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July 2009

Spotlight

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How to Work Effectively in Complex Systems


Peter L. Bradford, MSN CPHQ

Healthcare is an exceedingly complex system comprised of multiple interactive variables; therefore, professional strategic plans often become obsolete even before they are implemented. Without dynamic and constant revisions, performance improvement plans are often “dead on arrival.”
    However, this situation is changing, due in large part to new goals in healthcare that include gathering the right data, analyzing the data frequently, and reacting to challenges appropriately and quickly. These goals are providing healthcare providers the means to perform assessments, fully explore the variety of solutions available to them, and implement strategies in a coordinated, system-leveraging effort—all with the goal of producing large-scale systemic change. This new approach takes into account the myriad of factors that can enhance or derail an intervention. I recommend that to leverage complex systems, you should strive to do the following:
  • View your system through the lens of complexity. Failure to do this leads managers to ignore individualism and overlook the chance to enhance interactions among different—and differing—participants.
  • Build a good-enough vision. Don’t be overly detailed, academic, or rigidly adherent to a program. Teams, individuals, and organizations must remain flexible in their thinking and reactions. They should strive to balance rational, planned, and standardized processes with experimentation, autonomy, freedom, and intuition.
  • Steer away from rigidity. Avoid controlling information, forcing agreement, dealing separately with contentious groups, or submitting to highly hierarchal groups. Instead, foster creativity by promoting a flow of information, diversity, and connections between potentially competing and mutually dependent elements. Thoughtful and honest reflection is vital.
  • Uncover and work with paradox and tension. For many, this can be unpleasant. Expect the unexpected and be open to failure and conflict. Focusing exclusively on building consensus on single issues can thwart innovation and creativity. Remember that the most creative work is often done during periods of tension and conflict.
  • Be certain of uncertainty. Plan, but be flexible. Remain open to new ideas and to change. This openness will allow your group, task force, team, department, or organization to evolve quickly.
  • Listen to everything. Often what is not said at meetings but whispered in hallways is valuable and insightful information. Information comes in many forms—rumored and upfront—but all of it is important.
  • Understand complex systems and inertia. The Internet is a prime example of a vastly diverse, complicated system that self-organized on the fly and proliferated at an incredible speed. The lesson for organizations: Try anything and everything. Your attempts may lead to fortunate results!
  • Be nice but tough, forgiving but definite. Both cooperation and competition are often required when the stakes are high. Compete gracefully—try to mix competition with the essentials of cooperation to reach a common goal. Consider the hospital that buys and operates a failing private urgent-care center in the community. Perhaps its long-term goal is to consolidate control over local access points?
  • Find balance between uncertainty and predictability. Combine traditional processes with innovation. Mix things up by addressing uncertainty, rekindling a passion for change, building consensus, nailing down a project budget, establishing project timelines, and theorizing about goals. Just always be doing something!

Peter L. Bradford, MSN CPHQ, of Kaiser Permanente, will be speaking at the NAHQ Annual Educational Conference in September. He can be reached at pbradfordwv@earthlink.net. Bradford’s paper, Applications of Complexity Theory in Clinical Settings, will be posted on www.nahq.org in early August.