Design (re)Thinking Health Systems
Posted: May 10, 2013 Filed under: design thinking, knowledge translation, public health, systems thinking | Tags: design thinking, gigamapping, global health, health and wellbeing, health systems, Julio Frenk, knowledge translation, public health, science, system dynamics, systems thinking, visual thinking Leave a comment »
How might we design health systems to promote health and wellbeing and not just treat illness and disease and manage infirmary and chronic conditions? What if health systems were about health?
If we were to apply design thinking to health systems, what might be do?
In a previous post, I suggested that knowledge translation is too important to be trusted solely to health professionals, partly because they have largely failed to take up the charge. Taking a step back — a systems thinking perspective — one realizes that to design better knowledge translation, we need to design better health systems.
Julio Frenk, Dean of the School of Public Health at Harvard, believes this too. In a 2010 paper published in PLOS Medicine, Frenk comments on the state of health systems and examines how we might re-think them in light of global health challenges.
Health systems are the main instrumentality to close the knowledge–action gap. To realize this potential, it will be necessary to mobilize the power of evidence to promote change. Yet all too often reform efforts are not evaluated adequately. Each innovation in health systems constitutes a learning opportunity.
Frenk’s article is an invitation to engage in systems and design thinking about health. Both approaches invite pause to consider what the problem is in the first place. For design thinkers, problem scoping is the first step.
For systems thinkers this is akin to setting the boundaries around the problem.
Once we set the boundaries and find the appropriate problem, we then frame it appropriately for design. Problem definition is something often over-looked or under appreciated, but is the core of effective problem solving and design.
If I had an hour to solve a problem I’d spend 55 minutes thinking about the problem and 5 minutes thinking about solutions – Albert Einstein
Health systems are typically defined in light of professional services and policies aimed at making the sick well. They are essentially illness and disease (sick care) systems. This conceptualization, still dominant in the professional and policy discourse in many Western countries, places medicine at the centre of health services with the allied disciplines working alongside, but rarely ventures its gaze beyond the institutions of care or the conditions such institutions are designed to treat.
Frenk, writing in PLOS Medicine, suggests its time to expand our view of what makes a health system if we are to truly promote and sustain global health and see three key points as provoking such re-thinking:
First, health has been increasingly recognized as a key element of sustainable economic development [1], global security, effective governance, and human rights promotion [2]. Second, due to the growing perceived importance of health, unprecedented—albeit still insufficient—sums of funds are flowing into this sector [3]. Third, there is a burst of new initiatives coming forth to strengthen national health systems as the core of the global health system and a fundamental strategy to achieve the health-related Millennium Development Goals.
In order to realize the opportunities offered by the conjunction of these unique circumstances, it is essential to have a clear conception of national health systems that may guide further progress in global health.
Frenk offers some suggestions:
Part of the problem with the health systems debate is that too often it has adopted a reductionist perspective that ignores important aspects. Developing a more comprehensive view requires that we expand our thinking in four main directions.
First, we should think of the health system not only in terms of its component elements (like human resources, financing, hospitals, clinics, technologies, etc.) but most importantly in terms of their interrelations. Second, we should include not only the institutional or supply side of the health system, but also the population. In a dynamic view, the population is not an external beneficiary of the system; it is an essential part of it.
It’s important to note the mention of the role of the population and its dynamical impact on the system. As populations change dramatically in their composition and form of residency within countries, including a greater movement to urbanization, so too will the myriad factors that influence health systems. The people are the system and thus it will change as populations change. While Frenk lists this as one point of many, it is a radical departure for reductionists or those who see health systems as being about care, not people.
A third expansion of our understanding of systems refers to their goals. Typically, we have limited the discussion to the goal of improving health. This is, indeed, the defining goal of a health system. However, we must look not only at the level of health, but also at its distribution, which gives equity a central place in assessing a health system. In addition, we must also include other goals that are intrinsically valued beyond the improvement of health. One of those goals is to enhance the responsiveness of the health system to the legitimate expectations of the population for care that respects the dignity of persons and promotes their satisfaction. The other goal is fair financing, so that the burden of supporting the system is distributed in an equitable manner and families are protected from the financial consequences of disease.
