We Haven’t Started With the Biggest Picture
The understanding of the big picture is critical to effective and sustainable systems work. Bucky Fuller, called the Leonardo da Vinci of the 20th century, always started with the biggest picture possible, scenario universe. In some cases, you’ll see that the discussion below started with how the universe works and then distills down to how the current healthcare system works (or doesn’t). One of the big problems I see in most efforts to fix the current healthcare system is that well-meaning people have jumped much too soon into details and pieces of the overall system before understanding the big picture. This jump into the details too soon is a sure-fire recipe for frustration, disillusionment, and even hopelessness. Let’s take a look at the big picture.
Universal Laws at Work
Ilya Prigogine won a Nobel Prize for his Law of Dissipative Structures, which describes what happens to systems that resist change in a changing environment. In short, systems that resist change in a changing environment add complexity and so require more energy inputs to fuel that complexity. However, the system can only dissipate the original amount of energy and so becomes perturbed or stressed. As the system continues to resist change, stresses build up until the system rapidly moves into a state Prigogine called reorder. Reorder starts with a move into a chaotic state and then, over time, the energy reforms into a completely different system that can handle both incoming and dissipating energy. It is important to note that the new system is not a bigger or changed version of the old system. It’s completely new.
Stresses in Systems are Passed on to People
Over 35 years of applying the Law of Dissipative Structures in our systems improvement work in many types of organizations, including healthcare, we made a startling and I believe important discovery. The stresses that build in the change-resisting systems are passed on to the people who must work in those systems. Not only that, the stresses are passed system to system and hence spread throughout the organization and on to customers (patients) and suppliers. The further one gets away from the original source of stress (a given system), the less effect. However, the stresses will be felt to some extent throughout the organization. This fact aligns with Bell’s Theorem, which tells us of the connectedness of the physical universe (systems). But the stresses don’t stop there.
As the systems stresses (physical energy) are passed on to people, the energy is transduced to fear-based thoughts that are held in the mind. Each of these thoughts has an emotional fear-based component that individuals identify in some way as stress, unhappiness, frustration and, toward the “reorder” stage, potential for burnout.
The Mind is a System, Too
The mind is a system, too. The great Bucky Fuller goes even further in stating that, “Every thought is a system.” Einstein reminds us that we can’t solve our problems with the same level of consciousness (thoughts) used to create them. We have to expand and improve our thinking. Both with physical organizational and care-delivery systems and the systems that live in the mind as thoughts, we essentially get only what the systems will deliver.
Energy Drives Change
Understanding the nature of systems and how the mind works, we soon see that the degree of change, both in physical systems and systems of the mind, is proportional to the energy present at the time of the change. In the case of physical systems, the energy is stresses. In the case of the mind, the energy is emotional energy. Look for yourself. In ALL of the instances of great changes in your life, the events are circumscribed by significant emotional content. No emotion, no change.
There is some light at the end of the tunnel for healthcare. The stresses that have been building up in the systems of healthcare can be used to speed change. Similarly, the emotional stresses that have been building in the minds of care providers can be used to speed changes in thinking and shifting paradigms. However, for the necessary changes to be sustainable in healthcare, physical systems and paradigms must be seen as an integrated whole. The transformed systems are comprised of new, low-stress systems and expanded consciousness in the form of non-fear-based systems thinking.
No Vote – Change is Coming
I’ll conclude these thoughts with a word of both warning and hope. One of the striking things about universal laws such as the Law of Dissipative Structures is that we don’t get to vote on them. There’s no vote! These and other universal principles indicate that significant changes are coming to both the existing healthcare system and the mindsets that created it and are keeping it in place in its highly stressed condition. The only question is, do we want to be proactive and take the lead in making the necessary shifts, or be dragged kicking and screaming into the new healthcare reality that is now in the beginning process of re-creating itself. For the betterment of all, I say Carpe Diem.