Diversity and Structure Meets Systems and Design Thinking


The past few days I’ve had the privilige to speak to future healthcare leaders in the Health Organization Management Program at the Rawls College of Business at Texas Tech University. With every conversation I had with faculty, students, and researchers I was reminded of the value of diversity and the challenge that structure poses to encouraging the best aspects of diversity to emerge.

The positive side of diversity is that bringing together people from different backgrounds to bear down on a topic of shared interest in study (and practice) is an energizing experience. Last night I had the pleasure to speak to students who were getting their MBA’s with a healthcare focus. This group included pharmacists (and former deans), current physicians, training physicians, nurses, and even those who already had Masters degrees in other subjects like Public Administration. It was, by the standards of a usual healthcare education course, a pretty diverse audience. And as so often happens when diverse, engaged people come together, interesting conversation and learning happens.

The class was on systems thinking and its application to health care and public health and it provoked a series of discussions about how we too often structure our systems — particularly those in higher education and healthcare — to reduce the very diversity that leads to insights and engagement (the kind of thing we had last night). Because of issues of convenience, efficiency, and power (sharing or retaining) we often reject concepts that diverge from the norm, despite evidence or argument that they might succeed. An idea becomes habit and then soon is entrenched in what Jaron Lanier calls, ‘lock-in’. It becomes something we no longer question or we cease to challenge because it seems too hard to challenge.

A great example we discussed was the modern hospital. Hosptials are designed to reduce diversity in variation and service, create environments that support consistent ‘best practices’, and create a critical mass of service providers that is also efficient. While those ideas have some merit, they also embody an absence of systems thinking in their design at a fundamental level. Consider the very idea of putting all these people who are immunocompromised and often contagious together in one building. How wise is that?

Designing hospitals — or systems — like this suffers from a locked-in mindset that says healthcare needs to be delivered in large institutions for some of the reasons mentioned. It is so entrenched, that we don’t even consider that there could be many other ways to do this. Maybe some of those alternatives are more humane, safer and efficient. We don’t know, until we consider new ways of thinking and reclaim the diversity in the thinking that guides the structures we create.

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