[The complexity of medical organizations in the 21st century].

Our conception of medicine in the 21st Century is different from the way it was conceived in the 20th Century, and parallel to that, and medical organizations have changed and become more complex. These changes demand transition in traditional thought patterns and perception of the medical system as a "Complex Adaptive System" (CAS). In this article, the authors describe medical organizations as macro systems comprised of micro systems. They present a model of a Complex Adaptive System that permits us to address the challenges that face medical systems in the 21st Century. Management actions can no longer be based on a linear thought pattern and solutions such as "Planning-Study-Action". Action must be innovative and based on the advantages latent in micro systems, as an effective way to realize the macro system mission. In hospitals, for example, a clinical department consisting of the physician and medical staff, certainly a focal point of clinical knowledge and skill, can advance the quality of medicine, and the service and performance of the entire organization. But this is with the stipulation that synchronization is maintained between the micro system and macro system, which ensured that the organization function will serve the goals and vision of the hospital, while still contending with the challenges and competitive environment of the 21st Century.