Posted By Prucia Buscell,
Thursday, October 16, 2014
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In parts of Sierra Leone and much of West Africa, people have
traditionally kept the bodies of loved ones in their homes for several
days after death as mourners wash, caress, dress them and pray over
them. Because the corpses of Ebola victims are highly contagious, the
tradition has been a key vector in spread of the disease. Burial teams
from the Red Cross and other organizations have been attacked trying to
interfere with care of the dead. Some families have even hidden corpses
to make sure proper rituals can be performed.
In a Psychology Today post
, Steven Hayes
, PhD, Foundation Professor of Clinical Psychology at the University of Nevada, writes that behavioral science is as important
as medical science in discovering alternative rituals that honor both culture and safety.
Four years ago Beate Ebert, a German psychologist and others formed Commit and Act
, a nonprofit in Sierra Leone devoted to bringing psychotherapy to people traumatized by a decade of civil war and violence. Hannah Bockarie
a social worker fluent in Krio, the local language, led workshops,
evaluated through a partnering agreement with the University of Glasgow,
to train indigenous counselors and health care workers. When Ebola hit,
the organization was in a unique position to help. Hayes explains that
Commit and Act, already known in the community, was able to educate
people about Ebola and the practices needed to halt its spread
Bockarie also led local groups through therapeutic sessions that helped
them come up with alternative burial customs that honored their values
while allowing health care workers to safely dispose of bodies
beautiful example one group came up with was substituting the corpse
with a banana trunk," Hayes writes. "The body of the infected and now
diseased person is burned. Relatives keep a banana trunk at home, and
perform all the customary rituals on it, including kissing the banana
trunk before burial. In the end the banana trunk is buried."
says he is awed and inspired by "a pathway forward" that could not have
come from the outside, and that could not have been produced by
military intervention nor dictated by foreign aid workers.
He explains that the evolutionary biologist David Sloan Wilson's Evolution Institute
combined with Commit and Act to use Acceptance and Commitment Therapy (ACT)
along with principles from the late economist Elinor Olstrom
, who won a Nobel Prize in 2009 for works showing the skill of indigenous people in protecting common resources.
People who face a problem are the best poised to find ways to solve it. That's a key insight of Adaptive Positive Deviance
After the disclosure of the Ebola infection of a second nurse who
worked at the Dallas hospital where a man died of the disease, health
officials have aimed to promote caution without feeding panic. The
second nurse flew on a commercial airline
before she had symptoms and the CDC has asked all 132 passengers on her flight to self-monitor
and call a CDC hotline. Some politicians
propose a ban on travel to the U.S. from Western African countries. In Texas, a community college announced it was rejecting students from any country with confirmed cases of Ebola
don't know exactly how the two Texas nurses were infected, though
multiple news reports have suggested infection control protocols in place at the hospital were insufficient for Ebola
. National Nurses United
a nurses' union, said nurses at the hospital complained of confusion,
frequently changing policies and protocols, inadequate protection from
contamination and spotty training. Indeed the CDC has now recommended extra levels of protection for healthcare workers
caring for Ebola patients, as well as detailed guidelines for the
potentially hazardous process of removing contaminated protective gear.
CDC Director Dr. Thomas R. Frieden has said the most important
protection is for a site manager to oversee workers as they put on each
piece of personal protective gear, and as they remove and properly
dispose of each one. One hopes front line workers will be engaged in
finding the best ways to adhere to new protocols.
When Plexus Institute led a multi-year initiative to stop MRSA infections
the protocols in use at the time differed from what is being
recommended now for Ebola. But MRSA infection rates dropped dramatically
when front line healthcare workers collaborated to developed methods
that would achieve the most consistent adherence to the known protocols.
The late Jasper Palmer, a patient transport worker at Einstein Medical
Center in Philadelphia, devised a way to remove protective gear safely
while also reducing the volume of contaminated trash. It became known as
The Palmer Method. Watch here
Posted By Prucia Buscell,
Thursday, October 09, 2014
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Imagine not being told to turn off your cell phone at the opera.
