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The Complexity of 21st Century Health Care

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Because the outcome of the problem-solution process itself is of significant interest to many people, often the most important and difficult discussions revolve around agreeing on the criteria for solving a problem. At the level of public policy, the discussions revolve around reducing the number of deaths and keeping the economy from total collapse. How will we know if we have been successful in combating the virus if we don’t even know what “success” would mean: “lives or livelihoods”? At the personal level we must ask questions that are impossible to answer: whose feelings and whose life is most important in this family? We can’t even evaluate if the solutions are successful. We will continue to be plagued by the unanswerable question: Did we do the right thing?”

Miller and Page (2007) describe the settings in which what we call problems tend to emerge as “rugged landscapes.” As we have already noted, this type of landscape is filled with many mountains of about the same height. Think of the majestic mountain range called the Grand Tetons or the front range of the Rocky Mountains that citizens of Denver Colorado see every day. Compare this with a landscape in which one mountain peak dominates. In a rugged landscape that is complicated, one finds many competing viewpoints about which mountain is higher or which vista is more beautiful. A similar case can be made regarding the challenging problems that must be engaged by all of us individually and collectively during the pandemic invasion.

Dilemmas

When certain issues that we face appear impervious to a definitive solution, it becomes useful to classify them as Dilemmas. Many problems associated with COVID-19 are actually dilemmas. While dilemmas like problems are complicated, they are also complex, in that each of the many elements embedded in the dilemmas is connected to each (or most) of the other elements (Miller and Page, 2007). We may view the issue from one perspective and take action to alleviate one part of the issue, and we immediately confront another part of the issue, often represented by an opposing point of view offered (with passion) by other members of our family. community or society.

We loosen up our policies regarding the re-opening of businesses and find that rates of infection and death are rising dramatically. We let our son spend wonderful time with his girlfriend. He is very thankful, but other members of our family are fearful and even angry about his “selfish” behavior (“after all this is only a passing infatuation”). Leaders of a society and members of a family may not always recognize a dilemma for what it is.

We tend to see dilemmas in a limited or simplistic way and attempt to deal with them as if they are puzzles or problems. When that happens, we dig ourselves deeper and deeper into the complexity, seriousness, and tragedy. When faced with the multi-faced challenges of a pandemic (such as COVID) we are navigation more of a “swamp” rather than a sea. (Schön, 1991). As Schön notes, we must stay with the “messes” that are located in a swamp long enough to achieve real and sustained solution to the complex issues (dilemmas) we are facing.

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