Sustaining leadership in an unsustainable system.

Healthcare executive failures and departures are not only linked to the involved individuals' skills but also are often the result of complex dynamics reflecting larger system, societal, and global polarities and tensions. At the root of many of the challenges leaders face is system unsustainability. This article discusses common challenges as fractals of more complex dynamics, strategies for managing dynamics between organizations and their stakeholders, and approaches for leaders to sustain themselves within this unsustainable system.

"We are all in this together": integrated health service plans in Ontario.

Ontario's 14 Local Health Integration Networks (LHINs) produced their first major deliverable when they issued their integrated health service plans in October 2006. This article reviews the experience of LHINs in meeting this challenge, outlines the process and outcome dimensions of the plans and discusses eight opportunities for LHINs as they act on the basis of their plans.

Rebuilding organizational culture in the wake of a merger.

More and more, corporate culture is being recognized as an important determinant of organizational effectiveness. This article describes how the Centre for Addiction and Mental Health proactively focused on rebuilding its culture after a mandated merger. The long-term effects of this effort need to be monitored.

A model for professional nursing in organizations: the Rainbow.

This paper presents a model of professional nursing in organizations that provides cohesive direction to the development of patterns that shape how nursing is structured in an organization. Such cohesive direction can foster integration between the practice and the discipline components of nursing. The model can influence the structure of nursing on a macro level within the organization and on a micro level by influencing patterns of nursing care delivery.