Effect of complexity -How Will We Remember 2008?

We will remember 2008 as the year complexity, the Internet, and globalization overcame and overwhelmed humankind.

We will remember 2008 as the year complexity humbled us.

We will remember 2008 as the year unlimited credit in the form of a small percent of foreclosed mortgages turned the financial, and finally, the healthcare world, upside down.

We will remember 2008 as the year we learned complexity is more complex than anybody ever imagined when you tie it together as derivatives and when you intimately and instantly connect it to the rest of the world.

The year of our Lord, 2008, was the year, we learned,

Complexity is, well, complex, so complex that not even the “experts” comprehended it or anticipated its consequences.

Healthcare is an intimate part of a complex world, and is not immune, isolated, or protected from its vicissitudes.

Healthcare’s complexity is what makes it so resistant to change, or at least so we think.

In the complex interconnected worlds of humankind and healthcare, not everything, not every little detail can be planned linearly.

Life and human affairs are far from certain and are often dictated from the edge rather than from the center.

Political leadership can be organized and mobilized from the bottom-up through constant online contact with and feedback from supporters, many previously excluded from the political process.

The Web and its algorithms are not a satisfactory or total answer to controlling information flow or enforcing compliance, but it is a powerful tool for tuning to the edge of healthcare events, for understanding diversity and differences, for connecting inside and outside worlds, and for forecasting what works.

The world is full of paradoxes and tensions; these natural phenomena will always be with us, and there is no single answer for resolving them, in healthcare or elsewhere.

You must pursue multiple actions simultaneously and constantly innovate from the top-down as well as the bottom-up, and you cannot be sure of everything before you proceed with anything.

Nothing is absolute, you cannot completely control human behavior, or preach prevention, or plead for rationality in all things, and you must heed informal relationships, gossip, rumors, and sidebar conversations, and these shadow behaviors – these completely human, sometimes irrational, reactions, are important because they foretell workable health and business models and subsequent actions with any chances of success.

The human world, and its healthcare derivatives, work by “chunking,” by allowing complex systems to emerge out of links with simple things, out of convenient, simple, inexpensive, predictable, patient-centered, physician-accepted disruptive innovations capable of operating independently rather functioning seamlessly as dictated by centralized bureaucracies.

Success usually flows from cooperation and competition rather than conflict and conquering rather than one or another.

Many of the thoughts expressed above have their roots in the book Edgeware: Insights from Complexity Science for Health Care Leaders, VHA, Inc. 1998