Andrew Ware's activity
In group: Complexity Approaches to support Quality Improvement
-
Andrew Ware posted an update in the group Complexity Approaches to support Quality Improvement 8 months, 3 weeks ago
Bore da everyone,
Andy here from Cardiff.
I recently came across the Cynefin Co’s re-emergence: Complexity yarns with indigenous thinkers.
Some of you are likely familiar with Cynefin. I hadn’t heard Tyson Yunkaporta speak before from the Indigenous Knowledge Systems Lab (Deakin University Australia). I enjoyed them, and I though you might too.
There are four recorded webinars which you could listen to in the background while working at the computer. They cover a wide range of issues and topics not necessarily discussing healthcare, but do explore concepts within cultures and complexity. It might spark an idea.
Not that it came up in the webinars, but while I’m here, what is relevant to complexity approaches to QI is Ashby’s Law of requisite variety from a System Thinking lineage. If a system needs to be able to respond to the variation in an external environment, could reducing ‘negative’ variation have the unintended consequence of trimming too much fat and cutting the muscle? A paper by Plesk and Greenhalgh explored the role of the positive dimension of variation. With my clinical hat on, I relate this to having SOP’s as good practice but when faced with something different, being able to adapt so not to create failure demand and therefore waste later on.
I saw a post about ‘when is improvement bad?’ Did anyone attend? Was this issue explored?
I am starting my final research MSc module in October. I am interested in the mismatch of worldview, approach and technique. This is likely going to be a mixed methods study. If I need to interview anyone to get their take from a complexity point of view, would any of you be interested?
Diolch / Thanks
Andy
Hi Andy,
Thanks for posting these webinars; not had chance to view them previously so will make the effort to take a look. Also wondering on a Dave related note whether anyone has been exploring his latest work around Estuarine Mapping? I’ve watched some introductory webinars and think there’s something really useful in what he’s developing… Link here to one:
I think the notions of (requisite) variation and redundancy are key variables to attend to in complex systems as having some slack and space in complex systems supports the capacity and conditions for emergence and therefore novel responses (under conditions of constraint). I do think it invites some further consideration when we think about improvement in complex contexts – perhaps exploring what is ‘useful’ variation and ‘necessary’ redundancy may be part of a nuanced conversation in this area – how do we frame variation and redundancy as being beneficial under certain conditions rather than simply ‘waste’ or inefficiency??
And I’d be happy to help you with your research if you need some willing volunteers…
Best, Gareth
Prynhawn da Gareth,
How are you?
I haven’t had a proper chance to get my head around the Estuarine mapping. Thanks for sharing that link.
‘Necessary redundancy’ that’s an interesting concept, especially under certain conditions, I like that.
Could we start a thread as a nuanced conversation on this or a collection of stories and see where it takes us?
A story which I was told and will share, but as Tyson says in the webinar, “don’t spoil a good story with the truth” as I have no doubt its a bit of a tall tale – necessary redundancy was perhaps evident here.
Cost savings were required and it had been identified by two senior staff from another department, that there were two special care baby “beds” that were very rarely used and apparently was costing the organisation about £100,000 each (to staff, maintain ,etc) a year. So the obvious solution was to get rid of them and save £200,00 out of the budget. This proposal was made in isolation and aired at a senior meeting away from the staff, and directorate manager. As the story goes, there was someone fairly versed in complexity that got wind of this plan. They were operational at the time and linked to the unit. They managed to get into the next meeting and explained that actually it is rare for both to be used, it is not predictable when it happens, but it is foreseeable – not in the data but perhaps on the day from the situation awareness of the staff . There are times where they are at capacity and there will be a baby with acute needs which can be cared for by the unit, and it is evener rarer still that at full capacity and one more baby needs a ‘cot’. They have very rarely needed 3, almost never happens and that’s where a different activity would come in.
If both beds are removed and they then have a baby needing specialist care when they are at full capacity, considering where they are geographically, they figured out it costs £300,000 in money and wooden dollars, to get a helicopter to get that baby to the nearest unit where it can be cared for. Remember that’s each time it happens, and not a year. And if there is another baby at the same time that needs a helicopter already in the air to take them to the nearest unit…. well, it was at this point the message got across and the two people left with their tail between their legs. The two cots remained.
I have another story around ‘necessary redundancy’, but I’d like to hear some others first.
Thanks for volunteering and I will keep you in mind, it would be good to catch up with you anyway and see what happening in your neck of the woods. I have been supporting some Neuro-rehab work which was meant to take me to the North, but I was ill and couldn’t make it. Coming back in the future hopefully soon to take that work further.
Bye for now.
I tend to find Cynefin both useful and confusing. I have found that helping people in organisations learn about complexity very helpful to their understanding of how to understand and change organisations. So I wrote a piece that might be a bit more straightforward. Any thoughts that you might have would be welcome for rewriting it!
https://www.improconsult.co.uk/service-design-systems-thinking-blog/systemic-design-framework-complex
Thanks John,
I’ll be sure to check it out.
I understand what you mean by both useful and confusing. There are some colleagues that talk about complexity and they are really talking about Chaos theory. This is different to the term used in Cynefin which when pointed out to me, helped me think about it differently but also bring in those ideas – such as strange attractors and predictability derived from data.
I did a Liminal Cynefin online course and there was another layer underneath Cynefin which I found really useful and still come back to the material when thinking about scenarios people have found themselves in…and even sense check myself if I am not where I think I am.
I have watched a few videos on estuarine mapping, but can’t say I understand the method or purpose to use it than I already did.