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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Navigating on a Golf Course

This is all quite abstract, for we rarely roll balls down a warped plane. Let us take our illustration to a location with which many of us are familiar. This is a golf course—and more particular a green on the golf course where we are trying to putt in our golf ball. Imagine that we are a player trying to get the ball in the hole. The hole is an attractor. But it will only work as such if the ball gets close enough to the rim. Before we get there, we have to negotiate the surface between ourselves as the player and the hole. The putting surface has many other local attractors and barriers (little holes, ridges etc.).

This putting analogy may be a good one for us. Except in real-life, there are multiple putters all putting at the same time, often in random ways…so our balls are also banging into each other and ricocheting in the wrong direction, falling into the wrong attractor…or a different one than we intended. A self-organizing or coach-organizing team will produce patterns. and disciplined, feedback-full putting….like a dance of balls across the green, glancing each other, with dynamic ricochets that dazzle the observer and have all balls fall into their intended cup at the same time or in series that makes a rhythm that is danceable, for example. Teams are a way to develop meaningful patterns in otherwise random, chaotic systems.  Perhaps teams are a great attractor of some kind.

Frozen Middle Management and the Restricted Plane

When we find ourselves in a management role, we are often doing our best to develop our environment around efficiency. We are making sure the trains arrive on time, rather than exploring where the trains might be going in the future. We leave these more “distal” matters (distant time and space) to the strategists and leaders of our organization.  As middle management, our job is more “proximal” (short distance and short time span). We often focus on limiting unnecessary variability and narrowing the pathways of travel in order to reduce inefficiencies and make the most of the resources we have. Our managerial emphasis on reduction of unnecessary variability can lead us to forge strong barriers and obstacles to working outside of a pre-determined pathway. In healthcare, managers use many tools such as Clinical Pathways or Evidence-based Guidelines, Protocols, Checklists, and Procedures.

When pushed to the extreme, managers build up barriers to the point where there is only a single pathway down the warped plane. Over time these can develop into full-blown silos, with hard boundaries and barriers. Given this recurrent dynamic in many organizations (including health care) we can begin considering the relationship between Waddington’s Warped Plane and the provocative concept of “Frozen Middle Management” (Sterling, 2020).

Middle management wants everything to be predictable and controlled (that is the fundamental nature of being in a frozen state). On Waddington’s plane, this would mean that the walls on one of the pathways down the plane would be enlarged and strengthened (becoming like “silos”), so that the ball (operations of the organization within a specific division) will be able to travel down only this one pathway. There is no deviation—no moving to another pathway. This reminds us of the children’s toy, where balls are rolling down one pathway – from the top of a short tower to its base.

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