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The Complexity of 21st Century Health Care

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Puzzles

Puzzles are the everyday issues that we all must face. Puzzles have answers. They are uni-dimensional, in that they can be clearly defined and can readily be quantified or at least measured. Puzzles during the era of COVID-19 concern such things as how we schedule time at the supermarket to minimize contact with other shoppers or how do we obtain more protective masks. Puzzles also concern changes in our institutions to accommodate new COVID-19 laws— such as re-arranging an office floor plan or determining how many customers can enter our story at any one time. With a puzzle, the parameters are clear. The desired outcome of a puzzle-solution process can readily be identified and is often important to (and can be decided by) a relatively small number of people. It is the sort of issue rightly passed to the lowest level of responsibility where the necessary information is available.

Miller and Page (2007) use the metaphor of landscape to distinguish a complex challenge from other types of simpler challenges being faced in various systems, including organizations. They point to the image of a single, dominant mountain peak when describing one type of landscape. Often volcanic in origin, these imposing mountains are clearly the highest point within sight. For those living in or visiting the Western United States, we can point to Mt. Rainer (in western Washington) or Mt. Shasta (in northern California). Mt. Fuji in Japan also exemplifies this type of landscape. You know when you have reached the highest point in the region and there is no doubt regarding the prominence of this peak. Similarly, in the case of puzzles, we know when a satisfactory solution has been identified. We can stand triumphantly at the top of the mountain/puzzle, knowing that we have succeeded.

Furthermore, we can look back down to the path followed in reaching the solution/peak. We can record this path and know that it can be followed again in the future when, once again, we need to reach this peak or solve this puzzle. We have gone to the supermarket at the best time—when there are few other shoppers. The new protective masks arrive at our front door. Our staff members have set up partitions between desks at the office.

Problems

We have labeled the second type of issue that we face during the era of COVID-19 as a Problem. Problems can be differentiated from puzzles because there are multiple perspectives that can be applied when analyzing a problem. Several possible solutions are associated with any one problem and multiple criteria are applied to the evaluation of the potential effectiveness of any one solution. There are many more cognitive demands being placed on us when we confront problems than when we confront puzzles—given that problems do not have simple or single solutions.

Problems are multi-dimensional and inter-disciplinary in nature. They are inevitably complicated in that they involve many elements. Any one problem can be viewed from many different points of view that are each creditable; thus, it is unclear when a problem has been successfully resolved. We face the cognitive and emotional challenge of acknowledging multiple realities and solutions.

For example, because of the virus, our community closes unessential businesses, but we find that this devastates our economy. At a more personal level, we want our son to find a way to see his special girlfriend. Yet, we know that this risks his health and the health of other family members given the invasion and disruptive impact of COVID-19. At an even more profound and wrenching level, we want to bring our aging parent to our home and away from their senior living facility (which is threatened with virus). We know, however, that this will jeopardize the health of other family members.

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