DNP 708 Module 5 Reflection: Evidence, Innovation and Leadership Example

Evidence Took Me to the Door, Relationships Took Me Inside: A Reflection on Evidence, Innovation and Leadership

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

DNP 708: Systems Thinking in a Complex Health Care Environment

Instructor Name

Month Day, Year

Evidence Took Me to the Door, Relationships Took Me Inside: A Reflection on Evidence, Innovation and Leadership

Introduction

Back in Week 1, systems thinking looked to me like a way to draw better diagrams. After three versions of a map of heat deaths among older adults living alone, I see it as a way of deciding where to act when no one is in charge. This reflection considers the three words in the assignment's title, evidence, innovation and leadership, in the order I learned them.

Evidence: What It Settled and What It Could Not

Evidence did its most important work early. County research showed that heat deaths cluster where older adults live alone in poor, unshaded neighborhoods (Harlan et al., 2013), which told me who to look for. A laboratory study changed my plan: an afternoon in a cooling center drops an older person's core temperature, yet that gain is gone within hours of going back into the heat (Meade et al., 2023). Without that study, I would have built a program around getting people out of their homes for a few hours, and it would have missed the nights.

Evidence was less helpful on what to do next. I found no trial of a program like Summer Safe. The studies described risk and physiology, not how to make a utility program, a health plan and a church volunteer list work together. At that point I had to rely on reasoning about the system, informed by the course texts, and on the judgment of people who had worked on heat for years. Systems thinking research itself acknowledges that much of what helps in complex systems is learned by trying, measuring and adapting rather than proven in advance (Peters, 2014). The honest conclusion is that evidence pointed me to the door, and the design behind it is a hypothesis to be tested.

Innovation: Where the New Idea Came From

I expected innovation to mean a new technology. The one idea in my design that partners called new was not a technology at all: it was the decision to start in April, before the first warning, instead of reacting during heat waves. That idea came from Version 1's cost loop, which showed that once summer bills arrive, people have already decided to switch cooling off. The map made the timing visible.

The second source of innovation was other people. The paramedic referral button came from a fire captain during my stakeholder interviews; the faith group call list came from a pastor who already called her older members during monsoon storms. Weberg and Davidson (2025) describe innovation as something that emerges from networks and connections rather than from a single inventor, and that matched my experience closely. My contribution was to connect ideas that already existed.

Leadership: Leading Without Authority

The hardest lesson was about authority. I manage a home health agency. I do not manage paramedics, utilities, the county or churches, and every one of them was essential to the design. Quantum leadership, as the course text describes it, locates the leader's influence in relationships and shared purpose rather than in hierarchy (Albert & Pappas, 2025). In practice, that meant asking more than telling, offering my agency's data before asking for theirs, and letting partners shape their part of the program even when I would have designed it differently.

I also learned that my instinct under pressure is to shrink the problem until it fits what I control. Version 1 was that instinct on paper. Each later version required me to tolerate a larger, messier system and still choose a few places to act. The complexity literature describes that balance, living with uncertainty while acting through simple rules and small experiments, as central to leading in complex systems (Plsek & Greenhalgh, 2001).

Three Changes to How I Will Lead

1. I will map before I plan. For any new problem in my agency, I will draw the system, including the parts I do not control, before choosing a solution.

2. I will build learning into every program from the first week, with a feedback loop that reaches every partner, instead of waiting for a final report.

3. I will measure my leadership by the connections I create. At the end of next summer I will count how many partners share data and meet regularly, not only how many patients we enrolled.

Conclusion

Evidence told me who was dying and why the obvious fix was not enough. Innovation came from timing and from other people's ideas. Leadership, in a system no one owns, meant building relationships strong enough to carry a shared purpose through a Phoenix summer. I leave the course with a design to test and a clearer sense of the leader I need to become to test it well.

References

Albert, N. M., & Pappas, S. (2025). Quantum leadership: Creating sustainable value in health care (7th ed.). Jones & Bartlett Learning.

Harlan, S. L., Declet-Barreto, J. H., Stefanov, W. L., & Petitti, D. B. (2013). Neighborhood effects on heat deaths: Social and environmental predictors of vulnerability in Maricopa County, Arizona. Environmental Health Perspectives, 121(2), 197-204. https://doi.org/10.1289/ehp.1104625

Meade, R. D., Notley, S. R., Akerman, A. P., McCormick, J. J., King, K. E., Sigal, R. J., & Kenny, G. P. (2023). Efficacy of cooling centers for mitigating physiological strain in older adults during daylong heat exposure: A laboratory-based heat wave simulation. Environmental Health Perspectives, 131(6), 067003. https://doi.org/10.1289/EHP11651

Peters, D. H. (2014). The application of systems thinking in health: Why use systems thinking? Health Research Policy and Systems, 12, Article 51. https://doi.org/10.1186/1478-4505-12-51

Plsek, P. E., & Greenhalgh, T. (2001). The challenge of complexity in health care. BMJ, 323(7313), 625-628. https://doi.org/10.1136/bmj.323.7313.625

Weberg, D., & Davidson, S. (2025). Leadership for evidence-based innovation in nursing and health professions (3rd ed.). Jones & Bartlett Learning.