Page 1

Healthcare – Complicated or Complex?

Brenda Zimmerman, PhD Director of Health Industry Management Program Associate Professor of Strategy


Heart Rate Dynamics

( from Dr Ary Goldberger,Harvard)


Heart Rate Dynamics


Heartsongs • Listen to the “songs” of healthy hearts • Not random and yet not a rigid pattern • Between orderly and disorderly


Lessons From Physiology • “As humans we are complex and chaotic when healthy and rigidly orderly when ill.” Stuart Davidson

• Healthy heart has difference, irregularity, and is sensitive to changes in context ---- it is adaptable!


“You don't see something until you have the right metaphor to let you perceive it”. Thomas Kuhn Believing is seeing. ” Karl Weick


Mental models • Assumptions • Metaphors • Challenge of implicit vs. explicit mental models


Common Implicit Mental Models

• Scarcity • Gap analysis– what isn’t working • Parts • Complicated • Machine – like


Common Implicit Mental Models Alternatives/Opposites

• Scarcity • Gap analysis– what isn’t working • Parts • Complicated • Machine – like

• Abundance • Appreciative inquiry – what is working • Relationships • Complex • Life – like


In Health Care (almost) Nothing is Simple • Distinguish between “complicated” and “complex” problems • Dealing with complex problems as if they are complicated is like looking for your car keys in the lamplight • Seemingly intractable complicated problems can often be viewed more optimistically and unraveled when they are seen as complex


Simple

Complicated Complex

Following a Recipe

Rocket to the Moon

Raising a Child

The recipe is essential

Recipes are tested to assure replicability of later efforts

Formulae are critical • and necessary

Formulae have only a limited application

Sending one rocket increases assurance that next will be ok

Raising one child gives no assurance of success with the next

High level of expertise in many specialized fields + coordination

Expertise can help but is not sufficient;

No particular expertise; knowing how to cook increases success Recipe notes the quantity and nature of “parts” needed

relationships are key

Separate into parts and then coordinate

Recipes produce standard products

Rockets similar in critical ways

Can’t separate parts from the whole

Every child is unique

Certainty of same results every time

• High degree of certainty of outcome

Known

Knowable

Uncertainty of outcome remains Unknowable


Simple

Following a Recipe

Complicated Complex Rocket to the Moon

Raising a Child

The recipe is essential

Recipes are tested to assure replicability of later efforts

Formulae are critical • and necessary

Formulae have only a limited application

Sending one rocket increases assurance that next will be ok

Raising one child gives no assurance of success with the next

High level of expertise in many specialized fields + coordination

Expertise can help but is not sufficient;

No particular expertise; knowing how to cook increases success Recipe notes the quantity and nature of “parts” needed

relationships are key

Separate into parts and then coordinate

Recipes produce standard products

Rockets similar in critical ways

Can’t separate parts from the whole

Every child is unique

Certainty of same results every time

• High degree of certainty of outcome

Known

Knowable

Uncertainty of outcome remains Unknowable


Simple

Following a Recipe

Complicated Complex Rocket to the Moon

Raising a Child

The recipe is essential

Recipes are tested to assure replicability of later efforts

Formulae are critical • and necessary

Formulae have only a limited application

Sending one rocket increases assurance that next will be ok

Raising one child gives no assurance of success with the next

High level of expertise in many specialized fields + coordination

Expertise can help but is not sufficient;

No particular expertise; knowing how to cook increases success Recipe notes the quantity and nature of “parts” needed

relationships are key

Separate into parts and then coordinate

Recipes produce standard products

Rockets similar in critical ways

Can’t separate parts from the whole

Every child is unique

Certainty of same results every time

• High degree of certainty of outcome

Known

Knowable

Uncertainty of outcome remains Unknowable


Simple

Following a Recipe

Complicated Complex Rocket to the Moon

Raising a Child

The recipe is essential

Recipes are tested to assure replicability of later efforts

Formulae are critical • and necessary

Formulae have only a limited application

Sending one rocket increases assurance that next will be ok

Raising one child gives no assurance of success with the next

High level of expertise in many specialized fields + coordination

Expertise can help but is not sufficient;

