complexity theory and decision making in health system
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Complexity Theory and Decision Making in Health System. “ I never make predictions, especially about the future.”. Sam Goldwyn Mayer. Health Care. Driving. Scheduled. Airlines. Chartered. European. Flights. Railroads. Mtn Climbing. Nuclear. Bungee Jumping. Chemical. Power. - PowerPoint PPT PresentationTRANSCRIPT
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Complexity Theory and Decision Making in Health
System
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• “ I never make predictions, especially about the future.”
• Sam Goldwyn Mayer
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How Hazardous is Health Care
# Encounters / Death
Tota
l # o
f D
eath
s
Health Care
Bungee Jumping
1K10 100 10K 100K1 1M 10M
100K
1K
10
100
10K
1
Mtn Climbing
Driving
ChemicalManufacturing
CharteredFlights
NuclearPower
EuropeanRailroads
ScheduledAirlines
Dangerous Safe
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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).
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A
C
BX
Sufficient Cause Cluster Effect
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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.
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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.
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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.
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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.
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• Across all disciplines, at all levels, and throughout the world, health care is becoming more complex.
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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.
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Stacey Diagram
Close toAgreement
Far fromAgreement
Close to certainty Far from certainty
Level of AgreementDecisions will havevarying levels at which the entire system agree that a particular effect is desired.
The Degree of Certainty
Decisions are more certainwhen the cause and effectlinkages are well known.
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Stacey Diagram
Close toAgreement
Far fromAgreement
Close to certainty Far from certainty
Where there is not enough hard evidence
Where even enough hard evidence is not enough
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Stacey Diagram
Close toAgreement
Far fromAgreement
Close to certainty Far from certainty
Simple
Simple:
Straightforward
decision-making.
Rational
planning & control
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Stacey Diagram
Close toAgreement
Far fromAgreement
Close to certainty Far from certainty
Simple
Chaos:
Disintegration
patterns.
No discernible
& anarchy
Chaos
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Stacey Diagram
Close toAgreement
Far fromAgreement
Close to certainty Far from certainty
Simple
Chaos
Complicated
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Stacey Diagram
Close toAgreement
Far fromAgreement
Close to certainty Far from certainty
Simple
Chaos
Complicated
Complicated
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Stacey Diagram
Close toAgreement
Far fromAgreement
Close to certainty Far from certainty
Zone
of
Complexity
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Stacey Diagram
Close toAgreement
Far fromAgreement
Close to certainty Far from certainty
Good enough planning–minimum specification, simple rulesMultiple actionsExperiment and tune system plan-do-check-act
Listen to the shadow systemUse intuition, muddle throughMetaphorsUse complex thoughts for complex systems
Plan and controlRegulate
Scan forpatterns
Political decision makingNegotiation and consensus buildingCompromise
Judgmental decision makingMission and vision based decision making
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What is the fate of a complex system of decisions ?
Close toAgreement
Far fromAgreement
Close to certainty Far from certainty
**
Finding more cause components from already known cause clustersand discovering unknown cause clusters
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What is the fate of a complex system of decisions ?
Close toAgreement
Far fromAgreement
Close to certainty Far from certainty
*
*Consensus building around shared Values and beliefs
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What is the fate of a complex system of decisions ?
Close toAgreement
Far fromAgreement
Close to certainty Far from certainty
**
Falling into chaos : Organizational Collapse, Revolutions, Death
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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
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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.
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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.
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Thank You!
Any Questions!