Frenk’s third challenge is to affirm the very point of health systems at all.
While not explicitly speaking of systems thinking or design thinking, there is much that both fields have in common with Frenk’s argument. Design thinkers might ask: What have we hired our health system to do?
Frenk argues that our health systems must go well beyond just making gains in measured health outcomes towards dignity, respect and social justice.
Finally, we should expand our view with respect to the functions that a health system must perform. Most global initiatives have been concerned mainly with one of those functions, namely, the direct provision of services, whether they are medical or public health services. This is, of course, an essential function, but for it to happen at all, health systems must perform other enabling functions, such as stewardship, financing, and resource generation, including what is probably the most complex of all challenges, the health workforce.
Frenk did not identify specific solutions, but did pose some key questions for health systems design.
If we were to take this challenge up as designers and systems thinkers, what might we do? Here are some suggestions for inquiry:
- Consider new definitions of health like the one posed in the British Medical Journal that emphasizes looking at the social and environmental influences on health beyond just the absence of physical symptoms. Further inclusion of a psychology of human flourishing might add to this definition.
- Map out a new system visually with people at the centre, not professionals or institutions. What does that look like? Tools like a Gigamap might provide the kind of multi-media, multi-sensory visual way to conceive of the interrelationships that make up health system. System dynamic models can help this out as well.
- Engage people across this system to validate this map and co-create possible future models that could serve to shape discussion at multiple levels and mobilize civil society to support healthy environments.
- Create small scale, safe-fail / fail-forward, prototypes of small-scale innovations that can be tested, developmentally designed, and rapidly re-developed as needed to start shifting the system as a whole.
Designing health requires designing health systems. Applying new thinking and envisioning a system that is dynamic, comprised of people and just institutions is a start.
Photo: Bartolomeo Eustachi: Peripheral Nervous System, c. 1722 shared by brain_blogger used under Creative Commons Licence
Is Knowledge Translation In Health Too Important to Leave to Health Professionals?
Posted: April 24, 2013 Filed under: education & learning, innovation, journalism, knowledge translation | Tags: communication, health communication, health systems, journalism, knowledge exchange, knowledge integration, knowledge translation, librarians, social media, storytelling, teachers 7 Comments »
Knowledge translation — and its affiliated terms knowledge exchange, knowledge integration and knowledge mobilization — was coined to describe a process of taking what is known into what is done in health across the spectrum of science, practice, policy and the public’s health. As health issues become more complex due to the intertwining of demographics, technology, science, and cultural transformations the need to better understand evidence and its impact on health has never been higher. Questions remain: has demand met supply? How are the health professions dealing with this equation?
Translating knowledge
The Canadian Institutes of Health Research (CIHR), one of the earliest champions of the concept of knowledge translation in research, define it as:
a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically-sound application of knowledge to improve the health of Canadians (sic), provide more effective health services and products and strengthen the health care system.
These ideas are expanded below:
Synthesis – Synthesis, in this context, means the contextualization and integration of research findings of individual research studies within the larger body of knowledge on the topic. A synthesis must be reproducible and transparent in its methods, using quantitative and/or qualitative methods. It could take the form of a systematic review, follow the methods developed by the Cochrane Collaboration, result from a consensus conference or expert panel or synthesize qualitative or quantitative results. Realist syntheses, narrative syntheses, meta-analyses, meta-syntheses and practice guidelines are all forms of synthesis. Resources related to synthesis are available.
Dissemination – Dissemination involves identifying the appropriate audience and tailoring the message and medium to the audience. Dissemination activities can include such things as summaries for / briefings to stakeholders, educational sessions with patients, practitioners and/or policy makers, engaging knowledge users in developing and executing dissemination/implementation plan, tools creation, and media engagement.
