applications of complexity science to healthcare
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Applications of Complexity Science to Healthcare Brenda ZimmermanTRANSCRIPT
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Healthcare – Complicated or Complex?
Brenda Zimmerman, PhDDirector of Health Industry
Management Program Associate Professor of Strategy
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Heart Rate Dynamics ( from Dr Ary Goldberger,Harvard)
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Heart Rate Dynamics
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Heartsongs
• Listen to the “songs” of healthy hearts• Not random and yet not a rigid
pattern
• Between orderly and disorderly
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Lessons From Physiology• “As humans we are complex
and chaotic when healthy and rigidly orderly when ill.”
Stuart Davidson
• Healthy heart has difference, irregularity, and is sensitive to changes in context ---- it is adaptable!
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“You don't see something until you have the right metaphor to let you perceive it”. Thomas Kuhn
Believing is seeing. ” Karl Weick
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Mental models
• Assumptions • Metaphors
• Challenge of implicit vs. explicit mental models
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Common ImplicitMental Models
• Scarcity• Gap analysis–
what isn’t working
• Parts• Complicated• Machine – like
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Common ImplicitMental Models
Alternatives/Opposites
• Scarcity• Gap analysis–
what isn’t working
• Parts• Complicated• Machine – like
• Abundance• Appreciative
inquiry – what is working
• Relationships• Complex• Life – like
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In Health Care (almost) Nothing is Simple
• Distinguish between “complicated” and “complex” problems
• Dealing with complex problems as if they are complicated is like looking for your car keys in the lamplight
• Seemingly intractable complicated problems can often be viewed more optimistically and unraveled when they are seen as complex
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Following a Recipe Rocket to the Moon Raising a Child
• Formulae are critical and necessary
• Sending one rocket increases assurance that next will be ok
• High level of expertise in many specialized fields + coordination
• Separate into parts and then coordinate
• Rockets similar in critical ways
• High degree of certainty of outcome
• Knowable
• Formulae have only a limited application
• Raising one child gives no assurance of success with the next
• Expertise can help but is not sufficient; relationships are key
• Can’t separate parts from the whole
• Every child is unique
• Uncertainty of outcome remains
• Unknowable
Complicated Complex
The recipe is essential
Recipes are tested to assure replicability of later efforts
No particular expertise; knowing how to cook increases success
Recipe notes the quantity and nature of “parts” needed
Recipes produce standard products
Certainty of same results every time
Known
Simple
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Following a Recipe Rocket to the Moon Raising a Child
• Formulae are critical and necessary
• Sending one rocket increases assurance that next will be ok
• High level of expertise in many specialized fields + coordination
• Separate into parts and then coordinate
• Rockets similar in critical ways
• High degree of certainty of outcome
• Knowable
• Formulae have only a limited application
• Raising one child gives no assurance of success with the next
• Expertise can help but is not sufficient; relationships are key
• Can’t separate parts from the whole
• Every child is unique
• Uncertainty of outcome remains
• Unknowable
Complicated Complex
The recipe is essential
Recipes are tested to assure replicability of later efforts
No particular expertise; knowing how to cook increases success
Recipe notes the quantity and nature of “parts” needed
Recipes produce standard products
Certainty of same results every time
Known
Simple
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Following a Recipe Rocket to the Moon Raising a Child
• Formulae are critical and necessary
• Sending one rocket increases assurance that next will be ok
• High level of expertise in many specialized fields + coordination
• Separate into parts and then coordinate
• Rockets similar in critical ways
• High degree of certainty of outcome
• Knowable
• Formulae have only a limited application
• Raising one child gives no assurance of success with the next
• Expertise can help but is not sufficient; relationships are key
• Can’t separate parts from the whole
• Every child is unique
• Uncertainty of outcome remains
• Unknowable
Complicated Complex
The recipe is essential
Recipes are tested to assure replicability of later efforts
No particular expertise; knowing how to cook increases success
Recipe notes the quantity and nature of “parts” needed
Recipes produce standard products
Certainty of same results every time
Known
Simple
![Page 14: Applications of Complexity Science to Healthcare](https://reader033.vdocuments.net/reader033/viewer/2022042703/568bd5151a28ab2034972e0d/html5/thumbnails/14.jpg)
Following a Recipe Rocket to the Moon Raising a Child
• Formulae are critical and necessary
• Sending one rocket increases assurance that next will be ok
• High level of expertise in many specialized fields + coordination
