Purpose The complex and occasionally chaotic nature of health care has been previously described in the literature, as has the broadening recognition that different management approaches are required for different types of problems rather than a “one size fits all” approach. The CYNEFIN framework from Snowden outlines a consistent cognitive approach that offers the leader and leadership team an ability to urgently apply the correct actions to a given situation. This paper proposes a variant CYNEFIN approach for healthcare. Design/methodology/approach Consistent and accurate decision-making within health care is the hallmark of an effective and pragmatic leader and leadership team. An awareness of how one’s cognitive biases and heuristics may adversely impact on this cognitive process is paramount, as is an understanding of the calibration between fast and slow thinking. Findings The authors propose a variant CYNEFIN approach for health care of “act-probe-sense-respond” to resolve complex and time-critical emergency scenarios, using the differing contexts of a cardiac arrest and an evolving crisis management problem as examples. The variant serves as a pragmatic sense-making framework for the health-care leader and leadership team that can be adopted for many time-critical crisis situations. Originality/value The variant serves as a pragmatic sense-making framework for the health-care leader that can be adopted for many crisis situations.

Background: Patients with Functional Somatic Symptoms (FSS) are frequently encountered within healthcare settings such as Emergency Departments (ED). There is limited research regarding characterisation and frequency of FSS within frequent presenters to ED and no previous Australian evidence. This study aims to fill this gap. Methods: A retrospective, single-centre study of frequent ED presenters over a 6-month period was undertaken. Patients with >3 re-presentations/month were reviewed for the presence of FSS using Stephenson and Price’s 1 categorisation of FSS. Patients were divided into three groups – FSS, possible FSS (pos-FSS) and non-FSS. The characteristics of these groups were compared using descriptive statistics (chi-square tests, ANOVA). Person-time at risk during the 6-month study period was estimated for patients in each group and incidence of ED presentation for each group was then calculated. Psychological distress indicators for ED presenters with FSS, as noted by the treating clinician, were also analysed. Results: 11% (71/638) of frequent ED presenters were categorised as having FSS and 17% (109/638) as having possible FSS (pos-FSS). Mean ED presentations in the FSS group during the study period were significantly higher than in the non-FSS and pos-FSS groups (p<.01). Anxiety was found to be the primary psychological distress indicator associated with ED presentations with FSS. Conclusion: We found that, amongst frequent ED presenters, patients with FSS presented significantly more frequently to ED than those without FSS. We propose revising the model of care for FSS in ED to promote appropriate referral to therapy services as a possible demand reduction strategy to improve patient care and efficiency in ED.