Think of audience interactions with special apps providing bursts of
synchronized color on the screens of hand held devices. And imagine
special balcony seating where technologically inclined opera buffs can
live-tweet their experience.
is an engineer and music scholar who believes technological innovation
and artistic innovation are naturally linked and he is finding new ways
to bring opera into the twenty-first century.
Kim has taken a sabbatical from his post as director of Drexel University's ExCITe Center to collaborate with Opera Philadelphia in exploring how emerging technology can be woven into all phases of operatic production. As he explained to Maiken Scott at Newsworks.org,
"Music and technology have always been a part of my life. I just
couldn't decide which one I loved more, so I've continued to do both."
Kim double majored in engineering and music and also has a degree in
vocal performance practice. The ExCITe team developed LiveNote, an award-winning app for hand held devices that guides opera goers through the musical, artistic and historical elements of what's happening in some Opera Philadelphia performances.
People habitually carry so much tech around with them, Kim observed,
that it's "a little bit anachronistic" to keep asking that devices be
turned off. When Opera Philadelphia presented a free outdoor performance
of "Barber of Seville"
projected onto massive screens at Independence Mall, the audience of
6,000 got a new technological treat. Kim and his team designed a web app
that changed the color of every audience member's smart phone screen on
cue and in unison.
Kim notes operas over the centuries advanced innovations such as
pyrotechnics, trap doors, and imaginative lighting effects, so
technology, opera and audience interaction are a natural fit. Before
conventional darkened theaters existed, operatic audiences
were part of the pageantry. Kim thinks traditional nineteenth century
staging can make an opera seem remote today. We read "Hamlet" and
"Macbeth" because some human conditions are timeless, he said, and he
wants to find ways to recreate that timeless emotional connection
between opera and modern audiences. He believes technology will enrich
At Opera Philadelphia's performance of "Ainadamar," the balcony had a social media section for bloggers and Twitter enthusiasts.
Earlier this year Opera Philadelphia and The Franklin Institute participated in a global experiment
as a live performance of the robot opera "Death and the Powers
" was simulcast
from The Dallas Opera to more than ten locations in Europe and the U.S. The opera, by American composer and inventor Tod Machover
of the MIT Media Lab, tells the story of Simon Powers, a dying
billionaire who can't bear losing his family. He decides to upload his
emotions, thoughts and personality into "the system," from whence those
elements of him become absorbed into household objects that interact
with loved ones after his death. Audiences at the simulcasts received
secondary audio, video and multimedia through a specially developed app
downloaded to their handheld devices. Audiences could experience the opera
from the viewpoint of "the system," or a robot, and in addition had the
opportunity to influence visual aspects of the performance. Read a
, a discussion here
and learn about the technology here
Posted By Prucia Buscell,
Thursday, October 02, 2014
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his service in the U.S. Marines, Jake Harriman saw war and conflict in
Southeast Asia, Africa and the Middle East. A horrifying experience in
Iraq changed his view of the world and the course of his own life.
was a Special Operations platoon commander waiting for supplies on a
highway to Baghdad in 2003 when Americans fired warning shots at an
approaching car they feared might be full of explosives with a driver on
a suicide mission. An Iraqi man leapt from the car and ran toward the
Americans, waving his arms frantically. An Iraqi military vehicle
suddenly roared to the scene, sprayed his vehicle with bullets, and sped
away. The man, accompanied by Harriman, ran back to the car to find his
wife and two children fatally shot. The Americans didn't know it at the
time, but the Iraqi was trying to escape the effort of Saddam Hussein,
then still in power, to coerce poor farmers to sabotage coalition forces
in exchange for food.
