Themes
Our Themes
Netiv’s research portfolio spans four interconnected themes that collectively advance a novel way of understanding health systems.
❋ Complex Adaptive Systems
At Netiv, we understand health systems as complex adaptive systems, composed of networks of people, institutions, technologies, and norms whose behavior emerges from interaction rather than instruction.
Netiv uses complexity science to help health systems see themselves more clearly: how patterns of interaction take shape, how effects propagate, and where learning accumulates or breaks down. This perspective allows systems to move beyond control and compliance toward coherence, adaptation, and sustained performance under uncertainty.
How a Reimagined Command Centre Helps Patient Flow (2025)
Cook, E., Gutberg, J., Rosenberg, L. (2025). How a Reimagined Command Centre Helps Patient Flow. NEJM Catalyst, 6(9), CAT-24. DOI: 10.1056/CAT.24.0437
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❋ Antifragility
For Netiv, antifragility is not about resilience or recovery. It is about designing systems that improve through exposure to stress, variation, and uncertainty.
Health systems continuously face shocks such as workforce strain, demographic change, policy shifts, and technological disruption. Antifragile systems do not simply absorb these pressures; they use them as signals for learning and redesign.
Netiv applies antifragility as a design principle, focusing on structures, governance, and learning mechanisms that enable health systems to gain capability over time, rather than degrade through repeated strain.
❋ Value-Based Healthcare
Netiv approaches value-based healthcare as a system property, not a reporting framework.
Value is created or destroyed through interactions across the full care ecosystem, not within isolated pathways or performance metrics. Measuring outcomes and costs without understanding system dynamics risks optimizing one part of the system at the expense of another, and collective coherence.
Netiv integrates value-based healthcare with complexity science to anchor learning in outcomes that matter to people and communities, while recognizing the trade-offs, constraints, and interdependencies that shape real-world care delivery.
Gutberg, J., Cook, E., Rosenberg, L. (2025). Implementing the Pillars of Value-Based Care: Leadership Lessons from the CIUSSS Centre Ouest de l’Ile de Montreal. Healthcare Management Forum, 38(3), 206-10. DOI: 10.1177/08404704251317872
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❋ Artificial Intelligence
At Netiv, artificial intelligence is integrated as a foundational capability within health system design, extending system awareness, sense-making, and foresight rather than replacing human responsibility.
AI is used to integrate evidence, data, and lived experience at a scale and pace no individual or committee can achieve alone. Its role is to surface patterns, reveal interactions, and illuminate upstream opportunities, supporting a shift from episodic healthcare toward health, prevention, and early action.
Netiv designs and applies AI in ways that preserve human stewardship, legitimacy, and trust, ensuring that intelligence strengthens understanding and foresight without becoming an authority or an end in itself.
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Knowledge Products
Netiv’s Knowledge Products distill complexity-informed research and real-world system learning into concise, usable formats. Designed to support collective sense-making, they integrate evidence, context, and experience to surface patterns, anticipate implications, and strengthen learning over time.
Related Work
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Understanding the inevitable changes that technology has brought ― and will continue to bring ― to the healthcare industry will help all of us take more control over our well-being, prevent chronic diseases, and pursue care at the right time, at the right place, in the right way, from the right people. Diagnoses and treatments that once required highly specialized knowledge and equipment are becoming more widely available. Procedures and devices that existed only in large medical centers have shifted into community clinics, stores, and people’s living rooms. Today’s healthcare consumers have more autonomy than yesterday’s passive patients did.
Dr. Lawrence Rosenberg brings a lifetime of experience as a surgeon, medical school professor, and health system CEO to this exploration of every aspect of the changing landscape. Writing in plain language for consumers as well as medical providers, he connects the dots between parallel developments in technology and in healthcare delivery. The result is a wake-up call for healthcare providers to rethink what they do and how and where they do it. Healthcare is only beginning to catch up with other industries in using technologies such as virtual meetings and artificial intelligence, but already these tools are transforming people’s roles. Policymakers and those who train and employ healthcare providers must adapt. But everyone can benefit by better understanding what is happening, when to embrace new ways, and when to be skeptical or cautious.
