The Law of Dissipative Structures won a Nobel Prize in 1977 for the brilliant Ilya Prigogine. The law describes the process by which systems and subsystems in the universe (and healthcare):
– come into being
– naturally resist change, which stresses them
– become highly stressed and dysfunctional
– fly into chaos (called “reorder”)
– then reforms into completely new systems that are again stable, but at a higher level of functionality
Note: The old system no longer exists and has been completely transformed to a higher-level system. Importantly, the new system is not a bigger or better version of the old one.
Look Out for the Wobble
However, there is an interesting phenomenon that occurs in most systems prior to or as a system enters reorder; it begins to vibrate or wobble. This indicates stress levels in the system have built to the point we are seeing the beginning of the flight into chaos. That is exactly what appears to be happening in healthcare around the world and particularly in the US.
A spinning top is a system. It is quite stable as long at the rate of spin stays high. But as the top loses energy and spin rate, it reaches a point where it’s still spinning, but it begins to wobble. The wobble is the beginning of reorder. Like a spinning top preparing to fall, it appears healthcare has begun to wobble.
Smaller Wobbles Lead to Bigger One
The wobbles in healthcare were first observed with the demise of primary care and rural care. Notice that these wobbles put more stress on the larger system. Now healthcare has engineered a super wobble in creating the new pandemic of nurse and physician burnout. This wobble, left unchecked, has the potential to bring the larger system to its knees.
Will leadership in healthcare take on the challenge of reducing or eliminating the stresses in the care delivery systems that are the primary root cause of nurse and physician burnout? No. They won’t. The system itself won’t allow it. The system requires that the vested interests at the top of the healthcare system stay focused on maximizing profits regardless of the signs of reorder. What can be done?
Nurses and Physicians Must Fix the Systems in Which They Work and Rescue Themselves
A bottom/up, systems-based, transformation model (3D) has proved effective at UAB Medicine in reducing/healing burnout and solving other problems on the front lines. Here is a recent article published by UAB on implementation of 3D: https://lnkd.in/d5ZaGUeD. Notice the renewed energy of nurses and physicians.
UAB is submitting to prominent journals this month two peer reviewed papers on its 3-year case study of implementing 3D. Publication is likely in the next 60-90 days. Possibly this will open mainstream healthcare a little to 3D and give our nurses and physicians a chance to save themselves from burnout or worse.
For those interested in learning more about 3D, DM me. I have several useful resources I’m happy to share with you.