Describing those events to The Christian Science Monitor, Harriman said,
awoke inside of me-an anger that burned and grew. That day I vowed to
devote my life to giving people choices and hope where none previously
Five years later he founded Nuru International,
an organization dedicated to ending extreme poverty. To prepare for
this task, Harriman applied and got into Stanford University's graduate
school of business, where he studied economics, computer modeling, and
how to "design for extreme affordability" to get goods and services to
the poorest of the poor. The World Bank defines poverty as living on
$1.25 a day. Harriman looked deeper. Incorporating ideas of economists Mahbub ul Haq and Amartya Sen,
Nuru views extreme poverty as lacking choices necessary to attain basic
human rights. That's more than avoiding starvation. That means
addressing health, education and seeking conditions that foster
resilience in the face of catastrophe.
Stanford Professor James Patell,
who taught Harriman, told The Monitor Nuru differs from many
anti-poverty efforts in the developing world in that its goal is
sustainable projects that will be operated by local communities, and in
its commitment to bringing its model into war-torn areas. Harriman explains in his blog that the work began in Kenya
because he and colleagues wanted to build and test their prototype in a
relatively stable country before trying to introduce it into a chaotic
failed state or conflict zone. "We are attempting to build a high impact integrated development model
that is completely self-contained-that is it can scale on its
own-funded by capital produced in-country and led by nationals equipped
to innovate and effectively manage large scale projects."
said that Nuru seeks local community participants who are true "servant
leaders" who work to distribute power rather than consolidate it. Nuru
is a Kiswahili word that means light. Harriman was recently honored as a
veteran entrepreneur in the White House Champions for Change program.
Posted By Prucia Buscell,
Thursday, September 25, 2014
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farms are blossoming in several big cities, including Chicago, Kyoto
and Singapore, with plants growing in artificial light in specially
reconfigured buildings. The Brooklyn-based design firm Aprilli
has expanded the idea with a proposal for a giant tree-shaped
skyscraper the architects believe will maximize food production and
improve local environment through water and air filtration and renewable
The Urban Skyfarm, winner of an A'Design Award, is described in a FastCompanyExist story by Adele Peters.
Architects Steve Lee and See Yoon Park told Peters they envision the
giant agricultural skyscraper in the heart of downtown Seoul, South
Korea, a densely populated city with air pollution and other
environmental problems. There's little space for on the ground farming
there, and fresh fruits and vegetables at local markets are in demand
but very expensive.
Urban Skyfarm by Aprilli Design Studio
design mimics the shape of an enormous tree, with leaf-like open air
decks built of strong but light weight materials that provide as much as
24 acres for growing fruit trees and plants like tomatoes. The more
enclosed lower and inner portions of the structure have space for plants
growing in a more controlled environment. The roots, trunk, branches
and leaves have different characteristics to suit different farming conditions. The trunk houses a hydroponic
farm for greens, and wind turbines and solar panels at the top provide
energy to keep the whole mini ecosystem in operation. The solar panels
generate energy for night time lighting and heat where needed for plant
Another idea for agriculture in places where farms won't fit comes from JAPA, a design firm in Barcelona now called Forward Thinking Architecture. Architects there propose a system of looping towers that could float in harbors and provide new space for year round crops. In another FastCompany article by Peters, JAPA architect Javier Ponce explains that a network of towers called floating responsive architecture (FRA)
is designed for Singapore-or any other densely populated city near
water where food is expensively imported from long distances. Throughout
the towers, which would surround the city, networks of sensors would
monitor crops and communicate with networks in the city creating a data
management system that would keep track of food supplies and purchases.
Economists say as much as 30 percent of food is wasted, and Ponce says this system would aim for zero waste.
Kyoto Group - proposed network of towers around Singapore
While creative architectural vertical design may help supply nutritious
food to urban centers in the future, many creative projects are already
producing food in urban areas. One example is the work of entrepreneurs in Chicago
who bought an abandoned factory building and transformed it into a
multi-story indoor farm that produces everything from fish to salad
greens to beer. Another example is Urban Farming Guys,
a nonprofit based in Kansas City, dedicated to creating sustainable
urban communities, starting with local food and water security,
alternative energy and economic resilience.
