Some Business and Health Care Stories

In which were story-telling and thoughtful reflection illustrated complexity concepts.
Facilitators: Tom Petzinger, The Wall Street Journal
Mary Anne Keyes, VP, Nursing Affairs, Muhlenberg Regional Medical Center
Brenda Zimmerman, PhD, Schulich School of Business, York University

How we learn

• Brenda Zimmerman noted that the journey of learning difficult complexity concepts might be viewed as a spiral, in which we are constantly moving from theory to action to reflection and then back to theory. Our understanding develops through the interplay between these activities. (We might also start with action, move to reflection, then develop theory.) Story telling is important, because it allows us to witness the action and do our own reflection. This helps to illuminate the theory.
  

• Tom Petzinger told the story of Great Harvest, a company founded by a husband and wife team who put themselves through Cornell in late ‘60s by baking whole wheat bread. They moved to Montana to be closer to the wheat, then opened a small bakery and ground their own wheat. They would offer a free piece of their bread to anyone who came into the store.
  
  
• Through the ‘80s and ‘90s, the franchise grew to nearly 200 stores. How they did it is a wonderful case study in emergence and minspecs.
  
  The first page of the franchising agreement, in large print, reads “Anything is allowed.” Beyond that, franchisees are given a small set of simple rules: they receive the recipe for the bread, some notes on grinding, and they are advised to offer a free piece of bread to customers who enter the store.
  
  One other rule is that whenever anyone learns anything about baking, employees, whatever, they share it. Robust e-mail systems link everyone. As a result of the communication, a new gift box in Milwaukee, for example, may be copied by a couple of stores and, if it works, go system-wide. The rule is to be part of a learning system and share.
  
  
• Petzinger pointed out that this was an example of what theorist Mark White calls “Common Law,” which permits everything that isn’t prohibited, as opposed to “Roman Law,” which prohibits everything it doesn’t permit.

• The challenge: Mary Anne Keyes told of the career ladder program at the hospital where she once worked. “Everyone hated the program,” she said. The career ladder’s bureaucratic overlay was so great that it measured mostly whether nurses could get through bureaucratic obstacles.
  
  
• Keyes laid out this minspec to the nurses: develop your own criteria for evaluation.
  
  
• The nurses came up with some ingenious solutions. For example, they were able to identify the nurses they thought were outstanding practitioners and role models by asking questions such as “If your mother was coming in for heart surgery, which nurses would you want working with her?”
  
  
• The results: In the second year of the program, 95% of units participated (up from 50% in the first year). Each unit developed its own criteria, and they began borrowing from each other. “What mattered,” Keyes explained, “was the dialogue around what it takes to be a good nurse and what patients wanted.” The dynamic could change every year if people didn’t like it.
  
  
• Zimmerman asked the audience: what does this story have to do with complexity science? Members of the audience responded that is illustrated:
  • Self-organization
  • An information-rich environment to which everyone has access
  • Feedback loops
    
    
• In addition, audience members pointed out that the career ladder:
  • Allowed different relationships to form over time, nurses interacting differently
  • Forced creation of a shadow organization
  • Began with simple rules that created something not implicit in rules: better nursing care

• The challenge: Petzinger told the story of a furniture manufacturing company that saw its marketplace changing. Customers no longer were willing to order furniture in a showroom or from a catalogue, and then wait weeks for delivery. They wanted customized furniture shipped immediately.
  
  One Southern manufacturing facility brought in a new manager, a Yankee woman. She announced that the assembly lines would be torn up. She explained there would be six groups, told the employees to pick teams, and then figure how to build the new furniture – all while sharing expertise. These employees, who had always been instructed to leave their brains outside, were being asked to develop a new system.
  
  
• The company had approached a bifurcation point where the system could renew itself or create chaos. For a few weeks, it bordered on chaos.
  
  
• The results: Soon, productivity increased 50%, and company was mass customizing. Each group did it differently. Then the groups started to cross-pollinate. If one group started to fall back in one area, it would get information from others. People created connections because they now understood the whole. People who made the frames realized they now had to get rid of sawdust. They asked the people working the kilns if the sawdust made good fuel. Soon the sawdust provided so much fuel that the kilns were able to advertise to bring in outside work.
  
  
• “Choosing the right 15%” was critical. The dimensions of the change were signalled in interesting ways. For example, the windows had been painted over, creating a dismal environment. They were scraped, brightening the workplace and communicating that the context had changed.

• The challenge: Keyes explained: “If you can get antibiotic in patients immediately, the patient’s stay will be much better. A study contrasting hospitals showed us that our hospital took more time than reasonable to get pneumonia patients the antibiotic.” To get patients their antibiotics in an hour, she noted, would demand changing the whole system.
  
  
• Keyes got a group together to look at the front-end admissions processes, and found that current procedures would never allow the delivery of antibiotics within one hour. So the team changed the paradigm for admission. They designed a system where early hospital work, testing and initial treatment all get done in one location, before the patient moves to inpatient status.
  
  
• The results: At first the new process was only used for a small portion of admissions. However, they were so successful that their process soon encompassed all admissions, and then went beyond. Changing that one part of the work flow began changing everything.

• We don’t necessarily need to change the whole. Rather, we can choose small chunks, try out new ways, use only what works and build on it.
  
  
• Rules are context dependent. Chunking as displayed in the Muhlenberg story wouldn’t have worked at the furniture company.
  
  
• Innovation was a key theme. In contrast to the frustration that old systems aren’t giving us the capacity to innovate, complexity science makes sense of how people do innovate, whether they use its insights consciously or not. We can best understand how all this works by collecting stories, not putting together cook-book rules.
  
  
• Another key theme was the emphasis on identity, a widely held understanding of what the company should be. Mission statements are often vapid, full of words that no longer mean anything. But Great Harvest’s hippie bakers start with “Be loose and have fun.” A group of fire fighters came up with: “Prevent harm; survive; be nice.” Petzinger noted that he was amazed at how many behaviors can take place when people have this kind of identity.
  
  
• The paradox is that identity is essential, yet organizations that survive are the which are able to change that identity. If the mission is not a living identity, it will lock a company in.
  
  
• Zimmerman re-emphasized fun and innovation. It’s hard to be creative when you’re overly serious. Innovation occurs when people play with ideas in their organizations.

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