Rowe and Hogarth (2005) studied CAS and complexity leadership practices in public health nursing. When the formal leaders embraced the movement of decision making and policy setting from administration to the nurses on the frontline, the investigators reported an increase in experimentation and innovation that led to new service delivery models, and higher levels of responsibility and decision making for the practitioners. This study lends insight into ways to
improve efficiency, quality, and accountability in health care, all of which can impact cost. The apparent evidence gap between research and actual best practice for the patient may be mitigated through the complexity model as well. If practitioners were held more accountable and given more autonomy to practice to their appropriate educational level, then change could occur in a more constant and fluid way. For example, implementing best evidence on catheter care would not require a commit- tee to approve the new practice but rather the practitioner could use best evidence, current clinical judgment, and patient preference to provide updated and validated care (Melnyk & Fineout-Overholt, 2010). Allowing the practitioners to make these decisions takes the whole burden of complexity off of the formal leadership and policy setters and disperses it throughout the system so that the system can evolve accordingly. Admittedly, complexity leadership is not an over- night solution and is quite difficult to accomplish itself. Leaders in health care can begin to shift their thinking and work toward complexity behaviors to shift the organizational culture from one of hierarchy, inefficiency, and high cost, to one that embraces complex systems and continually searches for value- added innovations. This is really about a paradigm shift.