Posted By Susan Doherty,
Wednesday, September 24, 2014
Updated: Wednesday, September 24, 2014
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In 2013, Plexus Institute received a $2.1 million grant from the Bill & Melinda Gates Foundation for a three year project in California’s Long Beach Unified School District (LBUSD) to discover, develop and promote methods that help K-12 educators continually improve so that their students achieve better outcomes. On September 17, 2014, Plexus Institute President, Jeff Cohn, joined a Healthcare PlexusCall to discuss Leading Change in a Complex World.
In the following audio clips Jeff describes one of the best stories to come out of the project so far and provides some background on the project and the model Plexus Institute is deploying in LBUSD. A transcript follows each clip.
The Best Story
Jeff: The best story that has come out of the work so far involves a music teacher. He is literally a department of one for the entire school so he has no peers from a subject matter standpoint to collaborate with. This team gave him an opportunity to interact that he was lacking so he loved that. The team landed on focusing on a particular aspect of this new common core curriculum that I don’t want to spend our time on but it’s a big focus of trying to help "transform public school education.” And one of the domains pertains to students use of academic vocabulary. Words that help their teachers and parents and peers recognize that they actually know what they’re’ talking about and have come to their conclusions in a thoughtful and meaningful way. This music teacher felt that this wasn’t particularly relevant to him, but the rest of the project and the opportunity to collaborate was so enticing that he would stay a part of the team as his teammates figured out ways to help their students learn how to use these vocabulary words productively.
Jeff: Then we’re moving into April. His big looming task is helping the band and orchestra prepare for the Spring concert and he’s still trying to figure out a way to integrate this academic vocabulary, push himself outside of his comfort zone, and he lands on an idea helped by some ideas that he had heard his peers on the improvement team come up with. So, one night he gives as an assignment listening to a recording of a recent rehearsal for the band and he also sends the kids home with a copy of his conductor’s score and asks them to write a short critique of what they hear. He also gives them a list of 10 academic vocabulary words and they’re assigned to use at least one of them in their critique. So the next day he got these extremely thoughtful perspectives from the kids on what they heard where they did find ways to integrate these words. And, maybe to his surprise, but also gratification, they incorporated their critique into how they did their remaining practices together and ultimately led to by far the best Spring concert that he’s ever been a part of. I think this, for all, was a great example of the sort of bottom-up emergent kind of learning that this sort of environment can foster.
Joelle: I know that Plexus has an on-going grant project in the field of education. Who is involved with that, Jeff, and what are you learning?
Jeff: This has been a really exciting project to be a part of. Through a grant from the Bill & Melinda Gates Foundation we’ve been working initially in two middle schools in inner city Long Beach, California. I know I had this vision of Long Beach as this vibrant coastal community, which I guess in some neighborhoods it is, but in the two schools where we’re working it’s a very underserved group of kids. 95% of the kids on subsidized meal plans and over half English second language. The goal of the project is to help teachers learn or re-learn how to continually improve. There’s data that was not collected by the Gates folks but which they’ve held up to the schools and to us that shows that most teachers after the first few years of their career plateau in terms of their effectiveness and plateau at a level that produces student outcomes less than what we would hope.
Jeff: So, how can, instead of the usual approaches in education of external experts coming in and telling schools what they should be doing differently, how might they be able to discover the improvement practices that exist within their own schools but which are hiding in plain sight of which they’re not aware. We’ve been working with teams of volunteer teachers that have been meeting before and after school with regularity. These are a diverse group teachers who initially kind of stayed isolated from each other, did not communicate across subject matter and/or grade barriers, but over the course of the first couple of months as they met and as we used Liberating Structures to design the time in which they were interacting and starting to engage in this challenge we noticed the pattern of interacting changing. Now you hear things like a math teacher asking an english teacher and a phys-ed teacher for help on a certain issue that is a challenge to him.
Joelle: What model are you using to shape this work?
