Monday, November 5, 2007

Effect of complexity - Advice on Dealing with Complexity

“The best advice is to give no advice.”

Piet Hein, Grooks

Experts say the health system and medical practice itself are so complex nobody can understand them (or by implication) do anything about them.

When I hear this line, I think of Edgeware: Insights from Complexity Science for Health Care Leaders, VHA, Inc 1998). The book lays out nine pieces of advice. You may find them useful, even they come from a hospital organization and are being delivered by a blogger who has deputized himself as American physicians’ defender-in-chief.

The Nine Advice Principles on Dealing with Complexity

1) View your system as human interactions rather than as a machine or military organization with rigid rules. Be flexible. Adapt on the edge of human experience. In other words, it’s the patients, not the rules stupid.

2) Build a good-enough vision and provide minimal specifications rather than planning every detail. Don’t sweat the small stuff. When dealing with individual patients, it’s the small human gestures that count, not the overarching strategies.

3) Combine rationality (measurement , standards, and controls) with experiments (trial and error, risk taking and autonomy). Balance data and intuition. Data shouldn’t dictate what you do, nor should it be used to indicate your overall performance.

4) Pay attention to your practice’s edges where most information flows, differences, outside influences, control, and disputes occur. Deal with situations there one at a time. Listen to what your patients did before entering your practice and what they do after.

5) Uncover and work with paradox and tension. Don’t shy away from them as if they were unnatural. People disagree. Deal with it. Act incrementally. Between your patients and you, there are no miracles. There will always be uncertainties and differences of opinion.

6) Go with multiple actions at the fringes. Let your direction arise from what works. Don’t try to be “sure” before you proceed with anything. In an individualistic society like America, there is no single path to Nirvana.

7) Listen to the shadow system. Realize informal relationships, gossip, and hallway conversations echo how people actually think and what they do. Listen to your patients. They are telling you their diagnosis, their concerns, and their bias.

8) Grow by “chunking.” Allow your judgments to emerge out of simple solutions that work and are capable of being done independently. Always remember. Seek simplicity but distrust it in a complicated health system.

9) Mix cooperation with competition. It’s not one or the other. Let people compete with ideas and experiment. Dealing with patients is a dialogue not a dictatorship.

To this, I would add, cultivate “wild ideas” flowing from the frontlines. Don’t snigger. Listen, savor, and cogitate.


When coping with complexity, go to the edge of your practice. Go to the convexity. .For it’s there real things happen, where reality isn’t misshapen. Being there will help resolve your perplexity.


Indian Pharmacy said...

The first rule is the best one. I think that you should value your employee and think about them as human lives.

Selena said...

The writer is totally right, and there is no skepticism.