• Separate into parts and then coordinate
• Rockets similar in critical ways
• High degree of certainty of outcome
• Knowable
• Formulae have only a limited application
• Raising one child gives no assurance of success with the next
• Expertise can help but is not sufficient; relationships are key
• Can’t separate parts from the whole
• Every child is unique
• Uncertainty of outcome remains
• Unknowable
Complicated Complex
The recipe is essential
Recipes are tested to assure replicability of later efforts
No particular expertise; knowing how to cook increases success
Recipe notes the quantity and nature of “parts” needed
Recipes produce standard products
Certainty of same results every time
Known
Simple
![Page 15: Applications of Complexity Science to Healthcare](https://reader033.vdocuments.net/reader033/viewer/2022042703/568bd5151a28ab2034972e0d/html5/thumbnails/15.jpg)
Following a Recipe Rocket to the Moon Raising a Child
• Formulae are critical and necessary
• Sending one rocket increases assurance that next will be ok
• High level of expertise in many specialized fields + coordination
• Separate into parts and then coordinate
• Rockets similar in critical ways
• High degree of certainty of outcome
• Knowable
• Formulae have only a limited application
• Raising one child gives no assurance of success with the next
• Expertise can help but is not sufficient; relationships are key
• Can’t separate parts from the whole
• Every child is unique
• Uncertainty of outcome remains
• Unknowable
Complicated Complex
The recipe is essential
Recipes are tested to assure replicability of later efforts
No particular expertise; knowing how to cook increases success
Recipe notes the quantity and nature of “parts” needed
Recipes produce standard products
Certainty of same results every time
Known
Simple
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Know When Your Challenges Are In the Zone of Complexity
CertaintyClose to Far from
Clo
se to
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Know When Your Challenges Are In the Zone of Complexity
CertaintyClose to Far from
Clo
se to Simple
Plan, control
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Know When Your Challenges Are In the Zone of Complexity
CertaintyClose to Far from
Clo
se to Simple
Plan, control
Chaos
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CertaintyClose to Far from
Clo
se to
Simple &complicated
Plan, control
ChaoticSeek Patterns
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CertaintyClose to Far from
Clo
se to
?
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Nature of complex systems• Interdependence –
cause and effect less clear
• Unpredictability• Emergence• Embedded systems• Nonlinearity• Distributed control• RELATIONSHIPS
ARE KEY
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IOM “Crossing the Quality Chasm”
• Inspiration from complexity science• Principles of complex adaptive systems
resonated• Simple rules that repeat
– Current system– Ideal system
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Simple Rules – allow for swarming
• They give enough of a sense of direction without over-specifying
• Local solutions can be discovered (at the “edge” rather than center)
• Following same rules – can result in different solutions – Creates coherence rather than
consistency
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Lessons from complexity• Learning takes place at the edge of the
system - not the center
• Sustainable change is initiated at the edge of the system – not the centre
• Adaptation to changing external conditions occurs at the system’s edge– not the center
• Command and control makes it worse• Dr. Eric Knox, at AHA Patient Safety
Fellowship 2003
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Patient Safety• Goal is to reduce harm, injury
• Error producing conditions:– Unfamiliarity with task– Shortage of time– Poor communication– Information overload– Poor instructions– Etc..
• Swiss Cheese Model – “gaps” – system Reason, 2001
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The Patient Safety Problem -Simple• People are making mistakes
• Hire the best
• Create rules to correct behaviors
• Tell people to follow rules
• If non-compliance, shine light
• Get rid of or correct “bad apples”
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Patient Safety - complicated
• To err is human (slips, trips and lapses)• Refocus on system problems• Decrease reliance on memory and
other faulty human aspects• Standardize, routinize, reduce
variability • Human factors engineering• Safety culture
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Patient Safety - Complex
• Relationships are key• Focus on Humans – not just as “error
producers” or faulty machine parts• Communication focus • Include full system into processes – patients,
families, clerical staff, etc. • Look at patterns - simple rules that hold
system• Role of surprise and emergence – what is
working/why
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Complexity ConsistentMental Models
• Relationship-Centred Care
• Patient and Family Centred
• Holistic• Embedded
Systems
• Abundance• Appreciative
inquiry – what is working
• Relationships• Complex• Life – like
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“Managers would rather live with a problem they can’t solve
than with a solution they can’t fully understand or control.”
• Eric Bonobeau, researcher in swarm intelligence and CEO of Icosystems