A633.3.3.RB - Complex Adaptive Systems

Complex adaptive systems (CAS) are beginning to form the nucleus of several companies. Nick Obolensky mentions Morning Star and St. Luke as two examples in his text Complex Adaptive Leadership: Embracing Paradox and Uncertainty. Flat heiarchies, open information sharing, great emphasis on personal responsibility are all common features Obolensky says these companies share. This week I was to find a company that also used CAS and to also extract meaning for my organization.

A recent stay in the hospital and a second, more recent trip, to the emergency room led me to think about healthcare and CAS. A quick Google search turned up this article from the National Academy of Engineering regarding health care as a CAS.  They make a compelling argument and without reproducing their work here I can summarize why I agree.  

1. The health care industry is huge. Take a trip to the emergency room. How many parts are in motion? Ambulance crew, nurses, nurse aides, the doctor, maybe some clerical staff...that's just the obvious. What about behind the scenes? Cleaning staff for your room, lab technicians for your blood, staff to stock tools, sterilization of equipment, scheduling of MRI's and other equipment (MRI machines run on quantum theory by the way). Now expand to your insurance company and billing. The system has countless parts that all interact in their own way.
2. Hierarchies are relatively flat. Sure the doctor has the final say but nurses and technicians all have power. The doctor relies on the radiologist and the veteran nurse. The nurse relies on assistants and lab technicians. This means authority shifts from person to person and the players involved must trust each other
3. If done correctly the system is self-correcting. Lab work is done, information gathered, results are generated. Even in the event of a system failure (death of a patient) there are resources dedicated to finding out why and generating a results to aid in the prevention of future deaths.
4. There is no main point of control. Sure hospitals have administrators and doctors but control is fluid. Control shifts as a patient is in various rooms. There may be a framework in place to guide treatment but ultimately the locus of control is dependent on variables that often change.

When you stop and think about how massively complex healthcare can be just for a trip to the emergency room you can get a feel for how the system may start to exhibit traits of chaos theory and complexity science. Personally I think it's amazing it all works as well as it does. 

My organization responds to the whims of politicians and it is very hierarchical in nature. Applying complexity science to such an organization is difficult. The system is strangled by concerns that are often without form, by which I mean they are chained to opinion rather than fact. The foundation is shaky when it is dedicated to the whims of voters that, quite frankly, may or may not have any idea what they are talking about. I have made it clear in the past that opinions that are not based on verifiable information are not as valid as opinions that are. But isn't that the essence of complexity theory? What a mass of voters may or may not do is sometimes hard to predict. As Obolensky tells us, we have to go with these ebbs and flows. Therein lies a paradox. The system is chained to a chaos theory mass but in and of itself is very top-down and rigid. It actually makes very little sense. Chaos theory is part of quantum mechanics and as the great Richard Fynman said, "I think I can safely say that nobody understands quantum mechanics."