My presentation earlier today was on the use of complexity in health care. I went through some of the basics, in particular the links with cognitive science and the role of narrative. At the end of the session I put together a summary of the sorts of thing that go wrong. By wrong, I meant structured linear methods being applied to non-linear complex situations, but I was also targeting researchers and consultants who take up complexity and/or narrative, but then fail to follow through the implications in their work. The title of this post is not meant as an attack per se. Hypocrisy is a serious charge so I have placed it in quotations and prefixed it with understandable. It is very difficult, if you have been trained for years in a particular approach to change. Even if you understand complexity in theory, the practice of research and consultancy has been developed before that knowledge. There is thus a danger of failing to fully appreciate the degree of change necessary. This is particularly the case with demanding clients who want to know what they are going to get in advance.
So, here is the list, with some explanation .....
- Believing that their expertise is more valuable than the knowledge of their subjects, and that they can avoid bias. Too many experts (researchers and consultants are equally guilty) continue to insist that they have to interview subjects in the study and draw conclusion. They will say things like We draw our their stories or We allow them to speak in different voices. They talk about the need to interpret the material, to deconstruct it and allow the authentic voice to be heard. Sometimes they argue that senior people need to be interviewed by someone senior to take a project seriously. For reasons that I do not fully understand they actively resist any idea that stories can be told in context without their presence, or that people tagging and interpreting their own stories provides richer and more authentic research data than can be provided by the expert.
- Seeking to mandate ideal behaviour or organisational strucuture. I have heard many people talk about emergence, the need to create an ecology of agent interaction and the fact that there is no such things as best practice in a complex system. They then go on to talk about ideal models of behaviour (thus implying such a thing as best practice) for employees and leaders alike. They describe the ideal form of an organisation in the usual platitudes or organisational consultancy: open to new ideas, creating a no blame culture etc. All of their description implies that these things can be mandated, when in practice they evolve, they cannot be defined or designed they have to emerge through multiple interactions over time.
- Assuming an experiment will scale, or replicate in a different context. The fact that something works in one context (for example a particular hospital) does not mean that the outcome can be replicated in another place even if it similar. Each specific context is not fully knowable, and the interaction of agents in each context will be different in each case. We can replicate starting conditions and monitor for emergent patterns, damping and amplifying according to their efficacy but replication of outcome is not possible. I can understand this. A common senior management needs seems to be for a recipe with a known outcome. The researcher or consultant working with complexity does their client no favours by pandering to this need. better to be honest up front and set the expectations. Complexity interventions create unique contextually appropriate solutions. They do not replicate, neither do they necessarily scale.
- Focusing on efficiency, not effectiveness; thinking of stability, rather than resilience This is basic. Efficiency is all about stripping away superfluous functionality, stabilizing the system to an equilibrium state so that its performance is optimized. That is fine as long as the context does not change. If it does, then the reaction time may be too long. Resilient systems on the other hand have a degree of redundancy so that they can adapt to changing contexts.and as a result are effective under dynamic conditions.
- Using outcome based targets for other than ordered systems in equilibrium states Outcome assumes causality and repeatability. In a complex system this is not possible. Any attempt to create an outcome will be subject to the law of unintended consequences. You may get what you targeted, but the system adjusts in ways that may not be beneficial. For example setting a target to reduce time in an A&E unity, achieved the target but at the cost of occupying ward beds (people were shipped out just before the target deadline) as a result of which operations had to be cancelled. The classic response is to set a target for operations, but then there is another unintended consequence. The cycle of more and more targets produces a perverted system with so many measures that contextualisation and innovation are stifled in a blame culture.
- Using the wrong model of science for evidence. Evidence based policy is all well and good, but if your model of evidence requires provable outcomes in advance then your science model is locked into the last century. The critical switch in a complex system is from Safe-Fail design, to fail-safe experimentation. Evidence needs to be linked to experimentation not to outcome in a complex system.
- Using hindsight rather than foresight. Complex systems are retrospectively coherent. Anyone who works in complexity knows this, but many suggest future interventions and policy on the basis that you can repeat past success. The future has potential, we can sense some of that, we can influence its evolution. We can learn from what happened in the past. However we cannot use the past to predict the future.
Comments (4)
Dave,
I very much appreciate the insights you have provided in this post. It is very helpful to hear such a clear voice speaking to existential and situational events that emerge in complex systems usually for unseen reasons. A major problem which I believe your are speaking to is that frequently in the diagnostics, consultants come up with a Procrustean Bed and fail miserably. A flaw in this kind of thinking is the demand for clear unequivocal answers Perhaps it would be more helpful when looking at any complex system in its current state, to consider it is a solution to something and not necessarily a problem, (fail-safe). I have more thinking and digesting to do here. Thanks.
Posted by Gloria Fox | June 2, 2007 4:33 AM
Posted on June 2, 2007 04:33
Point 2 in the text is particularly interesting. I'm sandwiched as classic middle management at present, in a F100 company. Can't please superiors, subordinates or clients, no matter what. Superiors constantly espouse our "values", even awarding platitudes once a quarter for staff who demonstrate "living the values" (read - "if you all just did this, hey wouldn't this be a great place to work!"). Oddly, the values are merely convenient for leadership, trucked out to shore up outdated ideas or support "retrospective coherence".
Staff seem to see right through this, surprise surprise, and at the coal-face, a level of cynicism exists.
Emergence or evolution aren't valued, merely towing the line. If you're seen to question the values, their applicability and demonstration within the ranks, then you're seen as difficult and ornery, not innovative and creative.
I'd be keen to know Dave if a) you've seen this elsewhere in your travels (I'm sure there's something in there with the IBM experience?) and b) do any of the other Cog Edge readers have comments?
Thanks as always for giving me cause to carry on with my, at times, lonely crusade.
Posted by icanpress | June 3, 2007 11:36 AM
Posted on June 3, 2007 11:36
Hey, I resemble that! ("I was also targeting researchers and consultants who take up complexity and/or narrative, but then fail to follow through the implications in their work.")
Beginning a dissertation on emergent learning and the creation of organizational knowledge, I'm lost in the literature of pitfalls. Yes, it's dynamic/evolving/self-regulated, but if we're to reframe organizational knowledge to support emergent learning (independently created and made available), musn't we find some way of sharing success stories and practices that support a new paradigm in learning?
And musn't that come for what we DO, rather than what we DON'T?
Posted by Colleen Carmean | June 3, 2007 9:56 PM
Posted on June 3, 2007 21:56
Thanks for the comments Colleen. I think there are legitimate ways of doing research here (narrative based assessment was partly designed for it). However I am not sure about "success stories", that smacks a bit of a repeatable or inimitable recipe which I don't think is possible in a complex system. A complex system is dynamic not static. Also how do you independently create learning?
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June 5, 2007 4:05 AM
Posted on June 5, 2007 04:05