Preconference Tidbit #6 - Complexity Model
by Paul Uhlig
This the start of three
Tidbits about models for understanding and studying collaborative care.
This one is the Complexity model.
We are fortunate to have
people with us at our meeting who are true experts in complexity science. Luci
Leykum, our host from San Antonio, is a pioneering scholar in the application
of complexity science to the study of health care teamwork. Jeff Cohn is
President of the Plexus Institute, whose mission is the application of complex
systems in health care. Luci and Jeff will be able to take this Tidbit much
farther.
What is complexity?
· Baking a cake is “simple.” If you follow the recipe precisely, you
can be confident of the outcome, every time.
· Sending a rocket to Pluto is “complicated.” There are many things
to account for, but, if you calculate everything out well enough you can be
confident you will get there.
· Raising a child is “complex.” There are too many interdependencies
to figure it all out. Even if you do everything exactly like the parenting book
says you should, you really have no idea how things are going to turn out.
Hard! The good news for parents is there are some “simple rules” that are
pretty good guides for you: love them, teach by example, communicate, and so
forth. These guides won’t guarantee an outcome, but they are very likely to
help.
Complexity science is like
that. Complexity science helps us do complex, puzzling things that
are difficult to approach any other way.
Whereas ordinary science
takes snapshots of things, complexity science is like a movie. It assumes that
every system is always in motion, and always evolving. Complexity science is interested in how
systems grow, develop, evolve, learn, and adapt. Complexity scientists look for
factors that shape the growth and evolution of complex systems, and how they
can be nudged to develop in certain desirable ways.
A lot of quality
improvement in health care focuses on processes of care, trying to specify them
or standardize them. Pioneering researchers like Luci with a complexity
orientation take a different approach. Instead of trying to standardize
processes like a complicated recipe, they focus on the growth and development
of relationships, learning, sensemaking, and improvisation within the care
team, and how these are related to care outcomes. Taking this to an even higher
level, these researchers look for conditions and interventions in the care
environment that can help desirable care attributes emerge.
This research has a
language all its own that comes also from a related field of study called High
Reliability Organization theory. If you study these approaches, you will learn
words and phrases like heedfulness,
mindfulness, sensemaking, collective mind, self-organization, emergence,
co-evolution, uncertainty, adaptive reserve, sensitivity to initial conditions,
etc. These all make sense, but like any new language they may be somewhat hard
to navigate around at first. But they are worth learning.
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