Second Order Lean
Lean is second order change – it’s changing the way we make change.
Second order lean is making changes to the way we make lean happen – hence second order. Indeed it’s third order change.
The interesting thing about this is that the sort of relationship that shows up in nonlinear dynamics producing singularities and phase changes is often a third order differential relationship.
It also takes what Chris Argyris says about double loop learning to a new level. Triple loop learning?
Why simulate?
Two questions can be asked:
Are there any situations in which the healthcare specialist cannot anticipate what will happen?
If so, is there a way to build a model and then run it in such a way that the future can be anticipated a bit better?
Two more:
Will this lead to management policies?
Will these lead to better structures?
And another:
If we have this information, what sort of choices can we make?
The Case for Issue Mapping
Many of the problems facing groups today fail to reach a good conclusion because they are more complex than our approaches can handle. Although the participants in these processes are well-intentioned, they often have difficulty in keeping track of the ideas and therefore of the possible solutions.
Existing approaches help. They include Brainstorming, which has been used for decades, and is marked in particular by the “no judging” rule which helps to draw out the diverse ideas of the group without fear of criticism and rebuttal. Open Space Technology is also known for its capacity to bring about new thinking and to move towards consensus.
Mind Mapping was introduced in the 1970s to help visualize not only the multiplicity of ideas surrounding a given problem or solution, but also to indicate how these ideas are linked to one another. Often it is the connections among ideas that allow people to make sense of them, and to make decisions that lead to solutions.
Issue mapping builds on these approaches. Horst Rittel introduced the concept of “wicked problems” in the 1970s, and developed the Issue Based Information System (IBIS) as a framework for tackling
such problems. The methods were developed to help deal with political issues, so their application to business and enterprise situations seems reasonable.
Issue Mapping adds another dimension to Mind Mapping: in addition to the connections among ideas, the method adds another layer that exposes the logic of the ideas. It introduces the questions to which ideas are the possible answers. It also distinguishes those ideas that support other ideas, qualifying them either as good or bad answers to the questions. And it allows the questions and the ideas themselves to be positioned logically relative to each other.
Issue Mapping is not a self-contained solution, nor is it painless. The tool can get in the way, particularly in the early stages of use, where smart people may be distracted from the main dialog by the mechanics of the mapping. But with patient facilitation, this phase quickly passes, and the main dialog itself takes over, making the Issue Mapping transparent, which is what it should be.
For more information on issue mapping, refer to Jeff Conklin at Cognexus
Strategy to harness complexity.
In coining the phrase “Harnessing Complexity”, Robert Axelrod reminded us that we cannot be masters of complex systems. But having recognized their characteristic behaviours, it may be possible to take small steps that could channel bigger outcomes to our benefit.
In high performing healthcare organizations, teams learn to harness some of this complexity, guided by their strategic plans and by nourishing the emergent transformation initiatives that express their lean thinking.
The secret is in maintaining the “harness” - building the trust at and through each layer of the organization, and applying at each the awareness and judgment that strengthen the links between people and equips them with the insights to do simplified and waste-less work.
Healthcare as a Complex Adaptive System
For years we have grappled with the challenges of providing a healthcare service that will meet the needs of our communities. Valiant efforts have produced commendable results, yet the needs seem always to exceed the demands either for the population at large or for some segments.
Looking at the systems from a different angle may help. Instead of seeing them as a top-down assembly of components that could get the job done if only they would function as designed, it may help to see healthcare as a network of networks, connecting people who are skilled clinicians with people who are patients and clients, trying to function and behave as best they can as individuals, and trying to coordinate among themselves as groups and as institutions.
Some of the concepts of nonlinear dynamics and complex adaptive systems may be useful here. This web site is intended only as an accessible and available repository to myself for my own thinking and ramblings, occasionally with a simulation just to get a better understanding of how the systems seem to work, and possibly to find clues to how we could coax them to adapt to our capacity to support them.