Jeff: The [Bill & Melinda] Gates Foundation had come to us asking us for a proposal based on our previous Positive Deviance work. As we described our approach to Positive Deviance in a complex organizational setting they said, we hear you talking about PD, but we hear your talking about leadership, which we think is important in schools, and Liberating Structures, which we don’t know what they are but you seem to think they’re important, and something about networks and something about complexity, so it sounds to us like Positive Deviance plus plus. And, we wound up thoughtfully hearing what they were describing us saying and saying, yeah, actually our model of doing Positive Deviance work does include all those domains. This image that’s on the screenshare of the complexity lens and adaptive positive deviance at the center, that’s what we’re calling the whole Adaptive Positive Deviance, which is different than and greater than the sum of those individual components of a focus on leadership and Liberating Structures use and the complexity lens.
Posted By Prucia Buscell,
Thursday, September 18, 2014
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say we try harder, make better decisions and achieve more when we work
in groups that have racial, ethnic and gender diversity.
A Scientific American story by Katherine Phillips
describes research showing that scientists, businesses, banks, juries
and groups collaborating to solve problems do a better job when people
from diverse viewpoints and life experiences come together. People who
differ from each other bring differing information, perspectives and
opinions to the task at hand. They may also bring tension and
discomfort, Phillips writes, and that may be part of the benefit.
Phillips, a professor and senior vice dean at Columbia Business School, Margaret Neale, of Stanford University, and Gregory Northcraft,
of the University of Illinois, studied the impact of racial diversity
on small decision making groups. Business students at Illinois were
divided into groups of three and given a murder mystery to solve.
All participants shared a common set of facts, but each person was also
given an important clue that only he or she knew. To solve the crime,
the groups had to share all the information they collectively knew.
Groups with white and non-white members substantially outperformed the
all white groups. Being with similar people makes us think we all hold
the same data and perspective, which stops us from processing and fully
sharing information, Phillips explains.
In a study of jury decision making, Samuel Sommers of Tufts University
found that members of racially diverse juries exchanged a wider range
of information during deliberations. He has also found racial diversity
contributes to greater complexity in thinking.
Other research shows we are more diligent and more thoughtful when we hear views from people who differ from us. Anthony Lising Antonio,
a Stanford Graduate School of Education professor, and colleagues
conducted a study with 350 students from three universities. Groups of
these students were asked to discuss child labor practices or the death
penalty for 15 minutes. Researchers wrote dissenting opinions and had
both black and white students deliver them to their groups. When a black
student presented the dissenting opinion to a white group, it was
perceived as more novel and provoked broader thinking than when a white
student delivered the same dissent to a white group.
People also try harder if they're in ideologically diverse groups. Phillips, Denise Lewin Loyd,
of the University of Illinois and colleagues asked 186 people who
identified as Republican or Democrat to read a murder mystery and decide
who was guilty. They were told to write a persuasive essay designed to
convince a partner who disagreed. Half were told to make the case to a
member of their own party, and half were told to make the case to a
member of the opposing party. Both Republicans and Democrats were better
prepared for their discussions when their partners were from the other
Other studies showed that gender diversity benefitted big businesses. At companies that prioritized diversity, research found, those with women in the top ranks saw greater financial gains.
story did not specifically address economic diversity, which has long
been an issue in education, college admissions and housing. Low income students are underrepresented at elite universities, where incentive to enroll them is weak. Available public housing has dwindled over the last 25 years. Typing "resistance to affordable housing"
into Google brings 1,030,000 results. An eighth grade teacher in a
wealthy district recalled a fear expressed in a class discussion of
affordable housing: "One of the kids said 'these people making $50,000,
$60,000 a year are going to come in here and rob and mug.'"
Posted By Prucia Buscell,
Thursday, September 11, 2014
Updated: Thursday, September 18, 2014
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scholars believe work performance is influenced by our workspaces and
that design can enhance or inhibit human interaction. Researchers are
now confirming that's true, and even further, they're finding that
certain kinds of design encourage specific kinds of results. They also
suggest that productivity may be more a function of groups than of
individuals, and teamwork too can be fostered by design.
