My improvement approach started with attempts at ‘good science’ using logic and reason. This was the right approach, with good outcomes for patients.

However, after a secondment where some of the situations required dealing with uncertainty, tipping points of change and elements of disorder, I had to adapt.

The compulsion to bring order to a complex adaptive system is like a dog chasing its tail. So, I chose a different approach.

This involved changing the logic with which I approached a problem or situation.
This is the second blog in a two-part series on worldviews in improvement. For an outline of different worldviews and how they relate to improvement, see my first blog.

Logic and improvement in complex systems

In Social Research: Paradigms in Action, Blaikie and Priest say it is not possible to avoid adopting a worldview, but they do think you can make some fundamental choices. There are three main logics to consider when approaching improvement projects.

Inductive logic of inquiry: the practitioner starts in a bottom-up way with observations of the phenomenon or people’s own subjective interpretations. This is intuitive to clinical staff. The practitioner then develops questions or hypotheses to investigate the phenomenon. As these questions or hypotheses are confirmed or refuted the practitioner can build up a picture of what is going on. This is usually then called a ‘theory of change.’ Most of the time, a theory of change comes about by the next logic.

Deductive logic of inquiry: the practitioner starts in a top-down way. This is something many of us are already familiar with. This logic is usually developed from a set of existing principles, e.g., model for improvement or Toyota production system principles. It takes pre-existing laws or principles that are already formulated into a theory or model and applies them to a new scenario. In turn, this produces a new question, i.e., what did you learn from the last Plan, Do, Study, Act (PDSA) cycle that created some curiosity as to what was going on? Because this type of logic starts with a theory of change, there is a risk that a systemic element has been missed.

Abductive logic of inquiry: the practitioner is usually driven by a phenomenon or social problem itself. This is the approach I realised I was taking. The practitioner tries to explain why it is occurring, why now and in what ways. They may compare themes and dynamics that explain the issues from other situations, professions or past projects to help shed light on the issue. This can come off as challenging the status quo, when applying the concept of falsification to commonly held absolutes. For example, if the common discourse is that all crowds will riot, but there is evidence of peaceful crowds, then that ‘law’ does not always hold true. Mixed methods to triangulate findings seems to reside here.

Changing the logic for better outcomes

I believe systems methodologies and other approaches from across disciplines can offer insights into other traditions of understanding. I now consider what I understand about the situation and adapt my logic and reflect on my worldview. I do not believe it to be wholly inescapable, but by appreciating and reflecting on them, we can perhaps sidestep some pitfalls in thinking.

Changing the logic is not to be confused with changing the methodology. For example, with a classic improvement approach of define, measure, analyse, interpret and control (DMAIC) which has a deductive systematic logic element to it, switching out the tools for something qualitative instead of quantitative does not make it inductive nor systemic. The logic of method here, i.e. the methodology, is essentially the same. Only the tools have been changed.

Starting with a systemic approach such as an appreciative inquiry to understand the situation more holistically and then applying DMAIC would be considered a mixed methods approach.

Systems thinking and complexity science can offer insights into diverse ways of understanding. (See the poster from Ecolabs linked at the end of this blog if you want to learn more about those concepts.)

While worldviews may not be wholly inescapable, I believe that appreciating and reflecting on them can help us sidestep some pitfalls in our thinking.

Where do we go from here?

If we, as improvement practitioners, are to cultivate sustainable change, we need approaches to match the wicked problems we encounter. Dan Harley discusses some of these in his recent blog (see related links).

I invite you to consider incorporating some research principles, systems thinking and complexity science into your improvement practice.

Reflect on whether your chosen methodology aligns to the system it is to be applied to or whether it has been chosen because of the dominant worldviews on the project.

The best advice I ever had when something was not working was, ‘change your approach.’ I hope this blog might help you do that.

Join the conversation

What alternative approaches do you find useful? Let me know in the comments below. You can also continue the conversation on the Special Interest Group (SIG): Complexity approaches to support quality improvement.

Further resources

The Visual Communication of Complexity – May2018 – EcoLabs (cecan.ac.uk)