Home Organizational Psychology System Dynamics / Complexity Delivering Health Care in Complex Adaptive Systems II: Portraying and Tracing Implications of Working in a Dynamic System

Delivering Health Care in Complex Adaptive Systems II: Portraying and Tracing Implications of Working in a Dynamic System

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The Second State: Ice

We have already identified the way in which this state is manifest in certain mid-management conditions. We described frozen middle management and related it specifically to an unwillingness to reduce boundaries (so that the ball/issue will always be contained and its movement predictable). The frozen state can actually be as damaging as the fluid state—or even more damaging. In a frozen state, we are like marsupials who are trying to avoid the lion by standing absolutely still.

An important difference is to be drawn. The marsupials begin to “shake off” the accumulated adrenaline after several seconds. Human beings remain frozen. They rarely shake anything off (perhaps going for a run or swimming several laps). This failure to drain off the adrenaline leads to a very destructive state physically and psychologically. It is even more damaging if we are facing the challenge of a Frozen dilemma. We are embedded in “Locked in” polarities with eternal swings back and forth. Are these frozen dilemmas (as “Sacred cows”) even (or ever) discussable? The same applies to “third rails” that seem to be societal sacred cows regarding what we are to avoid at all costs. We can’t talk about the elephant in the room (usually a vividly imagined lion), thus remaining terrified and frozen, with adrenaline (and other activating hormones) coursing through our veins.

The Third State: Vapor

When water has turned into vapor—a gaseous state—then a system is in complete chaos (with minimal structure, seemingly random behaviors and absent or indiscernible causality). The elephant is loose and destroying everything.  The framework of complexity that has been offered by Snowden (2023) –presented in our previous essay in this series (Fish and Bergquist, 2023)–includes a dynamic link between Clear and Chaotic states. He describes a a short-circuit slide over a cliff of clarity into a sea of chaos. This slide suggests a rapid rise in energy from a frozen to a vaporous state without moving through the fluid or complex state. Such sudden shifts create a level of crisis which can be fatal if not navigated properly—as may have happened with our athlete who drowned in Lake Berryessa.

Snowden advises that a specific action be taken:  a sense-respondent mind-set is established when confronting a chaotic system. This is a mind-set that enables engagement of novel practices. For example, there is no question Covid-19’s influence on healthcare was to push it into the short-circuit toward chaos in a matter of weeks to months. Critical care units were overflowing and chaotic. Dead bodies were collecting in freezer trucks parked outside of the Emergency Departments. There was a major breakdown of civil engagement between patients and those nurses, physicians and others who provided care in a high-risk environment. Our healthcare systems were plunged into a vast and choppy sea of chaos. Members of the health care systems throughout the world had to survive in their own unstable kayaks. We continue to struggle with a successful emerge from this chaos even several years later. Turbulence still swirls around our hospital corridors and physician offices.

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