Health CAre


Application to Health CAre

Is health care simple, complicated, complex or chaotic? 

All of the above.  Many acute illnesses follow simple dynamics.  Other elements, such as treatment of many surgical diseases are complicated.  However, the “wicked problems” of access, cost, value and chronic diseases, as well as the delivery system itself, are complex

Since the Flexner Report of 1910, most of health care has been assumed to be complicated.  This orientation allowed tremendous advances in treatment of many of the serious medical problems of the last century.  Now that most of those have come under control, we are faced with the complex problems.  Unfortunately, our reductionist orientation will not be successful in dealing with these.  As Snowden and Boone pointed out, attempting to impose a reductionist order on complex problems will only shift the system into chaos.

And that is just what we risk at this time!

It is essential that health care organizations offer value for their services.  In “Redefining Health Care: Creating Value-Based Competition on Results”, Michael Porter and Elizabeth Teisberg outlined steps needed to reverse the destructive zero-sum competition that has produced the current morass.  Those organizations providing maximum value operate “at the edge of chaos”.  As this is counterintuitive to most business management philosophies, value has become elusive.  Yet that very property insures opportunity for those organizations that can understand these dynamics.

To operate at the “edge of chaos”, the organizational culture must support the process.  Dave Logan, another of my mentors, together with John King and Halee Fischer-Wright described the needed culture in “Tribal Leadership: Leveraging Natural Groups to Build a Thriving Organization”:

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