Paper: Complexity science and spread

Well, the best bit about this paper for me is the introduction of the terms SUS - scale up and spread!  It focuses on self organisation (complexity science principle) and how the complexity of healthcare and all the interactions are part of the problem of SUS programs.

Now, I'm biased and I'm with Ralph Stacey who says that when we think we can "control" or "use" self organisation then we are operating with a mindset not much different from Taylorism (see his work on complex responsive processes which superceded complex adaptive systems around 2001).

Whilst using insights from complexity science is useful, it is just that - an insight. When it comes to moving on to a more practical thought about - "so what do we do now", CAS and Complexity Science as such, falls flat.  There is a well trodden, pragmatic and practical systems theory and modelling that would be helpful in understanding interdependences - "Systems Thinking". Unfortunately it requires a bit of effort to grasp and seems not to have the cachet of "complexity science". Shame.

Soc Sci Med. 2012 Jul 4. [Epub ahead of print]
How complexity science can inform scale-up and spread in health care: Understanding the role of self-organization in variation across local contexts.
Lanham HJ, Leykum LK, Taylor BS, McCannon CJ, Lindberg C, Lester RT.

Resources to understand tragedy of the commons

At the Institute for Healthcare Improvement's National Forum today, Don Berwick used the example of 2tragedy of the commons" in his Opening Plenary. His pitch was to encourage healthcare leaders to cooperate and work for the wider and more common good and to beware of continuing to work on a self-centred and healthcare industry basis.

For those interested in the concept of "tragedy of the commons" I have put some links in here where you can get more information.

The original article by Garrett Hardin in 1968 which introduced the concept can be found here.

A special issue of Science magazine provides not only all the critical papers you need to read but also links to excellent web resources. You can find this here:

Some games you can play to simulate and understand what is meant by ToC (though anyone trying to get onto the conference wifi will know just what it feels like!). You can access these here:

One of my favourite bloggers covered ToC a while back. You can read his post and associated comments here:

I've been a fan of Systems Thinking for years. There are loads of tools and techniques to understand how ToC occurs and how to work with it. I'm looking forward to healthcare improvers adding systems thinking techniques into the regular and perhaps rather technical improvement techniques. You can learn about ToC using causal loop diagrams here, and discover resources at Pegasuscom.

Any more - please add in the comments below.

Projects need visions to manage uncertainty

I've never really gone for the whole vision "stuff" as the process often feels a bit unfocused and the outcome too non-specific to be of much use. However, today something clicked for me which made sense. I realised the purpose of the vision is to provide a map for the swampy area of our projects.

What is the swamp? It is where we are thinking about the future (time beyond immediate knowledge) and where this time intersects with large scale system change (lots of people, lots of stuff going on..).

If I have the desire to change a process which is mostly down to me and something I can do now, this feels a fairly certain and concrete process. It gets a bit more complicated if I think further into a future and also involve a wider group of people - team, department, organisation, community etc. At some point the amount of variables involved increase beyond the point of managing the process and even conceptually controlling the desired outcome. here I enter the swamp. A vision, therefore is the map I carry with me which has an outline, a representation of what this future holds for me and all the people also impacted by it. This helps me make sense not only of the future I am part of designing, but also of the present; it enables me to contribute to the uncertain future through my more certain actions right now.

We need system stars not individual stars

I thought I'd come up with a new idea only to discover that more than 80 years ago an article was written in The American Magazine about how perhaps the worst employee to have was the "brilliant" one because this was the person who would have lots of ideas, start them off and most likely never complete the work. You can read more about this orgininal article, called "Why I never hire brilliant men" here http://www.taoyue.com/stacks/articles/brilliant-men.html.

I'm interested in this topic because when it comes to the spread of good practice and scaling up good ideas across organisations and communities we so often focus on individuals. We point out the "champions", the so-called innovators, yet in my practical experience I am finding they really seem to be a turn-off at influencing others. I have written about this before.

What I am thinking about is that we focus on individuals because we are individuals. However, if we want system change we need to think about systems. And systems are not like individuals. They operate differently, to different rules, with different dynamics. We need to think decision-making processes, co-ordination, co-operation, collaboration and competition. Systems Thinking principles (from Senge's work) would be most appropriate here (more to come on this topic in future blogs).

So what we need are system stars for other systems to copy. We need to demonstrate that systems can operate the good ideas that we have. In healthcare we need to move away form the individualised models that we have and move away form the individualised model of scaling up to one which is more system focused - from its development through to its scaling up.

Creative Commons 2008 Sarah Fraser Attribution-Non-Commercial-No Derviative