According to a new report published in Harvard Business Review,
face-to-face encounters and chance encounters with others are vital for
improvement of workers in a knowledge economy. Authors Ben Waber, Jennifer Magnolfi, and Greg Lindsay
conducted experiments in which employees in hospitals and
pharmaceutical, finance and software companies voluntarily wore
isometric badges that captured social interactions, conversation,
movement, posture and physical location. They write that face-to-face
interactions are "by far the most important activity in an office," and
that unplanned encounters among people inside and outside an
organization improve performance.
Lindsay, who is working on a book he calls Engineering Serendipity, told Fast Company's Lydia Dishman
that employees wearing the devices were monitored for six to eight
weeks and data was randomized to protect individual identities. Content
of conversations was not recorded. Earlier research found that physical
distance negatively affected communication even among digitally
connected people. Interestingly, the Fast Company story says, studies by
Waber found that engineers who shared physical space were 20 percent
more likely to communicate digitally. When working on projects, they
emailed four times as often and finished 32 percent faster than
engineers working on the project in different places.
Waber, Magnolfi and Lindsay cite a 2012 HBR article by Alex "Sandy" Pentland
who did similar research tracing movements and interactions of
employees wearing badges. Pentland identified three key elements of
successful business communication: exploration (interacting with people
from diverse groups) engagement (interacting with people in your own
group) and energy (interacting with more people overall.)
an colleagues in their HBR story cite examples of spaces designed for
specifically desired results. For example, engagement tends to produce
more productivity. So if a business wants more productivity, walled off
work stations and spaces for small-group collaboration, could be a
successful design and the group's break area could be a crucial space
for chance collisions among group members.
The Norwegian telecommunications company Telenor designed
open, public spaces with "hot seating"-no assigned desks-and spaces
that could be easily reconfigured for different uses. Its executives
wanted change and innovation, so they designed the kinds of open spaces
that foster exploration and unplanned encounters. A design that fostered
engagement might have been detrimental for a goal of innovation.
company executives wanted to increase sales, but weren't sure what
behaviors would help. Deployed with badges, they found sales increased
when salespersons interacted with people on other teams-that is, when
they increased exploration. To encourage inter departmental mingling,
the company got rid of several small coffee stations that served half a
dozen people. They created bigger coffee stations, that served 120 people each, and replaced small cafeterias with a large one. Sales rose 20 percent.
authors caution that what works for one company might not work for
another and some results will be unintended. A furniture company, for
example, needed both exploration among some sales people and more
engagement among specific groups who needed improved
communication. Fewer desks and unassigned seats increased overall
interactions, but energy levels and communications declined. The authors
say changes didn't really create movement, they just reshuffled
stationery workers who didn't leave their unassigned seats once they sat
authors also suggest focus on individual productivity in performance
reviews tends to divert attention from the interactions that help group
performance. For instance, they write, if an employee improves group
performance by sharing some successful strategy, the group gain can more
than compensate for productivity the individual may have lost by taking
time to share.
Posted By Tom Bigda-Peyton,
Friday, September 05, 2014
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A recent PlexusCall featured the recent controversy between Dr.
Jill LePore and Clay Christensen on the topic of disruptive innovation. Three panelists shared their experience
with, and perspective on, Christensen's theory: Peter Jones, David Hurst,
and Dr. John Kenagy.
Dr. Kenagy said that successful organizations are designed to
keep doing what they are good at doing.
This prevents them from seeing, or fostering, innovations that may be
disruptive (game-changing). In
healthcare this is important because existing organizations, especially those
that are well-known and established, may miss or suppress a "game
changing" innovation that could provide a breakthrough on Kenagy's
area of focus, generating "more care at lower cost."* In order to support disruptive
innovations in healthcare, we need to create "safe places" in
which to experiment toward better and even disruptive solutions to healthcare's
problems. Kenagy went on to
elaborate on his methods for creating this kind of "learning line," or "safe to fail" lab in healthcare organizations.
