Something I’ve noticed from interviewing leaders is the number of times they use numbers in their answers. “There are four things you need to understand about that.” “I’ll give you two – no wait – three, examples.” “Two things to mention here …” And so on. It sounds planned, but it’s usually impromptu. It’s like […]
30 March 2018
Medicine has made profound advances in treating many diseases, but in its great strength lies its debilitating weakness.
Organizing for Professional Work
To understand this, consider how professional work tends to be organized. Much of it is rather standardized, carried out by highly-trained people with a good deal of individual autonomy—at least from their colleagues, if not from the professional associations that set their standards. Just as the musicians of a symphony orchestra play in harmony while each plays to the notes written for his or her instrument, so too can a surgeon and anesthetist spend hours in an operating room without exchanging a single word. By virtue of their training, each knows exactly what to expect of the other.
Accordingly, much of modern medicine does not solve problems in an open-ended way so much as categorize patients’ conditions in a restricted way. Each is slotted into an established category of disease—a process known as diagnosis—to which an established, ideally evidence-based treatment—referred to as a set of protocols—can be applied.
This standardization is not, however, absolute: it takes the form of tailored customization. (See our article Customizing Customization.) The predetermined standards—those protocols—are tailored to the condition in question. The patient presents with a pain in the chest; the diagnosis indicates a blocked artery; a particular stent is installed in a particular place; and an administrative box is ticked so that a standard payment can be made.
Misfits
The great strength of modern medicine lies in the fits that work. The patient enters the hospital with a diseased heart and leaves soon after with a repaired one. But where the fit fails can be found modern medicine’s debilitating weakness. Fits fail, more often than generally realized, beyond the categories, across the categories, and beneath the categories.
Beyond the categories lie those illnesses that fit into no predetermined category of disease. The patient may not be treated at all—indeed, sometimes dismissed as a hypochondriac—or forced into an inadequate, if convenient, category. Think about IBS (Irritable Bowel Syndrome), a label for ignorance, or some auto-immune conditions.
Across the categories fall those patients with multiple conditions that fit several disease categories concurrently. If these can be treated sequentially, the professional model of organizing is preserved. He or she is sent from one specialist to another. But where the conditions interact in more complex ways, as in many geriatric cases, more open-ended, collaborative problem-solving can be required. (The chief of geriatrics in a Montreal hospital, big on teamwork, used to say that a physiotherapist was their best diagnostician.) While geriatric departments may be encouraged to engage in such collaboration, much of the rest of medicine, where multiple diseases implicate different departments, each grinding in its own mill, does not. How often do we hear from frustrated patients: “Why can’t they just speak with each other, instead of passing around these little notes while I am being asked to describe my condition again and again?”
Beneath the categories lies a misfit that is no less common, or significant, than the other two. The fit is correct, but insufficient for effective treatment. Here medicine has to get past the “patient”, to the person.
Dr. Atul Gawande, in a New Yorker article entitled “The Bell Curve” (6 December 2004), reported on his observation of a renowned cystic fibrosis physician. He wrote the protocols that others used, yet had much better results. Meeting a young woman, and seeing a reduced measure of lung-function, he asked if she was taking her treatments. She said that she was. But he probed further, to discover that she had a new boyfriend and a new job that were getting in the way of taking those treatments. Together they figured out how she could alter her schedule.
Here, then, lay the good doctor’s secret: he treated the person and not just the patient, by delving beneath the medical context, to her personal situation.
Management and Medicine Alike
Of course, too much contemporary administration hardly encourages this kind of probing. If the administration of that doctor’s hospital was managing in the modern way, it may have questioned why he was spending so much time with this one patient. True she might live longer, but how to measure that in a budgeting system focussed on current expenditures?
Before any physician jumps on this point with great glee, he or she would do well to recognize that the management weakness here is not fundamentally different from that of medicine. Both suffer from an excessive tendency to categorize, commodify, and calculate—indeed, much like the rest of modern society. (See my TWOG on pat and playful puzzles.) Are managers who claim that “If you can’t measure it, you can’t manage it” any more sensible than physicians who claim that “If it’s not evidence-based, it’s not proper medicine”? Subscribing to either canon would close down both management and medicine.
