Close to certainty and far from agreement #WILTW

This is the 168th #WILTW

An entire generation’s knowledge of  chaos theory was based on a short clip in a Hollywood blockbuster (click here if video doesn’t play)

Some mathematicians have been relatively generous of this description although I suspect others view it in the same way marine biologists observe that clown fish are now called Nemo fish. What was being described was probably more akin to a complex adaptive system, a term which is being used increasingly frequently to describe healthcare environments. Thinking around complexity challenges the assumptions [1] that

  • Every observed effect has an observable
  • Even the most complicated things can be
    understood by breaking down the whole into
    pieces and analysing it
  • That if we analyse past events sufficiently, this
    will help to predict future events.

The final point merges into Black Swan theory but is also a cause of a great deal of tension between commissioners, policy-makers and providers of healthcare services. These challenges are encapsulated in the Stacey Matrix

Complexity Matrix (Stacey 2007)

The Stacey Matrix is a management tool designed to help guide the approach to a particular challenge. Just the insight that there are relationships between the certainty of outcomes following an intervention and agreement about what that intervention should be may be helpful. For example if the solution is obvious and all parties agree on it, the intervention is self-evident. Groups also may be agreed on what to do but no-one is certain on what the results may be. All too often there is little agreement on a path forward, even when the problem is very discrete and objective (close to certainty and far from agreement) .

These issues apply at micro (doctor-patient) and macro (health services-public) level. The former described by the treatment of a large inguinal hernia (likely to be agreement between doctor and patient that intervention is required) and the latter by the recent debate about the treatment of Charlie Gard.

There is nothing intrinsically clever about the way the matrix classifies complexity. However it is clear that it is often not recognised that systems are complex and so dis-agreements escalate. The below a list of interventions to improve flow in Emergency Departments.

Those who work in Emergency Care are likely to feel this is ‘close to certainty’ in terms of its impact and are often surprised at the ‘lack of agreement’ around its implementation. I offer no solution to this impasse other than an insightful response to this complex problem.

What have you learnt this week? #WILTW

(Thanks to Dr. Ben Teasdale for sharing the Stacey Matrix this week)

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Further Reading:

Complex Consultations and the edge of chaos

Lessons from Jurassic Park: Patients as complex adaptive systems

[1] Taken from Complex Adaptive Systems by the Health Foundation

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