However, healthcare also seems to be a special case of
disruptive innovation. As Kenagy
and other speakers noted, the notion of "disruptive" innovation
suggests the advent of a new product or service that disrupts the status
quo. But what is the "product" of
healthcare? Kenagy posits that we
have one product in healthcare: the health of the patient in front of us. This is a complex challenge, one that
suggests a different set of variables than those confronted by Apple or Google.
David Hurst and Peter Jones noted additional dimensions of the
healthcare challenge which differentiate it from other industries. Jones suggested that the popularity of
the "disruptive" idea may lead us down the wrong path,
especially when it comes to healthcare.
Do we want medical device startups competing for funding on the idea
that they have a disruptive innovation, when a better solution may be that a
consolation of companies all have parts of an overall solution that would be
better than any of them can produce on their own? The current funding model may suboptimize in terms of
overall problem-solving and advancing the health and well-being of individuals
and the wider society. For these
and other reasons, Kenagy asserted that "adaptive" innovation
may be a more appropriate term than "disruptive" innovation
How does a complexity view help us develop an optimal US
healthcare system? Let’s
assume that healthcare is a complex adaptive system. How do we represent our theory of the system itself? What are the metaphors of change that
can help us navigate the journey of disruptive innovation in healthcare? The panelists agreed that organic metaphors,
such as the butterfly effect or the self-organizing capacity of flocks of
birds, work better than mechanistic metaphors or system dynamics diagrams. If we want to mimic nature, the
panelists agreed, we need to promote conditions for trial-and-error
experimentation, such that the actors in the system can use a trial-and-error
pathway toward innovations that may become "disruptive."
Are there current efforts in healthcare to mimic nature’s
process of self-organization and evolution? What can we say about the conditions which foster this kind
of process in human organizations?
Viewing the situation through a complexity lens may help.
When we think about nature as a metaphor for self-organizing and
evolution, we need to think about the conditions in human organizations that
promote self-organization. We
would like to highlight three:
agreement among stakeholders; and
language and common framework for complex problem-solving.
Following the Stacey Matrix (below), "optimal uncertainty” refers
to a middle zone between chaos and simple problem solving. There is uncertainty but not so much as
to paralyze the organization; there is familiarity but not so much as to make the problem seem
routine. Optimal agreement is a
similar concept, in which we find a diversity of views but also enough commonality
to bind, or hold, the group together.
Finally, we believe the capacity for self-organization is fostered by a
common language and framework for complex problem-solving, such as the ability
to differentiate between simple, complicated, and complex problems and the
capacity to match appropriate methods to each.
How does all of this apply to healthcare? We will take up this question in our
Tom Bidga-Peyton is a Senior Consultant with Plexus Institute. Tom's work focuses on widening and accelerating the pace of improvement in individual, organizational, and large-system change initiatives.
Posted By Prucia Buscell,
Thursday, September 04, 2014
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Richard Stratton, executive, author and former drug smuggler, enjoyed
counting piles of hundred dollar bills. He says it was a "pleasant,
relaxing experience." Harvard Economist Kenneth Rogoff thinks hundred
dollar bills are nothing but trouble.
Both expressed their individual expertise in an NPR
interview with Melissa Block and Chris Arnold. Stratton, a novelist,
friend of the writer Normal Mailer, and later TV executive and magazine editor,
once served eight years in prison for drug smuggling. He told NPR the drug
business involved generating and smuggling huge sums of money as well as
narcotics. Rogoff thinks $100 bills are
all too often used to finance illegal activities, and that's a good reason to
get rid of them. Rogoff notes these big bills allow a person to carry $1
million in a briefcase. And why would anyone not engaged in nefarious
enterprises want to do that?
Rogoff goes even further. Writing
in the Financial Times, he proposes getting rid of paper money entirely and
replacing it with electronic money. Among other things, he argues, as electronic
payments, even for small amounts, become increasingly prevalent, the need for
paper currency declines. There would be complications, of course, and
international cooperation among governments would be needed. But Rogoff
suggests getting rid of large denomination bills would be a good start.
