The Zen of Organization

There is no inside. There is no outside. There is only context.

(From a conversation this morning on systems thinking, complexity, the problematics of so-called interdependence, and Effective Theory.)

The Value of Complexity Thinking

From an editorial by Dr. Jean Boulton, Visiting Fellow at Cranfield School of Management and Managing Director of Claremont Management Consultants in the UK, to appear in a forthcoming special issue of Emergence: Complexity and Organization on Policy and Climate change:

So what has complexity thinking to offer? One of the great difficulties in answering this question is that the question itself is framed within a reductive, Newtonian, machine paradigm. We want complexity thinking to give us answers and solid ways forwards because we believe that optimal solutions and predictable outcomes exist. Part of what complexity thinking has to offer is that is gives ample evidence that the future, whilst not being random, indeed being path-dependent, is nevertheless not predictable. There are often turning points where the future may evolve in more than one direction; the future is a complex product of the past, mitigated by chance and by choices; where different decisions in seemingly different spheres interact and mutually affect each other. So, whilst we might not like the picture it presents, complexity thinking emphasises interconnectedness and dynamic change and emphasises the limits to predictability and indeed to knowledge. And there is an argument to say that if we accept the reality of this, we may indeed do a better job of developing policy and creating processes.

It seems to me that there is an opportunity to focus learning, organization, social enterprise, and policy development in a context of complexity thinking, emphasizing diverse sustainability among cultural, ecological, and built environments, and resilience in the face of the inherent unpredictability of seeming intractable problems of our world.

Someone should create such a place.
[Grin.]

Innovating Innovations in Healthcare

Yesterday, I had the pleasure of visiting the Centre for Innovation in Complex Care. It is an interprofessional, trans-institutional organization, housed at the University Health Network in downtown Toronto that is

dedicated to studying how to improve the entire process of care for patients with multiple problems. Its purpose is to engage our patients and clinicians to identify problems with current healthcare practices and develop solutions for addressing them. Innovative research and evaluation in a real clinical environment will allow our clinicians to utilize the latest technology to improve patient care.

It is also, much to my delight, a UCaPP organization, and it is its UCaPP nature that is its key to success in achieving true innovation throughout every aspect of the healthcare system.

The Centre has active projects that range from improving clinical communications via new Blackberry applications, to methods that are focused on improving the in-patient experience, to completely rethinking and redesigning the systems and processes associated with treating atrial fibrillation, currently the most frequently encountered arrhythmia for which patients are admitted to hospital (not to mention being “challenging, costly, and resource intensive”).

So what makes the CICC innovative in its approach and organizational design – that is, what makes it UCaPP – and how does this influence its success? Fundamental to all UCaPP organizations is the idea that change happens where it happens, and the impetus for change can come from literally anywhere in an organization, or in this case, anywhere throughout the healthcare system. CICC members include physicians and nurses, pharmacists and nutritionists, engineers and designers, researchers and patients. It includes members from all the teaching hospitals in Toronto, and institutions elsewhere in Ontario. To become a member, one “only” needs to initiate a project (more on that in a moment), and find collaborators, which precisely echoes the process I’ve observed in other UCaPP organizations. Their “rounds” – medical jargon for socializing knowledge – are generally open to any interested party, and those who are interested in innovations in healthcare that address systemic or global issues are welcome to initiate a project conversation that is consistent with the Centre’s vision and values. As its Medical Director, Dr. Dante Morra, said to me, “if you’re interested in addressing a handwashing issue on 13E, we’re not so interested. If you’re interested in addressing a handwashing issue throughout the entire system, come talk to us.” Project participation is largely through self-nomination, which means that there is an emergent and organic vetting and review process that occurs throughout its life. There are lots of opportunities to share information, through weekly operational rounds, monthly deep-dive reviews of active projects in which all members from among multiple areas of expertise have an opportunity to contribute, and innovation rounds that look at new opportunities coming into the Centre.

The Centre strikes me as non-hierarchical, with any individual being able to take relative leadership roles, depending on the nature of what type of leadership needed at any particular time for any given project. Most important, however, is that the collaborative leadership creates a tremendous sense of camaraderie, with individual autonomy among the members, collective responsibility for the success of each project, and mutual accountability for the Centre’s overall success. It’s through innovations like this one that healthcare will become sustainable, especially in the face of increasing challenges and demands.