I have been "Maclimated" for the past 20 years. I don't know if it was initially out of an iconoclastic streak or what. Smugly, I would point out to my colleagues that I didn't have crashes--I have a Mac. Well, imagine my distress when my iMac wouldn't boot. Attempts at the usual repair were fruitless. I started to panic. True, I have an off-site backup service, but I need all of those files now! Then I remembered that program, "Time Machine", that I never really paid much attention to. It's running now on my desktop. I'll let you know if it worked!

A phrase in Dave's blog today, "Elephants, Fleas and the City of London" jumped out at me: design a system not for robustness, but for resilience. Hopefully, I did that with my Mac. Have we done that with health care?

One hundred years ago, medical education in the US took a radical change with the Flexner Report. Medical education was taken out of the apprentice model and firmly placed in the university system where training was standardized and grounded in "science"--anatomy, physiology, pharmacology. In other words, we realized that the principle diseases of the time had established cause and effect. A linear "scientific method" could be used to solve these complicated problems, and tremendous strides were indeed made.

However, at this juncture, our difficulty is not so much with understanding problems of anatomy and physiology, but with behavior, economics and motivation. In other words, the current stumbling blocks to medical problems are NOT complicated--they are complex.

Are we designing systems to deal with this complexity? Are we concentrating on building a robust system or a resilient system? Do we educate health care workers to deal with complicated treatments or complex treatments? Are concepts such as "emergence" and "starting point" taken into account when attempting to improve clinical quality?

These are some of the topics we will discuss. Hang on for a wild ride!