Monday, November 3, 2008

Systems think - Groupthink, Systemsthink , and Health Reform

As the nation gets set to embark on a new health reform era under a new president, doctors across the land worry about what lies ahead. Is a nationalized system dominated by large groups finally at hand? Or will the current chaos persist?

I don’t know, but personally I worry about the hazards of two mindsets - groupthink and systemsthink.

Groupthink


In a 1972 book Groupthink, Irving L. Janis, a Yale psychologist, explained how groups of experts could make colossal mistakes. Experts in groups worry about their personal reputations, their role in the new government, and whether if they deviate too far from the consensus of their peers, they will be ostracized as reckless mavericks. Very few professional economists, who number about 200, for example, warned of the current economic disaster while it was in the making.

There is little room for dissent among experts. An example in health care might be Democratic health experts who have yearned for so long and so desperately for government controlled Medicare-for-all system. To doubt the inevitability of such a system is moral heresy. To say that such a system might deprive citizens of freedom, choice, and individualism it to follow the doctrine of cruel conservatism. To point out that you cannot simultaneously have a robust economy and a pervasive welfare state, or suffer the fate of the stagnant economies of Europe, is unthinkable.

Groupthink exists on the conservative side of the ledger too. To stray from the thought that an unregulated free market with a completely consumer-driven model is to preach the doctrine of centralized command and control socialism is dangerous if you are to be a member of the conservative club.. To say consumers might not have the judgment and information to make responsible health care decisions is anathema.

To assert, as I do, that American want a mix of government control and individual choice, as long as someone else pays for it, is cynicism of the first order.

Systemsthink


Which brings me to systemsthink. Read or listen to experts on both government and free-market sides of the aisle, and you will invariably run across systems’ advocates. They say the answers in health care lie not in individuals, be they physicians, patients, or policymakers, but in large organizations deploying systems.

The best explanation of systemsthinking I have run across was not in some arcane academic or management book, but In a sports article in the November 2008 New York Times Sports Magazine by Jeff MacGregor, “Here Goes Nothing: Brett Favre, Freethinking Huckleberry in the N.F.L Industrial Complex, Tries to Make Something Happen One More Time.”

The Jets’ System – and its various subsystems – is just one of 32 such systems currently deployed across the N.F.L .industrial complex. These systems are all differing – systems for offense, systems for defense, systems for special teams. A system of systems.

It’s all very complicated and scientific and dull. For 25 years, the N.F.L – roughly parallel to the rise of the computer – the System has been ascendant. At once the weapon against chaos and a holy talisman against chance. They system is against intellectual human confusion and statistical weakness. It offers digital probability and plausibility. The System promises to abate risk and assuage uncertainty.

Systemsthinking pervades health care too – at Kaiser Permanenti and other large multispecialty groups, among experts in board rooms and corridors of health plans, hospitals, pharmaceutical companies, and academic medical centers.

Systemthink is understandable and necessary. Human beings, patients, physicians, hospital executives, and payers need systems discipline. We all need some system = socme context in which to operate, thrive, survive, and improve.

But as is the case with Brett Favre, there has to be room for individualism and heroism too. – for self-expression, grace, spontaneity, independence, and intuitive thinking and performance. Artists and athletes like Brett Favre and high performing physicians need a system in which to function. But the System needs the Art of Medicine too, wherein physicians can be free of the constraints of the system and its computer models. I worry in the future we will rely too much on groupthink and systemsthink and algorihmicthink, and too little on Humanthink and self-reliance.

18 comments:

Anonymous said...

Thousands protest in Russia at rallies across the nation.
The mobile news service facility is very new and unique concept that has created a buzz
among every citizen. These have become world famous with all
the passing days.

my homepage ... latestdailynews.com

Anonymous said...

This is my first time pay a visit at here and i am truly pleassant to
read all at alone place.

Here is my web page click through the up coming document

Anonymous said...

