COMPLEXITY AND HEALTHCARE ORGANISATION

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COMPLEXITY AND HEALTHCARE ORGANISATION
D Kernick St Thomas Health Centre Exeter
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Complexity and health care organisation

• Are health care systems different?
• The path to complexity in health care policy
• Complexity descriptive and prescriptive options -
  concept edge of chaos
• The use of metaphor in health systems

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Is health care different to other organisations?

• Paradox
• Ambiguity

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Is the message getting through?

• In the long run it is more efficient and
  effective to motivate and empower rather than to
  issue detailed commands
  The Cabinet Office 20001
• Management through hierarchy alongside
  management through networks Milburn 2002
• The NHS is the epitome of a complex adaptive
  system. Such systems dont always respond well
  to mechanistic formulae.
  Fillingham 2002

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Complexity and health care organisation

• Are health care systems different?
• The path to complexity in health care policy
• Complexity descriptive and prescriptive options -
  concept edge of chaos
• The use of metaphor in health systems

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Performance measurement and management - concerns

• where persons are exposed to the workings of
  laws which are inconsistent with their wills or
  needs, they remain neither passive, helpless or
  powerless but actively strive to modify the
  working of such alien laws.
• Selznick 1943

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Performance measurement and management - concerns

• Lipsky - Street level bureaucracy dilemmas of
  the individual in public services 1980
• Goodharts Law 1990
• Goddard balance checking and trusting 1999

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Low connectivity Stable Paradigms consolidate
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Low connectivity Stable, Paradigms consolidate
Unstable High connectivity Highly innovative but
gains not consolidated
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Low connectivity Stable Paradigms consolidate
Self organised criticality Maximally adaptive and
Efficient. Each element optimally fit without
disrupting fitness of others
Chaotic Unstable High connectivity Highly
innovative but gains not consolidated
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Holding the system at self organised criticality
the interplay between regulation and gaming
(positive deviance)
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Low connectivity Stable Paradigms consolidate
Self organised criticality Maximally adaptive and
Efficient. Each element optimally fit without
disrupting fitness of others
Chaotic Unstable High connectivity Highly
innovative but gains not consolidated
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Complexity and health care organisation

• Are health care systems different?
• The path to complexity in health care policy
• Complexity descriptive and prescriptive options -
  concept edge of chaos
• The use of metaphor in health systems

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Imported organisational metaphors
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Is the NHS organisation fit for purpose?

• Value for money? Efficient?
• Adaptable/flexible?
• Robust?

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A shift to Governmentality in the NHS

• Shaping the conduct of conduct
• Clear pathways and share feedback
• Nuturing developing social capital
• Incentives that motivate the intrinsic values of
  staff
• From competition to co-operation

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Alternative simple rules for leaders

• Have a vision and share it
• Agree core values - what is good and what is bad
• Agree boundaries - what is in and what is out
• Value and build on relationships
• Build on existing strengths
• Learn by failure

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All this talk About organisation is doing my head
in
Im sorry to hear that doctor
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COMPLEXITY AND HEALTHCARE ORGANISATION
D Kernick St Thomas Health Centre Exeter