How to Lead Using Complexity Theory in Healthcare

Healthcare fails when good people apply the wrong kind of solutions to the healthcare system.

This post highlights concepts that will improve your leadership using complexity theory. (see Edgeware: lessons from complexity science for health care leaders by B. Zimmerman, C. Lindberg, and P. Plsek)

Use a New Metaphor

Military and machine metaphors dominate healthcare thinking (e.g., cog, mesh, direct, follow, limit, leverage, tune, ramp up, etc.). These metaphors shape our solutions. Complexity offers something different:

Simple is like following a recipe to bake a cake: anyone can follow the instructions and get a good result.

Complicated is like sending a rocket into space: a team of smart people, improving process with each attempt, can figure out the best way to fly in space.

Complex is like being in a romantic relationship or raising a child: success with one is no guarantee of success with another.

Features of Complex adaptive systems:

Non-linear
Adaptive
Distributed control (central control slows system’s ability to react)
Size of input produces unpredictable effect (small input might create huge impact)
Large numbers of connections between a wide variety of elements

Leadership Principles

1. Focus on Minimum specifications / Good Enough: Don’t even try planning all the details before you start; it’s impossible. Get a clear enough sense of the minimum needed and get started.

2. Find Attractors: Learn which patterns or areas draw the energy of the system. Imagine how to attract a bird to leave your room vs. How to roll a marble down a track.

“Complexity suggests that we create small , non-threatening changes that attract people, instead of implementing large scale change that excites resistance. We work with the attractors.” p. 11

3. Get Comfortable with Uncertainty: Solutions need to be rapidly adaptable. They must be comfortable with both data and intuition, planning and acting, safety and risk.

4. Use Paradox and Tension: lead by serving, keep authority without having control, give direction without directives

5. Tune to the Edge: Don’t be afraid to stray from the centre. Go to the fringes for multiple actions ; let a direction arise.

6. Be Aware of the Shadow system: Gossip, rumor, informal relationships, hallway conversations

7. Use Chunking: Grow complex systems by connecting simple systems that work well

8. Mix Cooperation and Competition: don’t think either/or

(photo credit: www.nytimes.com)

Emergency doctors demand seven-day primary care support | GPonline.com

This headline comes from Britain (see the link at the bottom).

Many Canadians think they can stop “inappropriate visits” to emergency departments by educating the public. They assume people need more information.

Patients need more access, not more information.

Until we design the system to offer great ways to access care that fits into patients’ lives, we will continue to have patients accessing emergency departments for concerns that could possibly be handled in private offices.

But, we can’t just demand longer office hours. We need to support physicians in the community with acute lab and X-Ray support and attract physicians to work unsociable hours. (We wouldn’t need to attract physicians to work unsociable hours if MDs had to compete for patients.)

Emergency doctors demand seven-day primary care support | GPonline.com.

P.S. If hospitals changed from their current Monday-Friday, 9-4:30 schedules to a 7 day/week approach, we would increase patient flow and patient access, too.

Doctors, Incomes, and Fancy Cars

People look at the cars in the doctors’ parking lot to estimate MD income. Most folks still think that doctors are loaded, and doctors generally like to be thought of as rich.

This post looks at physician income, motivation, and public myths about what doctors get paid.

In a private medical system, if doctors don’t drive a Lexus or better, they must not be a good doctor.

In a publicly funded system, doctors should drive a Honda, otherwise we pay them too much!

Physician Income:

1. Physicians who work more, earn more.

Most MDs do not receive a salary; they increase their earning by working longer hours. Like any self-employed business person in a market that needs your services, time and energy are the only limits to earning. No matter what you earn per hour, if you work 100 hour weeks, you will earn $$$$, too.

2. Physician income does not equal take-home pay.

Most physicians hire staff, pay rent, lease equipment, and carry dozens of other expenses related to running a small business that eat up 35% of gross billings.

3. Physicians do not receive benefits.

MDs pay for their own pension, medical, dental, vacation, etc. Benefits typically cost 25% of income.

4. Physicians earn less than other professionals.

With similar training and experience (or much less), professionals in other industries (law, dentistry, finance) earn more.

5. Physicians don’t own all their bling.

Physicians aren’t known for financial prudence or frugal living. Fancy cars are often leased: one more payment to a stack of debt.

Physician Motivation:

1. Delayed gratification.

After 12-15 years of University, many physicians think they’ve earned the right to spend. After watching friends in other professions buy houses and raise families, physicians think they’ve earned the right to go deeper into debt with a fancy car.

2. Societal expectation.

Despite begrudging envy, non-physicians expect doctors to spend. They look askance if MDs drive up in an old vehicle. People need to see extravagance, any extravagance, to justify their firm conviction that physicians are loaded.

3. Peer pressure.

Very few docs resist dressing, spending, and living like their colleagues.

Summary

Physicians do very well and work very hard for it. Anyone who trains for years and works hard can do as well, or better, in North America. What’s holding you back?

(photo credit: asianweek.com)