Big retail and tech corporations see trillion-dollar possibilities in providing healthcare. These new players come with promises of convenience, efficiency, and cost savings, but without some of our healthcare system’s traditional restraints. The regulations and limits imposed on healthcare by governments and private intermediaries, such as insurance companies, are reaching the end of their sustainability. The COVID - 19 pandemic ex posed inequities and vulnerabilities in our access to healthcare but also sparked innovation. Patients Matter Most describes how some innovations are overcoming resistance to change and improving lives, and how others are introducing risks to our privacy. Real-life stories from a physician and healthcare leader who has been on the front lines of managing change make this book a compelling read. -
From Vision to Vitality is a powerful guide for decision-makers seeking to build resilient, people-first healthcare systems. Author Dr. Lawrence Rosenberg―a trained transplant surgeon and award-winning healthcare CEO―shares frontline strategies to transform complexity into clarity and operational chaos into coordinated, value-based care.
With stories from decades of leadership and lessons learned in the operating room and executive boardroom, this book reveals what truly drives lasting change in healthcare: courage, curiosity, and integrity.
Discover how to:
Lead integrated care across hospitals, long-term care, and community settings
Build a culture of excellence and accountability
Implement value-based systems that prioritize patient outcomes
Embrace innovation while navigating policy and risk
Inspire teams to lead with purpose at every level
If you’re ready to break through bureaucracy and deliver care that actually works―for patients, providers, and systems―From Vision to Vitality is your essential road map.
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Gutberg, J.*, Hertelendy, A. J.*, Mitchell, C.*, Gustavsson, M., Rapp, D., Mayo, M., & von Schreeb, J. (2022). Mitigating Moral Distress in Leaders of Healthcare Organizations: A Scoping Review. Journal of Healthcare Management, 67(5), 380-402. (*Denotes equal contribution and shared first authorship)
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Gutberg, J. (2022). Healthcare Leaders’ Sensemaking in an Extended Crisis. Resilience in Extreme Contexts Research Symposium 2022, University of Technology Chemnitz. September 29, 2022 [Virtual]. Role: Invited Speaker
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Gutberg, J., Evans, J. M., Khan, S., Abdelhalim, R., Wodchis, W. P., & Grudniewicz, A. (2022). Implementing coordinated care networks: The interplay of individual and distributed leadership practices. Medical Care Research and Review, 79(5), 650-662.
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Shaw, J., Gutberg, J., Wankah, P., Kadu, M., Gray, C. S., McKillop, A., ... & Wodchis, W. P. (2022). Shifting paradigms: Developmental milestones for integrated care. Social Science & Medicine, 301, 114975.
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Embuldeniya, G., Gutberg, J., Sibbald, S. S., & Wodchis, W. P. (2021). The beginnings of health system transformation: How Ontario Health Teams are implementing change in the context of uncertainty. Health Policy, 125(12), 1543-1549
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Gutberg, J., Berta, W., Perreira, T. A., & Baker, G. R. (2020). Scoping the contribution of middle managers to the strategic change process in healthcare organizations. Transitions and boundaries in the coordination and reform of health services: Building knowledge, strategy and leadership, 195-221.
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Gutberg, J., Shaw, J., Baker, G.R., Denis, J-L., Hoff, T., Tietschert, M.V. (2019). Management Theory for the Scale and Spread of Integrated Care: A Critique of Conventional Approaches. Academy of Management Proceedings. 1, 14972. doi: 10.5465/AMBPP.2019.14972symposium
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Shaw, J., Gray, C. S., Baker, G. R., Denis, J. L., Breton, M., Gutberg, J., ... & Wodchis, W. (2018). Mechanisms, contexts and points of contention: operationalizing realist-informed research for complex health interventions. BMC Medical Research Methodology, 18(1), 1-12.
“We can’t solve problems by using the same kind of thinking we used when we created them.”
— Albert Einstein