The Elephant in the Operating Room – Why Healthcare Can’t Change

It is a well-documented fact that in healthcare approximately 94 percent of the results produced, both good and not so good, is a function of the systems in which people work, not individual’s efforts. How many leaders and managers in healthcare know this and, more importantly, are systems thinkers who are skilled in optimizing systems to improve results or solve problems? Not many. I might add that optimizing systems is the proven best way to set care providers up to be successful in caring for patients and improving safety, surly an integral part of more conscious and effective leadership and management in healthcare.

Ilya Prigogine won a Nobel Prize in 1977 for his Law of Dissipative Structures, which describes what happens to systems that resist change in a changing environment and surly the case in the current healthcare system. 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 dissipate only the original amount of energy and so becomes perturbed or stressed. As the system continues to resist change, stresses build 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 and cannot be accurately predicted.

The Game Changer!

Over many years applying the Law of Dissipative Structures in our systems improvement work in healthcare and other organizations, we made a startling and I believe game changing discovery. The stresses that build in the change-resisting systems are passed on to the care providers 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 patients. 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 all systems in the physical universe. But the stresses don’t stop there.

As the system’s stresses (physical energy) are passed on to people, the energy is usually transduced to fear-based thoughts that are held in the mind as stress. Each of these thoughts has an emotional component that individuals identify in some way as stress, unhappiness, frustration and, toward the “reorder” stage, potential for depression, disengagement and burnout. With 70% of the US workforce being disengaged, we see significant systems stresses in most of our large, legacy industries. Of course, employees take these stresses home where they are passed on to family members in some way.

The More-Better-Different Trap

This is exactly what is happening in healthcare. As legacy systems for delivering healthcare resist change as the environment changes, over time those stresses are passed on to care providers and patients. In response, leaders and managers in healthcare unconsciously fall into the “more, better, different” trap, a form of temporary insanity. This brand of insanity entails doing more of what is no longer working, doing what is no longer working better, or plunging into doing what is no longer working differently, all the while expecting a different result. Leaders and managers in healthcare desperately need a paradigm shift, an expanded way of thinking about fixing healthcare.

The mind is a system, too. The great Buckminster Fuller goes even further in stating that, “Every thought is a system.” Because thinking is systematic, if we can understand the system, we can use many of our systems improvement tools to shift paradigms and expand thinking and consciousness. This is critically important because optimization and sustainability of quality, safety, outcomes and patient satisfaction systems are only insured when both physical systems and the systems of the mind are optimized. When it comes to sustainable change in healthcare, physical systems and how care providers, and especially leaders and managers, think are equally important parts of an integrated whole.

Why Six Sigma, Lean & Lean Sigma Aren’t Working

Every hospital has some kind of systems optimization program such as Six Sigma, Lean, Lean Sigma or others by another name. In the vast majority of cases, these programs are under-performing or outright failing. Why is that? The underlying principles these programs utilize are mostly solid. The stuff works very well in some companies, most of them foreign. Something is missing. That something is the paradigm shifts necessary to make systems optimization stick.

Albert Einstein reminds us that we can’t solve our problems with the same level of consciousness used to create them. For the most part, healthcare is stuck in the same old thinking used to create the massive issues faced by the industry today. Without some sort of an expansion of our thinking and consciousness to go along with systems optimization, healthcare will remain stuck in an endless cycle of more-better-different.

When we use a systems-based approach to both optimize systems and shift paradigms as two halves of an integrated whole, the sustainable results in healthcare are impressive, in some cases unprecedented. Check out the results produced in using this revolutionary integrated approach in improving healthcare.

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