My name is Eb and I work in an OR in a large city hospital. In 2005 I was studying Health Care Management and read a book called "Crossing the Quality Chasm" by the Institutes of Medicine (IOM). It had an appendix in it by Paul Plsek, a consultant, on "Complex Adaptive Systems". I was intrigued.
From Plsek's bibliography I found Mitchell Waldrop's "Complexity", and shortly after that I read Arthur Koestler's "Ghost in the Machine", and I felt that perhaps IOM's solution to what they called "quality" issues (wrong site surgery, hospital-based infections, medication errors, etc) was not effective.
IOM had created "10 simple rules to make health care better", and I felt that a hierarchical system didn't want so many rules. Who has time to remember 10 rules? I don't. Rather, each "holon" at every level of the hierarchical cascade maintains homeostastis by both looking without, at the meta-system which constitutes its environment, and by looking internally, and balancing its own constituent "holonic" parts, to meet the needs of the moment. One 'outward' and one 'inner' rule set, carefully chosen, could guide behaviors and thus determine the "personality", or behavioral patterns (with incipient survivability), of each agent. A simple yet robust rule set was essential.
Perhaps what Niels Bohr called the principle of "complementarity" is writ large across the universe, manifesting itself in every semi-autonomous, goal-seeking system, from the human nervous and endocrine and digestive and respiratory and circulatory systems right up to human political economies and natural ecosystems, and beyond.
I boiled health care quality down to 2 rules. One rule oriented outward, toward the meta-system, which I called "Best Practices", i.e. copy whatever anyone else is doing right, and don't try to reinvent the wheel. The internal rule, was "Clinical Integration", i.e. talk to one another. Communicate. With external and internal homeostasis algorithms the adapting system is best poised to respond appropriately to the shifting landscape. I wrote my paper and continued to read books on the subject. Eventually, I began to post some of my reviews and other thoughts on this site.
Any feedback would be appreciated.
Last modified 1/28/12