Transcript Complexity Theory and Decision Making in Health System

Complexity Theory and
Decision Making in Health
System
• “ I never make predictions, especially
about the future.”
•Sam Goldwyn Mayer
How Hazardous is Health
Care
Dangerous
Total # of Deaths
100K
Safe
Health Care
Driving
10K
1K
Scheduled
Airlines
100
Mtn Climbing
10
Chemical
Manufacturing
Bungee Jumping
1
1
10
100
Chartered
Flights
1K
10K
# Encounters / Death
100K
European
Railroads
Nuclear
Power
1M
10M
Health Care as a Complex
System
• Health care organizations can be
viewed as complex systems (Institute
of Medicine 2001; Plsek and
Greenhalgh 2001; Sweeney and
Griffiths 2002).
C
A
B
Sufficient Cause Cluster
X
Effect
Simple
• Baking a cake is a simple problem.
• Simple problems lend themselves to a
recipe approach.
• The process and results are generalizable;
and while special skill at cooking is a plus,
it is not essential for success.
~D O
M K
C
A
B
X
~D O
M K
Y
C
X I
A
B
G J
~D O
M K
Y
C
X I
A
B
G J
D
P
X
~A Z
~D O
M K
Y
C
X I
A
B
G J
D
A
~K
P
X
~A Z
~D O
G
M K
V
T
C ~G
N
P
S
R Z
C
X I
A
B
G J
U T Q
P
L
D H
D
A
~K
P
X
~A Z
Y
Complicated
• Sending a rocket to the moon is an example of a
complicated problem.
• Complicated problems are best dealt with using
formulaic and expert-knowledge approaches.
• The overall problem can be mechanistically
broken down into component parts (booster
rocket, cabin environment, navigational
equipment, etc.) and assigned to teams of
experts who utilize the proven methodologies of
their disciplines.
Complicated
• Rockets are similar in important ways,
meaning that success with one rocket
provides reasonable assurance of success
with future rockets.
• When surprising events do occur, we can
study these, build improvements into the
system, and thus raise the probability of
future success.
~D O
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M K
P
S
? Z
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X ?
A
B
G J
? ? ?
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A
~K
P
X
? Z
Y
Complex
• In contrast to simple and complicated issues, an
example of a complex issue is that of raising a
child.
• Success in raising one child is no guarantee of
success in raising another.
• Past experience, coupled with advice from
experts, can serve as a starting point; but we
know that simply applying the formula that
worked before may not lead to success, and
may even lead directly to failure because of the
second child’s resentment at being treated this
way.
• Across all disciplines, at all levels, and
throughout the world, health care is
becoming more complex.
Complex Adaptive Systems: Definition
• A complex adaptive system is a collection
of individual agents with freedom to act in
ways that are not always totally
predictable, and whose actions are
interconnected so that one agent's actions
changes the context for other agents.
Stacey Diagram
Far from
Agreement
Level of Agreement
Decisions will have
varying levels at
which the entire
system agree that a
particular effect is
desired.
The Degree of Certainty
Decisions are more certain
when the cause and effect
linkages are well known.
Close to
Agreement
Close to certainty
Far from certainty
Stacey Diagram
Where even enough
hard evidence is not enough
Far from
Agreement
Close to
Agreement
Where there is not
enough hard evidence
Close to certainty
Far from certainty
Stacey Diagram
Far from
Agreement
Simple:
Rational
decision-making.
Straightforward
planning & control
Close to
Agreement
Simple
Close to certainty
Far from certainty
Stacey Diagram
Far from
Agreement
Close to
Agreement
Chaos
Simple
Close to certainty
Far from certainty
Chaos:
No discernible
patterns.
Disintegration
& anarchy
Stacey Diagram
Far from
Agreement
Chaos
Complicated
Close to
Agreement
Simple
Close to certainty
Far from certainty
Stacey Diagram
Far from
Agreement
Chaos
Complicated
Close to
Agreement
Simple
Complicated
Close to certainty
Far from certainty
Stacey Diagram
Far from
Agreement
Zone
of
Complexity
Close to
Agreement
Close to certainty
Far from certainty
Stacey Diagram
Far from
Agreement
Good enough planning–minimum
specification, simple rules
Multiple actions
Experiment and tune system
plan-do-check-act
Political decision making
Negotiation and
consensus building
Compromise
Close to
Agreement
Plan and control
Regulate
Scan for
patterns
Listen to the shadow system
Use intuition, muddle through
Metaphors
Use complex thoughts
for complex systems
Judgmental decision
making
Mission and vision
based decision making
Close to certainty
Far from certainty
What is the fate of a complex
system of decisions ?
Far from
Agreement
Finding more cause components
from already known cause clusters
and discovering unknown cause
clusters
*
Close to
Agreement
Close to certainty
*
Far from certainty
What is the fate of a complex
system of decisions ?
Far from
Agreement
*
Consensus building around shared
Values and beliefs
*
Close to
Agreement
Close to certainty
Far from certainty
What is the fate of a complex
system of decisions ?
Far from
Agreement
*
*
Close to
Agreement
Close to certainty
Far from certainty
Falling into chaos :
Organizational Collapse,
Revolutions, Death
Stacey Diagram
• Many organizations are existing in all
areas of the matrix at different times.
• Traditional management methods are
effective in the Simple area.
• Management methods needs to be
altered in the Complicated areas – negotiation / compromise
– mission & values based
Stacey Diagram
• If you try to use traditional management
methods (plan & control) in the Zone of
Complexity, you usually get unintended
and unpredictable consequences.
• Complex Adaptive Systems can exist and
thrive in the Zone of Complexity.
• PDCA cycle is an example of management
in the complex zone allowing tuning,
experimenting, and good-enough planning.
System Design
• The distinction between these systems
is obvious, but frequently not taken into
account when system is designed.
• When the human components respond
in an unpredictable manner, they are
labeled as being unreasonable or
“resistant to change.”
• The designer then specifies behavior in
greater detail via rules, guidelines, etc.
Thank You!
Any Questions!