Evidence-guided medicine is fine, as is evidence-guided management. That good doctor used the evidence presented to him. But he probed beneath it, to that woman’s experience. Within and across the categories called medicine and management, physicians and administrators alike would do well to get past their common debilitating weakness, to engage collaboratively for better health care.
© Henry Mintzberg 2018, drawing from my book, Managing the Myths of Health Care
By David Brooks
Opinion Columnist
Once upon a time, power was held in the hands of a small elite. This elite occupied the commanding heights of society and controlled big, top-down organizations. It dropped products and messages from on high, and the rest of us passively consumed them.
Then along came the internet. Suddenly, information was dispersed across self-organizing, open-source networks of citizens who had the ability to collaborate, share and shape their world. Hierarchies were smashed, the wisdom of crowd was applied and transparency reigned.
O.K. That didn’t really happen. The first dreams of the tech revolution didn’t come true. Sometimes it seems power was just redistributed from one set of massive organizations to others — Amazon, Facebook, Spotify.
But something has changed. We have seen an explosion of new social organisms that don’t look like the old ones: Airbnb, Etsy, Black Lives Matter, #MeToo, Blockchain. If power in the Greatest Generation looked like Organization Men running big institutions, and power for the boomers looked like mass movements organized by charismatic leaders like Steve Jobs and Barack Obama, power these days looks like decentralized networks in which everyone is a leader and there’s no dominating idol.
Ccontinues in source: https://www.nytimes.com/2018/04/05/opinion/the-new-power-structure.html
Peter Kaufman on The Multidisciplinary Approach to Thinking: TranscriptLast week I had the great pleasure of attending a talk by Peter Kaufman on the Multidisciplinary Approach to Thinking. I would like to thank Mr. Kaufman for delivering such an engaging and insightful talk. His ‘three bucket’ approach to implementing and understanding multidisciplinary thinking is an immensely powerful tool. I hope you all find it equally compelling.
I transcribed the full event from my audio recording which you may listen to on SoundCloud. Throughout the transcript you will find;
Furthermore, I’d like to thank Spencer Hoff, President of the Cal Poly Pomona Economics Club, who graciously invited the Latticework Investing Community to attend. I would also like to thank the Cal Poly Pomona Economics Club for hosting such a great event.
(Note: If you’d like to receive email notifications regarding any future events, please subscribe. Also, please note that I’ve been unable to send direct emails to ‘@qq.com’ email addresses. So please register using a different account if possible.)
0:00 Talk Begins
Spencer Hoff: Thank you for coming. Today we’ve got Mr. Peter Kaufman, CEO of Glenair, who wrote this book, Poor Charlie’s Almanac about Charlie Munger. It’s an excellent book, best book I’ve ever read by far in my life. He serves on the board of Daily Journal with Mr. Charlie Munger and he’s going to give us a few words today. So please welcome Mr. Peter Kaufman everybody.
Peter Kaufman: Thank you. Now I’m happy to talk about a subject. I was asked to talk about the multidisciplinary approach to thinking. So I’ll start out with that. But if you guys get bored or something and say ‘Well I thought we were supposed to have fun listening to this today.’ You can raise your hand and say ‘Could you talk about leadership or team building or business strategy or ethics or something else?’ I gave a talk recently at Google, in fact I’ve given three talks at Google. And the first talk I gave they said ‘What are you going to talk about?’ And I said, ‘Well, what do you want to talk about?’ They said, ‘About whatever you want. What do you usually talk about?’ Well I usually talk about leadership, culture, team building, strategy, ethics. And they said, ‘We don’t hear about that team building crap. We get that all the time. We want to hear about self-improvement.’ So I will mix in with our multidisciplinary topic a little bit of self-improvement as well. Is that OK? OK.
