Comments on: Making ‘Sense’ of Health Care Costs and Other Complex Challenges

By: beth

beth — Sat, 04 Jun 2005 23:19:45 +0000

It’s unfortunate but understandable that this short New Yorker piece only looked at one part of the work of Wennberg and colleagues (with whom I have worked, in communications, for over a decade). As you so rightly point out here, Dave, and Kevin complains, change based on “best practices” alone doesn’t work, especially when it alienates and disregards the people who actually deliver the care. Wennberg’s group, and others, are looking not only at policy and organizational issues (and I’d argue that this is very important; without the patterns that these sorts of studies reveal it would be all too easy to ignore the incredible discrepancies that exist) but at strategies for empowering people at the microsystem level (the family-practice clinic, the intensive care unit) to study their own system and work together to create greater efficiency, quality, and team/patient satisfaction rather than having a top-down system “imposed”. They are also providing and encouraging graduate-level and medical school training to teach these concepts and hopefully help both new health care providers and mid-career professionals from experiencing the incredible frustration and burn-out we now see in the system. Only by creating a way for administrators, policy-makers, providers, staff and patients to understand the dynamics of this complex system and communicate together will we end up with any hope of real change – especially change that benefits the patient.

By: Jon Husband

Jon Husband — Thu, 02 Jun 2005 04:37:28 +0000

Just fyi .. in your neck of the woods (toronto) Cindy gordon and her helix commerce offering have just recently entered into strategic alliance with david Snowden and the Cynefin (Centre/Institute ?) to offer capabilities in “managing complexity”.I imagine that you know Cindy from your respective involvements in KM, but if not and you wantto connect with her, mike mcinerney knows her well and would introduce, I am sure.Personally, i’m dubious, as the material I received in an email brochure reads distressingly like all the other promises of consulting solutions-oriented fare … which means sell something that won’t go deep enough and won’t address rigorously enough the really hard mental-model and dynamics changing work that your “discomfort with the imprecision, uncertainty, lack of causality, and non-amenability to command-and-control hierarchy that complex approaches entail” statement sets out as a critical challenge.

By: Kevin Carson

Kevin Carson — Wed, 01 Jun 2005 04:47:38 +0000

The problem with “best practices” is, they’re determined by ass-brained bosses who know more about organizational/management culture industry-wide than they do about the actual production process within their own organization. I work in a hospital, and I don’t know how many times I’ve got an official happy-talk handout from HR about some new policy, justifying it as the “industry trend” or because “x out of y” hospitals in the region were already doing it that way. But since, as Kenneth Boulding observed, large hierarchical organizations create imaginary worlds in the minds of those at the top, their only feedback on how these “best practices” work out comes from those at the top of other organizations: resume carpet-baggers who have been shuffling between senior management jobs in one organization after another, who are just as clueless as they are. The only people in a position to identify the “best practices” in an organization are those at the bottom doing the actual work. And the bosses care fuck-all what we have to say. In fact, many corporations are so large that the transaction costs of identifying “best practices” and relaying the information to those in a position to implement them are higher than any possible savings. The only thing that keeps such organizations going is that they all belong to the same oligopoly industry, each firm competing against others with organizational cultures just as pathological as their own.

By: Herbinator

Herbinator — Wed, 01 Jun 2005 03:28:43 +0000

Geez, first glance at your post and my hackles immediately went up. Reading, I was calculating how much effort needed to be expended in answering. Then, your intent was revealed. Good thing, too; I like believing you to be aware.