Exchange – The exchange of knowledge refers to the interaction between the knowledge user and the researcher, resulting in mutual learning. According to the Canadian Health Services Research Foundation (CHSRF), the definition of knowledge exchange is “collaborative problem-solving between researchers and decision makers that happens through linkage and exchange. Effective knowledge exchange involves interaction between knowledge users and researchers and results in mutual learning through the process of planning, producing, disseminating, and applying existing or new research in decision-making.”
Ethically-sound application of knowledge – Ethically-sound KT activities for improved health are those that are consistent with ethical principles and norms, social values, as well as legal and other regulatory frameworks – while keeping in mind that principles, values and laws can compete among and between each other at any given point in time. The term application is used to refer to the iterative process by which knowledge is put into practice.
In short, knowledge translation is about taking what we learn and know from evidence, sharing that knowledge with others and assisting them to make useful health choices in practice and policy through KT.
This often involves communicating across contexts, disciplines, and roles between and from scientists, clinicians, policy makers and to the public alike. In a health environment that is increasingly becoming complex, the ability to communicate across boundaries is no longer an advantage, it’s an essential skill. While we may not always have the right language, we can translate meaning through stories.
But if stories are to be effective they need to be valued.
The value of storytelling
I’ve seen health professionals — scientists and clinicians — roll their eyes when you mention storytelling in a work context. It is as if the only legitimate role for stories is to communicate with children (which University of Alberta researchers are exploring as a tool for sharing health knowledge with parents). Yet, it is through stories that most people share what they know in every other context; why would it be different in health?
Perhaps it is the connotation that stories are ‘made up’ like children’s bedtime tales, but one need only look to journalism to find that we’ve been making ‘stories’ a central part of our life every day. We listen to drive-time radio for stories about the traffic conditions, we watch, download and listen to news stories filed by professional journalists and citizen bloggers alike on mainstream media, Twitter, YouTube, Facebook along with myriad sources across the web. Last week we were glued to various sources to learn stories — some of them false — and create stories about the events of the Boston Marathon bombings.
Stories are what conveys multiple information threads and puts it in a coherent context.
Stories are coherence engines.
Valuing knowledge translation
If knowledge translation is important then it should be reflected in research priorities and evidence for its impact on the system across different disciplines. Dr Shannon Scott and her U of A team recently conducted a systematic review of knowledge translation strategies in the allied health professions and found that the field was full of low quality studies that made it impossible to make firm statements on which methods were best among them . That team has recently proposed a systematic review looking at how the arts and visual methods can further contribute to KT in practice, although it likely the same issue with methodological quality might come into play here, too.
What she and her team are doing is looking at the process of sharing stories and, from a research perspective, sharing stories appears to not have been worth investing in scientifically. At least, not enough to generate a lot of studies and good evidence.
One could argue that knowledge translation is still new and that it takes time to generate such evidence. That is partly true, but it is also an easy prop for those who want to avoid the messiness that comes with communication (and its problematic research context), learning from others, and creating more equitable information spaces, which is what knowledge translation ultimately does. Knowledge translation has also been in use for almost 20 years so in that time — even with the most dismal assessment of the length of time it takes to put knowledge into practice — we should be seeing some decent research published.
KT is fundamentally about sharing. Journalists’ are rewarded for sharing — the more they share and the more people who they share with (as measured by readers, listeners, viewers etc..) the more successful they are in their work. Teachers are rewarded for sharing because that means that they are teaching people. Librarians are rewarded for sharing because that means people are checking out books and using the resources in their library.
We don’t apply the same standard to academic research, even though we have some crude metrics to measure reach and impact, and there is roughly no metric for the degree to which clinicians share among themselves. Maybe this needs to change.
I have scientific colleagues who are fierce in the face of their most strident academic critics and have delivered keynotes to auditoriums filled with researchers that are nearly paralyzed in the face of speaking to the public. This is not fear of public speaking, its fear of speaking to the public.
Should they be? I don’t think speaking to the public should be expected to be enjoyable for everyone, but neither are doing statistical calculations, completing ethics applications, or presenting posters at conferences, but we still expect scientists to do that. We still expect nurses, doctors, psychologists, medical technicians and social workers to traverse complex social problems to talk to their patients in an open and honest way.