So why is it important to be a multidisciplinary thinker? The answer comes from the Austrian philosopher Ludwig Wittgenstein (link 1, 2, 3) who said, ‘To understand is to know what to do.’ Could there be anything that sounds simpler than that? And yet it’s a genius line, to understand is to know what to do. How many mistakes you make when you understand something? You don’t make any mistakes. Where do mistakes come from? They come from blind spots, a lack of understanding. Why do you need to be multidisciplinary in your thinking? Because as the Japanese proverb says, ‘The frog in the well knows nothing of the mighty ocean.’ You may know everything there is to know about your specialty, your silo, your well, but how are you going to make any good decisions in life…the complex systems of life, the dynamic system of life…if all you know is one well?
Continues in source: Peter Kaufman on The Multidisciplinary Approach to Thinking: Transcript – Latticework Investing
My last post explained the thinking behind the softening of systems thinking – to include the reality of human beings into the mix.
I ended by noting that this naturally leads on to the hugely important question of how interventions into social systems (i.e. attempts at improving them) should be approached…
What’s the difference between…?
The word ‘Science’ is a big one! It breaks down into several major branches, which are often set out as the:
Natural science can be further broken down into the familiar fields of the Physical sciences (Physics, Chemistry, Earth Science and Astronomy) and the Life sciences(a.k.a Biology).
The aim of scientists working in the natural science domain is to uncover and explain the rules that govern the Universe, and this is done by applying the scientific method (using experimentation1) to their research.
The key to any and every advancement in the Natural sciences is that an experiment that has supposedly added to our ‘body of knowledge’ (i.e. found out something new) must be:
This explains why all ‘good science’ must have been subjected to peer review – i.e. robust review by several independent and objective experts in the field in question.
“Erm, okay…thanks for the ‘lecture’…but so what?!”
Continued in source: Lights, camera…and ACTION! | Squire to the Giants
[I put this here both because I think ‘Human Factors’ and the whole safety industry has a lot of good stuff to say about systems, meaning-making etc – and because this reflects on the ‘homelessness’ of systems thinking too]
Most fields of professional activity have a settled home within the divisional and departmental structures of organisations. Operational staff work in operational divisions. Engineering staff work …
Source: The Organisational Homelessness of ‘Human Factors’ | Humanistic Systems
The long read: Timothy Morton wants humanity to give up some of its core beliefs, from the fantasy that we can control the planet to the notion that we are ‘above’ other beings. His ideas might sound weird, but they’re catching on…
I’m curating a range of useful and interesting resources for people new to and curious about systems thinking and practice, which I’ll pop on our CoLab Dudley site and update as we discover new resources. I’ve made a start, I’d love to know what you’d add to the resources below and why. If you are familiar with / regularly use any of the resources below I’d also love to know what you think of them / why you use them.
Learning opportunities
+Acumen Systems Practice
A free 10 week online course. You will need a local team to take the course with.
Open University OpenLearn Systems Thinking and Practice
A free 8 hour online course
Available to download free:
Available to buy:
Source – and more in the comments: Systems Practice: what resources do you find useful?
Meaningfulness as key system dimensionThere is a lot of talk about social systems design and human systems approaches in this blog, but the human dimension seems to be missing sometimes. While exploring the question of how human systems thinking evolved, i.e. in the Darwinian sense of the word, I came across the Princeton University Institute for Human Values (UCHV), in particular their publications page. Two publication drew my attention: Frans de Waal’s “Primates and Philosophers: How Morality Evolved” (2009) and Susan Wolf’s “Meaning in Life and Why It Matters” (2010). Maybe I am lazy, but I didn’t read the books (I don’t have access and my book cases are full), so I just watched De Waal’s Ted Talk (here) and Wolf’s 2017 Shipka lecture (here) to enlighten me. De Waal surprised me (elephants!), but Wolf gave me something that I have been searching for a while: a fundamental way to fit people in systems thinking from an individual point of view. So that’s what I am going to summarize in this blog (see concept map with in grey my additions). I also think that Wolf should get together with De Waal and a few others (e.g. Christopher Boehm) to tentatively integrate evolutionary anthropology. It is my personal belief that if we can show that human biology evolved simultaneously with evolutionary serendipitous discovery-invention-design of speech, fire, tools, morality AND systems thinking (all of them social!) there is a stronger case to bring systems thinking to the forefront in human debate (democracy, governance), business development, and education (all of them social).
continutes in source: Meaningfulness as key system dimension | CSL4D
One of my favourite articles is The Complexity of Failurewritten by Sidney Dekker, Paul Cilliers, and Jan-Hendrik Hofmeyr. In this posting I’d like to shed more light on the contributions of Paul Cillliers.
