Issue and
Opportunity… It was suggested that the human element is often
a weak link in many current QI approaches. Pareto analysis doesn't
often yield things like "relationships" as a root cause. CAS theory
suggests that interconnections are key in emergent behavior of a system.
How can we balance and honor both rational analysis and human interaction
to shorten the path to constructive emergence of improvement?
Shortcomings
in QI Where We Think Complexity Concepts Can Help… Suggestions
so far include: seeing patterns where we could not see them before...
directing attention to interactions... understanding the role of relationships
in both organizational and clinical improvement (how exactly does
the Placebo effect or Hawthorne effect work and can we harness this
power rather than "controling for it" to get it out of the way of
our thinking?)... a deeper understanding of how change occurs... deeper
understanding of the role that context plays in whether improvement
and change happens... going beyond the reductionist view of problem
solving.
Recalling the
Stacey diagram again, we might go after root causes in the current
QI way when there is a strong signal, but use multiple approaches
and experimentation at the edge. We must be careful to include the
scientific method within whatever broader approach we develop. It's
"both-and."
Dialogue and
Both-And Thinking… Many QI successes appear as stories about how
a team teased apart the elements of the system to find root causes.
Could it be that the improvement really had little to do with this
and more to do with the complex interactions within the team that
allowed new ideas to emerge? This question lead to a discussion about
the role of dialogue in improvement efforts. Again, dialogue and rational
analysis are a "both-and" pair (not either-or). Dialogue may shorten
the path to constructive emergence of improvement. But that dialogue
can be aided by rational analysis. Structure helps.
Thoughts About
Demonstration Projects… Need to do more thinking.
Ultimate Goal
of This Line of Thinking… We can make a major contribution to
improvement science if we can clearly point out the limitations of
current QI technology and demonstrate a framework that is broad enough
to both include that current technology and extend it.
Note:
This topic might be subsumed under the "Enabling Natural, Adaptive
Improvement" or "Diffusion of Best Practice" topics. However, there
is benefit in focusing on it directly.