Why is it when scientists are speaking to policy makers, clinicians to scientists, policy makers to the public, or any professional to another from another discipline, speciality or division we decide its not critical for them to make the effort?
Why don’t we do the research to support it?
Why is it OK not to do KT because its uncomfortable, awkward, difficult or confusing?
Declining interest, rising demand
It is perhaps for reasons like this that knowledge translation is so poorly understood and taken up as a focus for research. Looking at Google NGram data (which tracks mention of specific topics in books and publications) we see a steady rise in citations until about 2003 followed by a levelling off. Keep in mind that the leveling begins before social media became known. In the years after Twitter, Facebook and YouTube — arguably the most powerful communications media we have for doing knowledge translation widely (but perhaps not deeply) — there is roughly no sharp increase.
Below are the citations for the terms knowledge translation, knowledge exchange, and knowledge integration from 1996 (when the Web first started gaining wide use beyond academia and the military) and 2008, the latest year for which there is available data. Note that the numbers reflect general mentions as a percentage of overall terms, so they are relative, not absolute values.
Figure 1: Google NGram Data for KT, KE & KI: 1996-2008
Is there so much other stuff to talk about in 2013 that the relative importance of knowledge translation is diminished?
A look at Google Trend data using the same terms finds that not only are these concepts not growing, their mention is actually shrinking.
Looking at the three terms we see that all three concepts have declined over time. During these years — 2004-2013 — we saw not only the birth of social media, but the rise of Internet-enabled handheld devices to allow knowledge to be shared anywhere there is a data signal. We now have apps and nearly all of the Internets resources in our pockets and we are seeing a decline in the use of these terms.
Figure 2: Google Trend Data for KT, KE & KI: 1996-2013
Where to?
So to review: We have a body of evidence in KT that is problematic and incomplete at the same time we have a decrease in use of the terms, while at the very same time we have a sharp rise in available tools and technologies to share information quickly and a continued, steady demand for more information to make decisions for health providers, patients, policy makers and insurers.
Yes, the data presented here are not perfect. But does it not make sense that there should at least be some trend upward if knowledge translation is valued? Should we not see some shift to more research, better research evidence, and greater interest given the tools and scope of communications we have through social media?
This begs the question: is knowledge translation in health too important to leave to health professionals?
In future posts this question will be looked at in greater depth. Stay tuned.
* Blog has been updated since original post
Twitter shows how the news is made, and it's not pretty -- but it's better that we see it
Posted: April 15, 2013 Filed under: knowledge translation, social media | Tags: Boston, journalism, media, news, social media, Twitter Leave a comment »
Not long after the Boston Marathon bombings occurred on Monday afternoon, several Twitter users noted that these kinds of real-time news events illustrate how incredible the service is as a source of breaking news, but at the same time how terrible it is.
Sure enough, there were plenty of fake news reports to go around on Monday, from reports of suspicious vehicles to the arrest of alleged perpetrators -- just as there were during superstorm Sandy…
Evaluating Health Promotion Social Media Strategies for Public Health Impact
Posted: April 11, 2013 Filed under: eHealth, evaluation, social media, systems thinking | Tags: developmental evaluation, evaluation, health promotion, public health, social media, strategy Leave a comment »
How is social media stacking up?
I recently spoke at an interactive workshop presentation at the 2013 Ontario Public Health Convention (TOPHC) looking at social media use in public health and the strategies available for evaluating those strategies in practice. The talk was focused on the tools, methods and approaches and the inherent challenges in dealing with a dynamic social communication environment.
Here are the slides from that presentation.
Evaluating Health Promotion Social Media Strategies for Public Health Impact
Image: Shutterstock (used under licence)
Hacking the Classroom: Beyond Design Thinking
Posted: April 6, 2013 Filed under: design thinking, education & learning | Tags: creativity, design, design thinking, education, hacking, learning, theory Leave a comment »
Design Thinking is trending is some educational circles. Edutopia recently ran a design thinking for educators workshop and I attended two great workshops at SXSWedu 2013 on Design Thinking:
Design Thinking is a great skill for students to acquire as part of their education. But it is one process like the problem-solving model or the scientific method.
