A void also exists when a system is filled with silos. If no one is talking to folks in the adjacent silos then cracks will inevitably widen regarding the overall knowledge contained in the system. It is in these cracks that we find nothingness. While, as Ralph Stacey suggests, we might find creativity operating in the nothingness of cracks, we are also likely to find that information doesn’t pass through these cracks, leaving the system fragmented and dysfunctional. Such would seem to be the case in American health care, at least according to Elisabeth Rosenthal (2017/2018, p. 238). She observers that:
“This U.S. HEALTHCARE SYSTEM gradually evolved sector by sector, hospital by hospital, doctor by doctor. What the players are doing is, technically speaking, perfectly legal. Participants in the marketplace respond to the incentives and opportunities a market allows. That’s what they’re supposed to do. Each component of the system is genuinely convinced that it’s not so bad, not responsible for our $3 trillion medical bill. Someone else is more to blame. Drug spending is only 10 percent of the national health budget! Nursing homes are only responsible for 5 percent of health costs! Payments to doctors only 20 percent! Dermatology accounts for only 4 percent of Medicare expenditures! Each segment of our medical system is convinced that its charges are reasonable. But put all the little excesses together and you get healthcare that is much worse and much costlier than the sum of its parts. We, the patients, are stuck in the middle, and it seems we’ve reached critical condition.”
As in many other systems, such as American postsecondary education, the “critical condition” in American health care seems, as Makary suggests, to be “man made.” It is a product of neglected history, inactive curiosity, and the isolation of various sectors within the system. We might come to a similar conclusion when considering other sectors of American society – such as our legislative sector and the sector that provides us with many social services.
Do It Right the First Time or Learn from the Mistakes
All of this leads to two major lessons to be learned regarding Negative Utility. The first lesson is: Do it right the first time or don’t do it at all. A failed attempt at the introduction of an innovation into an organization not only results in the absence (nothingness) of a good idea being accepted; it also results in the increased resistance to new ideas in the future. Organizations become “bullet proof” and recalcitrant win the day. If new ideas and innovation projects are to be introduced, they should first be pilot tested or considered, enacted and reviewed in a temporary setting – perhaps in a collateral organization. With plans in place for the appropriate, thoughtful and gradual introduction eventually of this idea or innovation, if successful in pilot form, into the organization.
The second lesson is: If the new idea or innovation isn’t working as originally planned, then use the “failure” as a source of increased insight regarding the system in which it is being initiated. If members of a system simply leave the new idea or innovation behind and place a “self-sealing” shield around it (“we don’t talk about what happened”), then a void is created which hinders any new learning or improvement in the system. As Chris Argyris and Don Schön (Argyris and Schön, 1978; Argyris, 2001) have noted, there is nothing wrong in making mistakes in an organization; it is only “wrong” if nothing is learned from this mistake. The “stupid” organization is one that keeps making the same mistake. Sadly, this has often been the case in American postsecondary education and American health care.
