Leadership of the Pioneers of Nursing Informatics: A Multiple Case Study Analysis

Date of Completion

January 2012


Health Sciences, Nursing|Sociology, Organization Theory




This multiple case study analysis examines the leadership of an elite group of nurses known as The Pioneers of Nursing Informatics. Leadership was examined using a lens of Complex Adaptive Systems theory as developed by Cilliers (1998) following Yin's (2009) methodology of Multiple Case Study analysis with cross-case synthesis. The research questions focused on why the pioneers were considered leaders, and how the conditions and context were associated with the emergence of the specialty and the associated activities and accomplishments of the pioneers. Study propositions focused on the emerging nature of the specialty of nursing informatics, elements of leadership, the qualities of pioneers as leaders, and the historical and professional context which influenced the events of the time. Data sources included previously conducted interviews, focused interviews, curricula vitae, archives retrieved from the National Library of Medicine, and personal supplemental documents submitted by participants. Data from four individual case studies were analyzed, followed by a cross-case synthesis resulting in the development of 10 themes that were directly related to the 10 characteristics of a complex system. These themes were grouped in one of three clusters describing the agency of leadership: conditions, context, and characteristics. Themes which described the conditions of agency were entitled: Equilibrium Equals Death; Large Number of Elements; and Non-linear. Those which described the context of agency were entitled: History and Open Systems. Those which described the characteristics of agency were entitled: Locally Responsive, Recurrency, Richness, Short-range, and Dynamic. These results are consistent with previous studies which identified elements of complexity in the leadership of nurses, and discussion regarding future impact in practice, education and research were discussed. This research led to the following definition of leadership: Leadership is a complex, emerging process in which the content, context and characteristics of agency are orchestrated in dynamic interplay with the environments in which they function, to result in achievement of a desired outcome.^