The Importance of Journalism to Public Health: 10 Years After SARS How Are We Doing?
Posted: April 4, 2013 Filed under: public health, social media, systems thinking | Tags: developmental design, developmental evaluation, evidence, health communications, health reporting, Helen Branswell, journalism, Julie Leask, media, public health, social media, systems thinking, Wayne MacPhail 2 Comments »
Risk communication in public health with Julie Leask
If a health scare manifested itself in the world and there were no journalists to cover the story, what would the impact on the public be?
That is a question that lingered with me throughout the start of the 2013 Ontario Public Health Convention (TOPHC) which began with a morning dedicated to improving public health communication. Opening up the conference was a series of linked keynote presentations from a risk communications researcher (Julie Leask); a former newspaper editor, journalism professor and social media advocate (Wayne MacPhail), and one of Canada’s leading health specialist reporters (Helen Branswell).
The Academic’s Perspective
Keynote speaker Julie Leask (pictured above) and her colleague Dr. Claire Hooker (a good friend of mine) have been looking at the ways journalists engage in risk communication with the public on matters of public health from immunization to SARS to understanding the health priorities of professionals. In 2010 they published a paper looking at how the media covers health topics and argued that the health professions need to be aware of how stories are made, communicated and to be an active partner with reporters if they are to have positive impact in moments of health scares.
“It’s too late when the crisis comes up” – Julie Leask speaking on the need for public health to get engaged with the public using social media
In a previous post I wrote about how journalism is the fourth estate of medicine and public health. Journalists are the storytellers that the public listen to and are charged with looking at a problem from many perspectives to develop that coherent narrative that speaks to their audience. These are qualities that most scientists and public health professionals don’t bring to their jobs, nor are they always expected to or even should. As such, journalists play an important role for this very reason.
Nonetheless, the health sector has an uneasy relationship with journalism. Health professionals – particularly researchers — poorly understand the world of journalists and sometimes view the profession with suspicion. Julie Leask and her colleagues have found this to be the case, but argue that it is no reason to shy away from engaging the public using the tools that are comfortable to journalists. She spoke to the invaluable role of specialist health journalists in acting not only as producers of high quality health content in the news, but also guardians against low quality content making into press. In speaking to her research, she pointed out that specialist health journalists help educate their peers and editors on health issues, which are often complex and require more than a passing understanding of context to communicate well, as key gatekeepers for quality in the health landscape.
The Editor’s Perspective
To this end, Wayne MacPhail, a former editor of the Hamilton Spectator, argued that public health has a near ethical imperative (my choice of term) to be in the social media space to not only promote good health, but counter and challenge myths and misinformation. This isn’t some naive pronouncement that we’ll eliminate the snake oil sales or quackery that proliferates in the public sphere and media, but rather a simple observation that we have no chance of making impact if we are not even engaged in the space at all.
Like Leask, MacPhail says that it’s too late to engage the public when a health crisis comes up and that public health needs to be in the conversation stream before that happens.
The Reporter’s Perspective
Reporting through SARS to today: Helen Branswell
Helen Branswell, a reporter from The Canadian Press, rounded out the panel and spoke frankly about the dwindling resources and rapidly changing landscape in journalism. She was on the front lines of reporting the 2003 SARS outbreak and showed a picture taken during that time of an empty newsroom and remarked how that the scene is the same now only for different reasons (limited budgets due to decreased ad revenue and the related shift to digital information on the web being two such reasons, among others).
Branswell paints a bleak picture of the present and future in many areas of health journalism. Stories are increasingly being covered by general reporters who may treat the story the same as they would a traffic incident, political story, or crime; journalists who are unlikely to know the context and details that are critical to communicating the nuances present in health matters. Interns are replacing some full time or veteran reporters in the newsroom and there are only a handful of specialists in practice.
Pressures from time, budget and competing interests in the newsroom are all contributing to an environment where quality health reporting is threatened.
What Next?