No particular expertise; knowing how to cook increases success Recipe notes the quantity and nature of “parts” needed

relationships are key

Separate into parts and then coordinate

Recipes produce standard products

Rockets similar in critical ways

Can’t separate parts from the whole

Every child is unique

Certainty of same results every time

• High degree of certainty of outcome

Known

Knowable

Uncertainty of outcome remains Unknowable


Simple

Following a Recipe

Complicated Complex Rocket to the Moon

Raising a Child

The recipe is essential

Recipes are tested to assure replicability of later efforts

Formulae are critical • and necessary

Formulae have only a limited application

Sending one rocket increases assurance that next will be ok

Raising one child gives no assurance of success with the next

High level of expertise in many specialized fields + coordination

Expertise can help but is not sufficient;

No particular expertise; knowing how to cook increases success Recipe notes the quantity and nature of “parts” needed

relationships are key

Separate into parts and then coordinate

Recipes produce standard products

Rockets similar in critical ways

Can’t separate parts from the whole

Every child is unique

Certainty of same results every time

• High degree of certainty of outcome

Known

Knowable

Uncertainty of outcome remains Unknowable


Close to

Know When Your Challenges Are In the Zone of Complexity

Close to

Certainty

Far from


Close to

Know When Your Challenges Are In the Zone of Complexity

Simple Plan, control

Close to

Certainty

Far from


Know When Your Challenges Are In the Zone of Complexity

Close to

Chaos

Simple

Plan, control

Close to

Certainty

Far from


Chaotic

Close to

Seek Patterns

Simple & complicated Plan, control

Close to

Certainty

Far from


Close to

? Close to

Certainty

Far from


Nature of complex systems • Interdependence – cause and effect less clear • Unpredictability • Emergence • Embedded systems • Nonlinearity • Distributed control • RELATIONSHIPS ARE KEY


IOM “Crossing the Quality Chasm” • Inspiration from complexity science • Principles of complex adaptive systems resonated • Simple rules that repeat – Current system – Ideal system


Simple Rules – allow for swarming • They give enough of a sense of direction without over-specifying • Local solutions can be discovered (at the “edge” rather than center) • Following same rules – can result in different solutions – Creates coherence rather than consistency


Lessons from complexity • Learning takes place at the edge of the system - not the center • Sustainable change is initiated at the edge of the system – not the centre • Adaptation to changing external conditions occurs at the system’s edge – not the center • Command and control makes it worse • Dr. Eric Knox, at AHA Patient Safety Fellowship 2003


Patient Safety • Goal is to reduce harm, injury • Error producing conditions: – – – – – –

Unfamiliarity with task Shortage of time Poor communication Information overload Poor instructions Etc..

• Swiss Cheese Model – “gaps” – system Reason, 2001


The Patient Safety Problem Simple • People are making mistakes • Hire the best • Create rules to correct behaviors • Tell people to follow rules • If non-compliance, shine light • Get rid of or correct “bad apples”


Patient Safety - complicated • To err is human (slips, trips and lapses) • Refocus on system problems • Decrease reliance on memory and other faulty human aspects • Standardize, routinize, reduce variability • Human factors engineering • Safety culture


Patient Safety - Complex • Relationships are key • Focus on Humans – not just as “error producers” or faulty machine parts • Communication focus • Include full system into processes – patients, families, clerical staff, etc. • Look at patterns - simple rules that hold system • Role of surprise and emergence – what is working/why


Complexity Consistent Mental Models

• RelationshipCentred Care • Patient and Family Centred • Holistic • Embedded Systems

• Abundance • Appreciative inquiry – what is working • Relationships • Complex • Life – like


“Managers would rather live with a problem they can’t solve than with a solution they can’t fully understand or control.” • Eric Bonobeau, researcher in swarm intelligence and CEO of Icosystems


Applications of Complexity Science to Healthcare  

Applications of Complexity Science to Healthcare Brenda Zimmerman

Read more
Read more
Similar to
Popular now
Just for you