Delivering Health Care in Complex Adaptive Systems I: The Nature of Dynamic Systems

Delivering Health Care in Complex Adaptive Systems I: The Nature of Dynamic Systems

Jeremy Fish, M.D. and William Bergquist, Ph.D.

We face a major challenge in seeking to lead complex mid-21st Century organizations—and this is particularly a challenge regarding health care organizations and systems. It seems that many leaders convert complex dilemmas into simple puzzles. When they do so, they find that no matter how they solve the puzzle, a new puzzle pops up and undermines their progress. These befuddle leaders are replicating the old Sufi story of the wise people and the Elephant. The “wise” people are blind—and they are relying on their touch when seeking to determine the identify of what they are touching. “It’s a rope”, “It’s a horn”, “it’s a tree”. The label given depends on where they happen to be standing with regard to the elephant and as a result which part of the elephant they are touching.

Some of the “wise” leaders of American health care (and most other health care systems in the world) declare that the problem is burdensome governmental regulations. Others declare that the elephant of disfunction is actually protective diagnoses (based on fear of lawsuits). Among those who are particularly fearful of or distaining of the elephant’s presence in their life, the problem is uncontrolled costs or the transformation of human-service oriented health care into a for-profit enterprise. However, the elephant is seen and defined, it seems to be very much out of control and given its large size there is widespread fear that it will trample everything.

Another wise narrative is centered in an African creator story. This story concerns polarities The God of the realm decides to wear a hat, Red on the right side and Blue on the left. He gracefully glides between two tribes, one on the right, one on the left. “Our God wears a Red hat” the ones on the right declare. “Our God wears a blue hat!” shouts the other tribe. The tribes begin wearing the hats of the appropriate color and soon there are skirmishes, eventually raids, and then full-on warfare to prove which God is superior. This God, of course, has a humorous streak. So, just before the war starts, he walks the other direction, thus reversing the colors. Confused and baffled, both sides decide to cease their warfare and create a co-council of wise men to study the Gods together.

The elephant is clearly present in mid-21st Century health care. Furthermore, there is warfare (sometime clearly present) among the various constituencies who view the elephant in diverging ways. The divergent perspectives have widened—and polarities exist regarding the color of the health care hat. There are even green, yellow, brown, purple, and occasionally white hats to complement the red and blue hats and to further confuse the situation. The Gods have indeed been mischievous and those who dwell in or are served by the health care community have not found a way to cease their warfare and create a co-council.


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About the Author

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Jeremy FishDr. Jeremy Fish, MD is a Family Medicine Specialist practicing in the State of California with over 31 years of experience in the medical field. Dr. Fish serves as program director and co-founder of the John Muir Family Medicine Residency Program. He was the California Association of Family Physician’s 2020 Family Physician of the Year. Jeremy Fish received this recognition in part because he “models the way for family medicine residents by providing exceptional care in a state-of-the-art, team-based care model he designed and shepherded through accreditation”. The CAFP citation continues. Dr. Fish “embodies all that the award recognizes: a family physician who presents the finest characteristics of family medicine and is directly and effectively involved in public service and activities that enhance the quality of life for patients and communities in California. Despite having many years of clinical experience under his belt, Jeremy Fish remains a humble practitioner with healthy curiosity and an enjoyment of learning which he loves to share with both medical students and residents. As a physician leader, Jeremy is willing to be on the cutting edge and traverse difficult, yet rewarding, pathways to advance Family Medicine.”

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