ABSTRACT
In this chapter, the authors start from the wider concept, looking at the health system as a whole and then narrow down to local systems and then down to organisation, looking specifically at culture, how to assess it and how they might influence it. They consider the system first and then the implications for leadership. As a way of illustrating the interdependencies of a complex adaptive system, let's look at a 23-year-old presenting in primary care with symptoms of generalised anxiety. It may also have been influenced by previous experience of the general medical practitioners (GPs) practice and the ease of access to an appointment. The GP practices and local networks can also be viewed as complex adaptive systems that respond to internal and external influences in ways that may be unpredictable. In some of these networks, a wide range of organisations attempt to deliver some services together, often from a background of different cultures.
