Home Organizational Psychology System Dynamics / Complexity The Complexity of 21st Century Health Care

The Complexity of 21st Century Health Care

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The sign of a viable health care organization is that it can live with and manage its dilemmas, paradoxes and polarities in real time, without questioning its identity at every turn in the road, whip-lashing its strategies, tearing and rebuilding it structures reactively, or scapegoating its people. The dance of oscillation is hard to avoid—but it can (and must) be managed.


As we begin to address the challenges associated with dancing (and even oscillating) landscapes, we enter a domain in which problems, dilemmas and polarities seem to merge into Mysteries. Mysteries operate at a different level than puzzles, problems, dilemmas or polarities. Mysteries are too complex to understand and are ultimately unknowable. A specific mystery is profound. It is awe-inspiring or just awe-ful. A mystery is inevitably viewed from many different perspectives and is often deeply rooted in a specific culture and tradition. Mysteries have no boundaries, and all aspects are interrelated. COVID-19 is fundamentally a mystery.

We don’t know why this horrible virus has afflicted us. At a more sacred level, do we deserve to be “punished.” Are the wages of sin now evident? Is this some divine retribution for the inequities and warfare we have inflicted on our fellow human beings. At a more secular and political level, perhaps the virus is just highlighting the cracks in our societies that have been ignored for many years. At yet another level, we might ask if Mother Nature is simply trying to take back her environment—given that we can see all around us the signs of a clearer and less contaminated world (given reduced automobile travel and industrial production).

Mysteries are constituted of multiple and often nested dilemmas. They are beyond rational comprehension and resolution, and they must be viewed with respect. Some mysteries relate to traumatic and devastating events: Why did I get out of the World Trade Center while my desk mate perished? Why did the fire reach our home but not the one next to us? Why did my child die before me? The virus evokes many profound questions of mystery. Why is my mother forced to die alone? Where does all this anger in our society come from? Will this ever end?

While it is often hard to identify or honor the positive mysteries in our life, they can be found during moments of reflection. How did I deserve all these years of health and security? What is my destiny? Why have I been so blessed in my personal and professional life? Why did I fall in love with this person? Why did this remarkable person fall in love with me? How did I ever raise such an exceptional child?

There are even blessed mysteries to be found during this difficult time of COVID-19. Isn’t it wonderful that my son has found love during this difficult period? How did I earn so much affection from these people who have been asking me about my health during the pandemic and have reached out to offer support? And most importantly, Mother Nature (speaking through COVID) can be our teacher. We can learn from and engage in major health care reforms based on this learning from COVID.

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