I asked the panel what they thought public health should do to ensure that the healthy stories are reported well and there was little answers. Helen Branswell said, truthfully and somewhat cheekily: “buy newspapers”. She reminded us that we should be paying for the quality content and supporting good journalism in practice if we want it to survive, which is hard to argue against.
But that alone will not do all the work needed to preserve good journalism. I spoke to another conference attendee, a formally trained journalist who is now working with a research firm, about the ways in which journalists have helped other organizations craft their messages and engaging the public citing the Calgary Police Service’s social media team as an example. This pointed to ways in which journalists can make a difference in matters of public health and social services.
Yet, what about investigative journalism? What about the potential conflicts that come from being paid to report on issues that might be critical of the organization who does the paying (e.g., Ministries of Health, Departments of Public Health, Universities and colleges etc..)? This model doesn’t solve that, but it is at least another option.
Yet, the examples from public health taking this challenge of working with journalists up are few. Many still believe that social media is another means of broadcasting, which misses the mark. Others still view social media, journalism, engaging with the public through the media, with suspicion on the grounds that much of the work out there is not evidence based.
But what evidence did we have when SARS hit us 10 years ago? We had lots of epidemiological data on infectious disease, but that was only part of the story. Many of the leading health scientists were adapting their models, creating new ones and only after the disease left did we really have a full sense of what happened. We learned as we went.
This is what social media is all about, too. The lessons from major health events — disasters, outbreaks, and pandemics — parallel social media. It is innovation space at its clearest and thus there is an imperative to view it as innovation space with the tools and lenses that best support movement within complex adaptive system. From a communications standpoint, social media and the tools of modern journalism (and the style of communication they employ) are one thing to consider. Developmental design and evaluation are also among these tools combined with systems thinking.
Linear thinking and action will not work in a complex system and as this panel pointed out, there is much reason to be concerned if we are not prepared to communicate and support those that communicate well in such times when — not if — they come back.
Ten years after SARS how better off are we? And if we are better, how are we communicating that to the public?
Normative Complexity: Breaking Up is Hard To Do
Posted: March 26, 2013 Filed under: complexity, innovation, psychology, systems thinking | Tags: complexity, design, jeans, mental health, mindfulness, minimum specifications, normative behaviour, psychology, psychotherapy, Russell Ackoff, social innovation Leave a comment »
Normative behaviour is what we expect from others operating in the world around us. It is what defines the world “normal”. It’s based on a complex array of history, social conventions, mores, values, context and timing, but it is the reason we know weird or odd from something else. Weird, is by definition, something that is not normal.
What I Learned From Denim
Many years ago I saw a TV special looking at the world of fashion and was struck by the process of designing denim jeans for men. The audience was told that jeans are often designed based on the prototype of the ‘average’ man and then worked out from there. What struck me was that they also said the ‘average’ man has a size that matches about 1 in every 7500 men. So the average — the normal — is not average at all. Indeed, he is particularly rare. Male models who represent this size do very well in their profession.
While there is a norm of social behaviour, there are actually very few people who are wholly ‘normal’ in their actions, nor are there obvious cases where normal is indeed, then norm in social systems. Why? Because social systems are complex by their very nature. They bring together diverse, overlapping, dynamic elements together operating at different scales simultaneously. This is complexity.
Just as individuals we bring our familial history, education, gender, sex, age, faith (if it exists), height, race (which might be highly mixed), experience, physical abilities, fashion choice, body type, vocal acuity, energy level and on to every single interaction we have. Every one of those factors — of this limited group — bring with it a set of unique attributes that individually and socially have differing weight and ‘normality’ depending on the circumstance. To imagine that there is a place where all of these line up with everyone else is utterly absurd if not statistically impossible.
Yet, we cling to the idea that normal exists and might even be something to aspire to. We push a conformity on to our expectations of each other and our research that is unreasonable and often harmful.
It’s not unexepcted. From our earliest days in the society we belong there is pressure to conform. Norms are what hold societies together. They are what creates culture. But where the confusion comes in is with the treatment of norms as truly common things that is universally positive (if attainable).
