A century later Charles Darwin incorporated Adam Smith's thinking into his theory of natural selection. The notion of competition was introduced into biology. Later, economists returned the compliment by introducing the Darwinian metaphor into the business environment. Biologists subsequently argued that competition was not necessarily the all-powerful force but merely one of the many factors that shape ecological communities. This, translated into the business environment, placed importance on creating opportunities to adapt in a complex network of companies that collaborate, compete or both.
Success lies at the boundary of the two states.
Survival in an unpredictable environment depends primarily on maximising adaptability. In order to survive health systems need policies that make them flexible, that buffer against the shock of sudden unforeseen change. Health care systems risk becoming rigid and are therefore unable to adapt to meet societal needs. Clinical leadership is leading change to meet the societal needs driving reform. Clinicians have an opportunity to exercise leadership for the improvement of care, but they must first agree to address the aims of the reform and to adopt an agenda of specific changes in their own work that are likely to meet the social needs driving the reform movement.