lessons from the edge

“Closing Commentary”

In which Gareth Morgan summed it all up, and Tom Petzinger “wowed” the crowd with a spontaneous, written remembrance of the conference
Facilitated by by Tom Petzinger and Gareth Morgan

• Tom Petzinger “interviewed” the participants, and took notes on their responses. Next, he asked whether the conference was successful. Everyone agreed it was. He then introduced Gareth Morgan to do a “professional” summing up while Tom disappeared to write the column. (Note that his column appears after these following Gareth Morgan notes.)

• Misconception #1. “Thank God I only have to do 15%!” Simply doing 15% doesn’t let you off the hook. Don’t celebrate over the 85% you don’t have to do. Rather, find the 15% that makes a difference!
  
  
• Misconception #2. “It’s mere metaphor.” Don’t dismiss complexity because it relies so heavily on metaphors. Metaphor is one of the most powerful forces creating and shaping meaning. Newton’s metaphor of the Universe as a celestial machine had an enormous effect on society. Darwin’s “survival of the fittest” is a metaphor that legitimized predatory capitalism. That’s not “mere” metaphor. Systems thinking is a metaphor which states that organisms and organizations exist in environments. These “mere metaphors” have created enormous change.
  
  There are dangers to metaphor. The danger occurs when we lose sight that science is based on metaphor. All science is metaphor. However, we’ve grown so used to those metaphors that people have taken it as a literal description of reality.
  
  
• Misconception #3. “Oh God! I forgot my specs!” Minspecs are not a series of rules that must be memorized. The point is to create them when they’re needed. Minspecs help you create boundaries to shape organizational efforts. It’s a question of putting boundaries around a new system without limiting it.
  
  
• Misconception #4. “Oh I’ve got to go back and kick some buts!” Much has been said about identifying the “buts” – the contradictions that can halt change. Don’t go overboard addressing every “but.” If there are one or two contradictions that embody all the others, you only need to address them, as with the Pareto effect. It’s a question of digging and diving deep.
  
  
• Misconception #5. “This complexity stuff is great! I’m going back to apply it to everything I do!” Maybe the most important thing to remember is that complexity science isn’t appropriate for all problems. It works best where there are no clear answers. So you may actually create confusion if you use it where a mechanical approach would be more appropriate.

• NOTE: This is the column Tom Petzinger wrote at the close of the conference, based upon his interview of the participants.

  PRINCETON, N.J.—Can health care save itself? It’s a question whose answer is unknowable, but one whose very asking improves the probability of a favorable outcome.
  
  That, in any case, was the understanding that emerged from an extraordinary meeting of health-care professionals here this week, a conference called “Leading from the Edge of Chaos.” What, you might ask, is the relevance of chaos to health care? “Life is chaos,” explained one participant. Said another: “Health care is complex, but simple rules may suffice.”
  
  VHA Inc., with underwriting from the Robert Wood Johnson Foundation, convened the two-day meeting at the Merrill Lynch Conference Center in a teaching facility that inspired memories of a Psych 101 lecture hall. (Contrary to erroneous reports in an earlier Front Lines column, VHA does not stand for Veterans Hospital Administration.)
  
  The meeting drew the participation of nearly 200 health care professional—nurses, doctors, administrators and academics. The weenies from Risk Management were nowhere in attendance, however.
  
  The gathering opened with a presentation by Clint Sprott, who described how nature, like health care, is extremely complex and unpredictable in what it does, yet may be highly knowable through the laws by which it does it.
  
  Jeffrey Goldstein told a cautionary tale about the former Yugoslavia, revealing to the conference for the first time the discovery of something called the Tito Attractor.
  
  Gareth Morgan described the power of metaphor and the virtue of paradox. He suggested that health-care professionals can never manage the future if they keep trying to predict it—but that they need to follow only a few specifications to have a major impact on it.
  
  Appearing with Mary Ann Keyes of Muhlenberg Regional Medical Center and Tom Petzinger of The Wall Street Journal, Brenda Zimmerman reported that action and theory can produce startlingly similar results, whether the objective is baking bread or delivering antibiotics.
  
  Ary Goldberger told the group that equilibrium, despite some popular assumptions to the contrary, can equal death, while health essentially is disorder. Asked whether his discovery would improve his odds of career advancement, his superiors at Harvard Medical School declined comment.
  
  William Sulis turned the entire proceedings on their head. Instead of arguing that natural systems can serve as metaphors for man-made systems, he showed that a man-made system—a computer—can serve as a metaphor for a living one, the brain.
  
  On the second day the entire group self-organized into storytelling sessions that variously revealed:

  • how self-organizing nurses, freed to follow their individual visions, can literally distribute the hospital throughout the fabric of the community;
    
    
• how divergent organizations can come together and grow a new culture in a way that no one could ever plan;
  
  
• how an open mind—and an open heart—can create a new space where creativity and caring can grow.
  
  

Curt Lindberg of VHA concluded the conference by distributing a thick three-ring binder full of penetrating and original research materials— Edgeware, he called it—a book that all by itself was worth the price of admission, particularly as it contained several earlier Front Lines columns.

And so—as always, dear reader—your feedback is welcome. You can reach me at tom@petzinger.com

Copyright © 1999, VHA Inc. Permission
to copy for educational purposes only.