It rises like an ancient bird of prey, powerful, beautiful and perfectly designed for its purpose. Though it last sailed 1000 and more years ago, there is no mistaking the beauty, speed, and capability exuding from its elegant prow. At 24 meters long and 5 meters wide, the Gokstad ship at the Viking Ship Museum in Oslo is magnificent as an object of art. As a tool of war it would have been mesmerizing as it floated over the waters making 12 knots.http://en.wikipedia.org/wiki/Gokstad_ship

But even this “Karvi” is the smaller cousin of the larger “Snekkje” and “Skei” used with such effectiveness as the Norsemen burst out of Scandinavia to make such a lasting and deep impression on the cultures of Western Europe and the Slavic lands to the East. In light of Dave’s “robust vs resilient” tension I brought up yesterday, these ships serve as a very useful metaphor.

The construction and mechanics (“structure and process”??) of the Viking longship was quite different than the techniques used by the ancient Greeks and Romans in their shipbuilding. A modern boatbuilder, if using traditional methods wooden boatbuilding, would have more in common with the ancient shipwrights than with the Norse experiment. War galleys of Greece and Rome were build for strength and naval tactics, primarily ramming and sinking the enemy at sea. They used massive sawn and hewn timbers and stout ribs to absorb the shock of combat.

The Norse, on the other hand, used exceptionally light and flexible techniques. The strakes of the Gokstad ship are only about 2.5 cm thick. The oak strakes are split, not sawn, from the tree while green, and bent into the graceful form of the hull. The strakes overlap each other–“clinker” built–which allow small bubbles of air to reduce the turbulence while underway. The supporting ribs are added after the planks–the reverse order of a vessel built for strength. All of this allows for an extremely light vessel, of shallow draught, capable of great speed and maneuver and flexible enough to bend in response to heavy weather.

In the “Complex Adaptive System” of seaborne raiding of the 9th Century, these attributes clearly created a significant advantage for the Vikings: they could make the passage rapidly, sailing into shallow estuaries and disgorging their complement of raiders before the alarm could be raised. When needed, they could cross great distances of open ocean in foul weather. They could sail closer to the wind than their contemporaries. In short, they were extremely resilient, able to take advantage of the problems as they occurred and quite capable of exploiting unforeseen circumstance.

What does this tell us of the current situation of healthcare, especially here in the US? Healthcare is an extreme example of a Complex Adaptive System. There are many stakeholders, a constantly emerging order and a nonlinear response to stimuli. One could attempt to design a “robust” system to deal with every possible eventuality. It would be incredibly arcane, with a vast array of rules and complicated contingency plans to meet our present best estimate of what the problems will be 10 years from now. It would be incredibly expensive, and would rely upon enforced order to a very high degree. Sound familiar?

A resilient system on the other hand would recognize the emergent order inherent in a Complex Adaptive System. It would attempt to create boundaries and foster behavior that would be directed to stay within those boundaries. It would allow for differences in starting point and recognize the complex dance of structure and process in producing outcome. It would have very few rules, but those rules would prevent catastrophic failure, allowing for small failure as that is the best incentive for improvement.

David’s “The Birthday Party” represents a resilient system. It is geared for “effectiveness” and not just “efficiency”. No birthday party will be the same. We need, at least in my personal opinion, to recognize the need to insure that no one is exposed to catastrophic failure in the health care system. The only way to do that, however, is to design our ship like a Viking longship, and not like a Roman war galley.

As an aside to those who read my first entry–I was fortunate that my computer system did indeed prove to be “resilient”. The hard drive in my iMac is dead. I will need a new drive and will take the opportunity to get a new machine, but I have a habit of purchasing hardware a month before its newer, better, cheaper model is rolled out. With MacWorld coming up in February, I have decided to wait. So, I bought a new external hard drive, restored my system from my Time Machine backup and am in business (at least for now!).

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