory's principles that challenge the ideology of nursing and hospital management. Complexity Theory defines systems as open and nonlinear with memory and independent webs of interactions, and it stresses that creativity and survival lie between chaos and stability, at the edge of chaos. It extends beyond the superficial analysis to deeper, hidden layers of meaning expressed through symbols and behaviors. A key concept to understand complexity theory is attractors, which act as catalysts to move behaviors in different directions. Interactions and behaviors are mediated by attractors to produce numerous variations of responses from past memories and present information. How managers respond is significantly influenced within attractors reflected through trust/distrust, resistance, and communication, both verbal and nonverbal. The purpose of this study is to contribute to the understanding of nursing and hospital management responses to organizational change by examining systems and their interrelationships and interdependencies via complexity theory. Complexity theory assumes that systems can run themselves, which dramatically challenges conventional understandings of the role of healthcare managers. This research's particular focus relates to how hospital personnel spontaneously self-organize and regroup to move towards the "edge of chaos" in an attempt to align themselves in the fluctuating landscapes that confront healthcare today.

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