Systems Change
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Introduction
change
structural: org chart
process: team meetings etc
culture: hardest, but also the key
Types of problems
type I - clear problem, clear solution - can be solved by leaders
type III - unclear problems and unclear solutions - can only be solved by groups
social determinants of health (inequality) are type III
decentralized responses
complex systems - immune system, economics, autonomous agents with diverse strategies, integrated across all sectors. empahsis on autonomous experimentation.
rugged fitness landscape - many peaks, some better than others. to get to best, got to go down first...
allow many teams to go out and try things out; communicate among the groups.
then migration to best peak
to be able to adapt to a complex environment, you need to be at least as complex yourself
competence and knowledgfe becomes gained by doing; tacit
abundant small-scale, safe-fail experimentation
resilience is so important - capacity to withstand shock without catastrophic failure
all systems grow over time; often, the more elaborate and connected they are, the more rigid - resilience thus decrease.
more sophisticated technologies and web-empowered consumers are rapidly boosting the cost of health care
rising costs have led to effeciciency being the central principle for the administration
maximizing the effeciency much increases the complexity and reduces reslieince and capacity for innovation.
we need to encourage as much distributed innovation and safe-fail expereimentation as possible
we need to recognize an exclusive focus on short term and effeiciency is not good
what's working now? even in a rough and ready way...
what's best now is not going the be the best in the future...
don't try to get it perfect.
crisis can be very helpful in providing greatest opportunity for innovation and fundamental reform
homerdixon.com
often we think big problems are best solved by getting the best experts together to talk.
instead, we need to get people in the field to
evidence-based comes in lots of forms; can be explicit, presentable in graphs and tables. other times, it can be much more difficult to state, instead comopsed of a lifetime of experience.
the more we
some researchers think their job is to design intervewntion and then test them; instead we need to be able to study the experiments that socieity's members are carrying out all the time in their lives
when we're all at the table together, it is a good idea to have some randomness from people who don't quite fit, who offer bizarre solutions;
Resources and References
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