The final step toward making your funny picture or video popular
is to find the right distribution. These make great funny pictures,
and can be as blatant as the example I just
gave, or as simple as a spelling mistake. Now, people from all ages
like to watch the funny videos.

my weblog; simply click the following site

Anonymous said...

Anyone who needs a new idea to stay motivated should definitely try this.
Even if your small business doesn't have some sort of refrigerator (a rarity today) you can choose vegetable and fruit that do not even require refrigeration. Get your heart rate up with a quick burst of fast movement.

Here is my site :: fitness tips and workouts

Anonymous said...

I'd like to find out more? I'd want to find out more details.


Stop by my homepage; visit the following web page

Anonymous said...

The new tablet would be a further extension of these concepts and yet another step into the future of computing for Apple.
I have more stuffings in me from yesterday than I care to
think about. All kinds of sports news today are offered live through the television.


Feel free to visit my blog post ... Latest Daily News

Anonymous said...

Take a look at your schedule and come of with solutions ahead of time for lunches and dinners
out, this will give you a game plan to follow. You may want to try the buddy system, as lot of people
find that this motivates them tremendously. Most of us love it; going to Mac - Donald or Burger King from time to time.


Here is my web page - ciaoamigochat.net

Anonymous said...

People talk themselves out of exercising so easily, and the opposite can be so easy.
Then you'll have no trouble motivating yourself to do it. If the answer is I''''''ll do whatever takes''''''''.

Stop by my web site: Click This Link

Anonymous said...

So, while I am no roving reporter I am endeavoring with my menial reporting skills, to bring you.
The promotion of good health is necessary to ensure that people are healthy, wealthy and wise.
You can only visit once a day and there is no guarantee that you
will get anything from it but as I always say, free is free.


My web blog :: Latest Daily News

Anonymous said...

Well, as we know world is changing day by day and its every single move in politics, business or even entertainment world affects our lives a lot.
He tells the tale of a young boy, a tot, who was riding a toy car near
the railroad crossing. ' They always intend to take public view on variousu topics.

My web blog ... Latest Daily News

Anonymous said...

Hence, it was all about the biotech resume objectives.
The gels went through a trypsin digestion and then were analyzed
by a MALDI-TOF-TOF mass spectrometer, which identified the proteins digested from the gels.
R Bennett, R Phipps, A Strange, P Grey 'Environmental and human health impacts of growing genetically modified herbicide-tolerant sugar beet: a life-cycle assessment' Plant Biotechnology Journal 2:273-278 (2004).


My web page Biotechnology and Bioengineering

Anonymous said...

It improves blood and oxygen flow to the muscles that are
recovering from the prior hard workout. You have to find a way to take the tips you learn and make maximum use
of them. If the answer is I''''''ll do whatever takes''''''''.


Look into my web blog - www.veteranjournal.com

Anonymous said...

If a wide search is made on the internet, services can be utilized easily that are provided by
them. Talking of the walking dead, congratulations to Hugh Hefner, who is
getting married at age 84 to 24-year-old beauty
Crystal Harris. Every now and then, new stars emerge and
disappear in the blink of an eye and every smallest detail about the same becomes important celebrity news.



My web site ... latest celeb news

Anonymous said...

Way cool! Some very valid points! I appreciate you
writing this article and also the rest of the site is also really good.


Here is my blog dailynews

Anonymous said...

Just wish to say your article is as surprising. The clearness in
your post is just cool and i could assume you're an expert on this subject. Well with your permission allow me to grab your feed to keep updated with forthcoming post. Thanks a million and please keep up the gratifying work.

Visit my blog - Buy Le Parfait

Anonymous said...

Hmm is anyone else encountering problems with the images on
this blog loading? I'm trying to figure out if its a problem on my end or if it's the blog.
Any feed-back would be greatly appreciated.

Have a look at my web site :: Test Force Xtreme

Anonymous said...

Excellent web site you have got here.. It's difficult to find quality writing like yours these days. I honestly appreciate people like you! Take care!!

my web site :: Le Parfait

Anonymous said...

Saved as a favorite, I really like your blog!



Also visit my weblog - Muscle Rev Xtreme