Monday, December 2, 2013

Systems Thinking
Grow complex systems by chunking – Allow complex systems to emerge out of links among simple systems that work well independently and are capable of working independently.
Brenda Zimmerman, Curt Lindberg, and Pau Plsek, Edgeware: Insights from Complexity Science for Health Care Leaders, VHA, Inc., 1998
When I think of health systems:
·         I think of progressives, like President Obama and his crew, who think until we have a single-payer system, we have no system.

·         I think of ObamaCare, an overly complex system that  redistributes  $250 billion from  the private sector and Medicare  to the uninsured, underinsured and  to Medicaid and exchange health plans designed by government. ObamaCare is Medicaid on steroids.

·         I think of the evolving  U.S. economic system, a system now is in an essentially a zero-growth mode,  and in which  there are winners (government and the perceived disenfranchised)  and losers (the private sector and the middle class).

·         I think of Dr. Charles Krauthammer (born 1950), who says the US. Health care system is an incredibly complex ecosystem which has evolved over the last 70 years and which government will never be able to manage.

·          I think of Peter Drucker (1909-2005), the father of modern management, who said businesses must take a “systematic, organized, and purposeful” approach to marketing and product development but that government cannot do the same because of its addiction to bureaucrtic procedure and its  attitude that wicked  business sector  and its obscene  profits are bad –ergo, government ownership must be good.”

·         I think of George Halvorson, CEO and Chairman of Kaiser, who maintains that “systems thinking” is the key to any successful health care enterprise and to successful health reform.

·         I think of John A. Powers (1922-1980), program information officer at the National Space Agency, who said of the moon shot, “All systems go. Everything is A-OK,” which works for focused government systems like space shots and the atomic bomb, but not for building a pluralistic health system involving multiple stakeholders.

·         I think of conservative economists, Friedrich Hayek (1899-1992), who said, “I am certain that nothing has done so much to destroy the juridical safeguards of individual freedom as the striving after this mirage of social justice”, and his protégé, Milton Friedman (1912-2012) who  succinctly summed it all  up by declaring, “There is no free lunch.”

·         But mostly I think of the nine principles for leaders of complex health care systems.

These principles are:

1.       View your system through the lens of complexity, rather than as a rigid government system governed by mandates, regulations, and rules that demand and require coercion of the populace.

2.      Build a good enough system rather than trying to plan control every detail. Everyone’s crystal ball is clouded.

3.      Lead from the edge rather than from the center by balancing intuition data, planning and action, safety and risk.

4.      Tune to the edge – that’s where the action is. That’s where diversity and differences, connections inside and outside the system, and power and anxiety are located, not in some remote authoritative place that perceive it has all the answers.

5.      Live with paradox and tension – they are part of the human condition and always accompany change. Your opponents are not your enemies. Help make them your helpmates. Listen to them rather than to yourself.

6.      Go with multiple actions at the fringes, rather than believing your overall plan have  all the ingredients of successful change as dictated by your philosophy.

7.      Listen to what goes on in the shadows –informal relationships,   opponents’ arguments, hallway conversations, rumor, and gossip.  These things are telling you what might go wrong.

8.      Grow your complex system by linking successful existing proven systems rather than replacing them with your big system’s big untested principles.

9.      Mix cooperation with competition rather than ridiculing or putting down the opposition who may be more right than wrong.

Tweet:  When thinking of system changes, remember Rome wasn’t built in a day. Move incrementally.  The barbarians are at the gates.

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