Rogoff and others have said 75 percent to
percent of all U.S.
currency world-wide is in $100 bills. And many experts think easy flow of
huge amounts of anonymous cash facilitates
tax evasion as well as illegal trafficking in drugs, weapons and human
Times notes that when someone with Rogoff's heavyweight credentials
questions the future of physical money in a conservative, influential
publication like the Financial Times, "The world should sit up and
from physical to virtual money would be momentous. Would underground and
unofficial currencies flourish? Would crooks find ways to exploit the
transition? Stratton, who no longer holds $100 bills, told
NPR he thinks criminals would adapt.
Judson, an economist at the Fed, told
NPR she's not convinced there's a need to get rid of the Benjamin Franklin
bill because there's really no way to know how much cash in circulation is
being used for good or evil. Some historically huge $100 bill transactions have
been conducted by government. After the invasion of Iraq in 2003, the U.S.
$12 billion in shrink wrapped hundred dollar bills to Iraq to pay Iraqi
ministries and U.S. contractors. Planes delivered literally tons of cash from
New York to Bagdad for disbursement by the U.S. led Coalition Provisional
Authority. Congressional investigators later found control of the cash was
lacking, and accounts
on how much remains unaccounted for.
Posted By Prucia Buscell,
Thursday, August 28, 2014
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Leana Wen, MD, an emergency physician who has worked in inner city hospitals in St. Louis, Boston and Washington, D.C., writes in her blog about the painful experience of administering short term fixes to patients whose long term afflictions lie beyond her realm.
She describes a 19-year-old who has come to the emergency room three
times with cuts and broken bones and gunshot wounds. An 8-year-old
without an inhaler living among relatives in an overcrowded house with
lots of smokers comes to the emergency room struggling to breathe. A
38-year-old single mother diagnosed with cervical cancer four years ago
never got to see a doctor as she struggled with three part time jobs,
the care of four children and inadequate insurance. By the time Dr. Wen
saw her in the emergency room, her cancer had spread to her lungs and
"We in the ER provide a necessary service, but it's far from being sufficient," she writes in her blog The Doctor is Listening.
"We need to recognize that health does not exist in a vacuum, that it
is intimately tied to issues such as literacy, employment,
transportation, crime and poverty. An MRI here, a prescription there,
these are Band-Aids not lasting solutions. Our communities need
innovative approaches to issues like homelessness, drug addiction,
obesity and lack of mental health services." The route to good health,
Dr. Wen says, is in the community. Dr. Wen is coauthor of the book When Doctors Don't Listen.
When he was still writing the Wonkblog for the Washington Post, Ezra Klein
described an experiment in Oregon to rebuild the state's Medicaid
program around community health rather than individual fee for service
treatments. Klein tells a story Oregon Gov. John Kitzhaber loves to
tell. Kitzhaber, a former emergency room physician himself, calls it an
illustration of what's wrong with our healthcare system. A 90-year-old
woman with well-managed congestive heart failure lives in an apartment
without air conditioning. When her apartment gets too hot, the strain on
her cardiovascular system causes heart failure. Medicare will pay for
an ambulance and $50,000 to stabilize her, but not $200 for a window air
The 90-year-old may be hypothetical, but the story illuminates a
common paradox, and Oregon's experimental approach starts with creation
of 16 Coordinated Care Organizations (CCOs) that are responsible for assessing the health of their communities. Kitzhaber has given the CCOs flexibility on how they can spend Medicaid money. They can buy that air conditioner. An NPR story
describes a Medicaid purchase of a minivan for community health workers
who can be available around the clock to pregnant women trying to stop
substance abuse, and to help mothers get to doctors' appointments,
school and jobs. What makes CCOs different from accountable care
organizations, or managed care, is the community component. Once they
assess needs, they have to come up with ways to address them. So money
can be spent on care coordination and community health workers with the
aim of preventing some expensive emergency care. Gov. Kitzhaber told
Klein, "We're investing in health. It's just a paradigm shift."
With thanks to Annette Garner, who teaches in the nursing program at the Health & Science University, Portland, Oregon.