It is the often mis-attributed following quote to many that still stands out as true:
There is nothing so uncommon as common sense
In complexity science, norms are not disregarded, but are only minimally useful in helping understand patterns of activity. There are path dependencies, which guide certain activities and point to the importance of knowing where things start to help trace the manner in which they project outward. There are things called minimum specifications, often referred to as ‘simple rules’, that can help us create certain conditions within boundaries to shape behaviour. Yet, no matter how we shape these, the normative condition is not and will not be normal in any sense like your favourite pair of jeans.
What Relationship Break-Ups Can Teach Us About Complexity
Psychology and Psychotherapy, when operating at its best, helps people to understanding their true selves independent of, although interdependent with, the world around them. It falls short when it pushes people to conform to social norms apart from their true self. This is a shame.
Ask anyone who has endured a particularly heartfelt breakup of a relationship about normal and you’ll see the pain caused when we ascribe normative behaviour to complex systems. Sensemaking in a breakup is hard to do because of the massive cultural and social baggage we attach to them. Marriages, engagements, boy/girlfriend partnerships, affairs, flings, and flirts all bring socially normative expectations (and taboos) with them. And yet, if you think to any of those relations you’ve had I suspect that you’ll find that at its core there was relatively little ‘normal’ actually going on. Each relationship has its own cadence, pattern and normalness to it.
The best relationships have their own way of creating patterns that are unique to themselves, which is why we can’t replace or hope to replace one with another. They are irreplaceable for the very reason they are special. Not necessarily better or worse — but perhaps more congruent, happy, loving and so on — but different. The things that turn one person on are not the same as some one else and this is what makes relationships hard, but also exciting. This is what a complex adaptive system is like in real life.
Unless there was some obvious punctuated event like an affair or assault or major crime, most relationships don’t end because of a single thing. There might not even be a clear sense of what the “thing” that caused the breakup was. Sometimes people drift apart, sometimes the spark disappears, other times individuals forget who they are, while in some cases people discover themselves to be altogether new. Even still, sometimes this all happens at the same time, over time, in ways that neither couple can see until they are too far apart to connect. A complex system.
Treat this like a linear system and you may find potentially catastrophic consequences and hence the drama that TV and film introduce in their break-up scenes. For a funnier, but no less important take on this, see the video below from Dave Snowden.
This happens with lovers, spouses and friends all the time. A look to popular psychology or media will suggest that there are ways to handle this and no doubt efforts will be made to show how ‘healthy’ people transition and what they do to do so. These ‘healthy’ people will represent the ‘norm’. They’ll take time out for themselves, they’ll ‘get back up on the horse’, they’ll do the Eat, Pray, Love journey.. All of these might work, but they are based on an assumption that whomever is recommending these strategies knows the complexity of the individual’s case to whom they are referring.
Some therapists do, many do not. If you’re in for two or three sessions it will undoubtedly fall to the latter.
This is parallel to what we do in our efforts to inspire systems change. We look to the norms of our society, our discipline, our sector, our community and so on and we hire people for the equivalent of one to three to five sessions to tell us what to expect and do. What we get is Dr. Phil, which sounds great, allows us to boil enormous complications into a one hour soundbite or self-help book, and feel good because we are doing something that matches society’s expectation and we end up with what Russell Ackoff suggests as doing the wrong things righter.
Minding Our Norms
We expect to go into these encounters being the 1 in 7500 male model for jeans, when we are our own model for our our denim.
Work in complexity means breaking up with normative expectations and becoming mindful of what our own unique ones are as well as what the minimum specifications are that link us to that common thread of humanity — society, discipline, family, community, whatever. This is not easy. Mindfulness is very hard, but remarkably simple.
The more mindful we are of the rules and norms we live by or try to live up to, the better we can understand where they fit and where they collide against our own specific condition and setting and better craft strategies and design opportunities for real, genuine social innovation and not a caricature.
We need to be the model for our own jeans. When we do that, the fit will be both bespoke and very fashionable.
Photo by Muffet Used under Creative Commons Licence