Professor Cilliers was a pioneering thinker on complexity working across both the humanities and the sciences. In 1998 he published Complexity and Postmodernism: Understanding Complex Systems which offered implications of complexity theory for our understanding of biological and social systems. Sadly he suddenly passed away in 2011 at the much too early age of 55 due to a massive brain hemorrhage.
My spark for writing comes from a blog recently penned by a complexity colleague Sonja Bilgnaut. I am following her spade work by exploring the implications of complexity for safety. Cilliers’ original text is in italics.
Continues in source: 7 Implications of Complexity for Safety | Safety Differently
Tuesday 10 April 2018 – 7pm to 8.30pm
Second Home Spitalfields
American theoretical physicist and writer Leonard Mlodinow will be making a special appearance at Second Home Spitalfields to discuss these big questions and more, exploring the ideas outlined in his new book Elastic, which argues that we need ‘elastic thinking’ to succeed in a fast-paced changing world.
Elastic draws on cutting-edge research from neuroscience and psychology to explain the differences between analytical and elastic thinking, revealing how we can actually train our brains to be more creative and innovative.
Leonard discovers how flexible thinking enabled some of the world’s greatest innovations and creations – from cinemas introducing jumbo-sized popcorn portions to Mary Shelley writing her masterpiece Frankenstein – and investigates how organisations like Nike and Pokémon Go have demonstrated an elastic ability to adapt to new technologies.
Leonard will be in conversation with journalist and author Steven Poole.
Tickets are free for members and £3 for non-members.
You can also prepurchase a copy of the book (from our bookshop Libreria) with your ticket which will be ready for you on the night.
All proceeds from our cultural programme go to the Kibera Hamlets School in Nairobi, where Second Home has funded the construction of a new school building designed by our architects Selgas Cano.
Source: Cultural Events Programme & BeBetters | London, Lisbon, LA | Second Home
It was over a year ago that The Guardian informed us of ‘a warning from the Local Government Association (LGA) that councils will soon need to make deep cuts to essential services. This will…
I’m leading a (very small) piece of work for a children’s charity focused on local systems change.
While I know quite a lot of material about this subject, I’d be enormously grateful if people could respond to this post with anything they consider relevant – and particularly any summaries?
This is social systems relating to children’s early years literacy, child protection, wellbeing in general. I know it is quite a wide field…
cheers!
Benjamin
Imagine a grim, appalling, but unfortunately all-too-common scenario. A primary school is under attack from a deranged gunman. Shots have been fired, and the gunman stalks the school corridors, looking for children to kill. In one of the classrooms, a nine-year-old child is cowering under his desk with his teacher, both hearing the approaching footsteps of the gunman.
As the gunman opens the door to their classroom, we freeze time, and imagine two possible alternative scenarios. In the first, both teacher and pupil are unarmed and defenceless. In the second, the teacher has a firearm, which he has in a holster.
Given these specific circumstances, I’m sure most of us might consider it would be better – at that specific moment – for the teacher to be armed with a gun, than to be unarmed and defenceless. With a gun, he might, at least, be able to surprise the gunman, leaping up from his hiding place and firing several rounds at him, incapacitating him. That would certainly be better than the alternative of being effectively powerless as the gunman enters the classroom.
So, given these specific circumstances, we could reasonably think that is a good idea for a primary school teacher to be armed with a gun.
But would any of us then draw the conclusion that it is a good idea to arm primary school teachers in general? Just because our particular teacher might benefit from having a gun in the specific circumstances of a gunman approaching him down a school corridor, do we then think it makes sense to for all primary school teachers to be equipped with an easy-to-access handgun, throughout the school day?
continues in headline link…
An interesting intellectual history of the OODA loop, from the prime contemporary source on the subject.
What was Boyd Thinking? And when did he think it? In his own words: For the interested, a careful examination will reveal that the increasingly abstract discussion surfaces a process of reaching across many perspectives; …
Systems Community of Inquiry 
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