Addition to Christmas List of Health Reform Books

Edgeware is a thinking approach. This is not a program that you roll out in organizations with banners and coffee mugs. It is a new way of thinking and seeing the world – and, hence, a new way of working with real organizational and health care issues.

Edgeware: Insights from Complexity Science for Health Care Leaders, by Brenda Zimmerman, Curt Lindberg, and Paul Pisek, VHA, Inc, 1998

December 9, 2011- When I suggested a list of Christmas health care books in yesterday’s blog, I forgot to mention one of my favorites, Edgeware.

Edgeware is a 1998 paperback of 228 pages. You can buy it new on amazon for $26.49 and used for $4.69.

No, Edgeware is not about kitchen knifeware. It’s about health care’s complexity. It’s about taking and handling risks at care’s cutting edge.

Though Edgeware predated the health reform law by a dozen years, Edgeware's lessons apply to dealing with complexities at the edges of today’s health law.

Edgeware sets forth these principles.

• View your system through the lens of complexity – Health organizations are not like a machine or military organization. Reform is about dealing with complex, often fickle, human beings.

• Build a good-enough vision with minimum specifications - The government’s mistake is trying to implement a sweeping vision with maximum specifications. This mistake may bring down ACOs, EHRs, and the IPAB Indepedent Payment Advisory Board),

• When life is far from certain, lead from the edge. Balance, intuition, planning, and risk, giving honor to each. Government reform tries to lead from the center and gives no honor to what is intuitively wrong at the edge.

• Tune your place to the edge, fostering the “right” degree of information flow, diversities and differences, with power considerations inside and outside the organization – Don’t try to control everything, deal separately with contentious groups, seeking comfort with each.

• Uncover and work with paradox and tension – These are natural with sweeping reform. Live with them.

• Go for multiple actions at the edge- rather than being absolutely certain before you do anything. Uncertainty is the name of the reform game. Health care uncertainties are a big reasons businesses don't hire.

• Listen to the shadow system- gGossip, informal relationships, rumors, and hallway conversations – They are powerful and may dictate future actions.

• Grow complex systems by chunking – These systems emerge from links of simple systems that work well independently.

• Mix cooperation and competition - This will always be true with hospitals and physicians. You cannot force competiton. It doesn’t work.

Tweet: Health reform follows the principles of complexity science. Learn how to adapt to complexity by reading the book, Edgeware.