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Tag Archives: Complex systems

Identity Crisis (DC Comics)

Rescue is on the way; thank goodness for the superhero to save us. (DC Comics) (Photo credit: Wikipedia)

Right now, there is the proposed NHS Reinstatement Bill, a lobby document which lays out a way to reverse many NHS reforms.

This lobby document, which is what is it, is familiar reading, and brings back various structures that in the past have failed. You can find information on it at this link.

What is interesting about this approach is the aura of respectability that it wraps itself in, by proposing the changes as a legislative draft, almost as though it were ready to go to committee.  This is, obviously, an influencing tactic designed to force debate onto the topics covered in the proposed bill, and disarm critics who don’t agree that the points in the lobby document are the right starting points. In that respect, the lobby document polarises positions, particularly against current policy direction.

The whole lobby document’s comments and notes identifies proposed changes to a variety of existing legilsation. What we don’t find, though is any evidence that the authors were in any way persuasive  or influential during public consultations at the time. We call that ‘sour grapes’.

Approaches such as this suffer from the following:

  1.  a belief that the fundamental values underpinning the health service can only be protected in a particular way and these are the ways things used to be.
  2. a belief that the changes that have been made have violated these values; moreover, that the solutions have made things ‘worse’ as they see it.
  3. selective use of academic research to support the positions that one wishes to avoid changing.

New PublicManagement as reform of government itself must sit uncomfortably with this regressive thinking.

For the authors, they would no doubt point to market failure logic to prove that the NHS should not be ‘marketised’ as they put it, forgetting that a greater fear is ‘government failure’, for which there is ample evidence, not just with the NHS but a whole host of other public initiatives and legislation that has wasted public money.

Healthcare systems are complex and by trying to overlay what they see as simple solutions to the problems they claim arise from the reform agenda of past years, they misrepresent what the actual problems are. As messy, or complex/wicked, challenges, the authors believe that by taking away that messiness, they’ll also take away the problems. But they know just as well as anyone, that their solutions will only create, perhaps even recreate, the very problems that led to reform in the first place, except now they will be today’s problems, not yesterday’s.

One might argue that the authors are committing a type 3 error, of unintentionally solving the wrong problem well, but that would assume that they have are not clear in their minds what they are proposing. Therefore, it appears they are do know better and are committing a type 4 error, of intentially solving the wrong problem well because that fits with their policy preferences, or prejudices.

That’s why this is a lobby document, designed to intensionally convince, (is mislead too strong?) others of their definition of what the NHS problem is.

Regardless, the lobby document and the authors are caught by a fundament policy trap: of solving the wrong problem.

Want to know more?

Government failure in the UK is examined in Anthony King and Ivor Crewe, The Blunders of Our Governments, 2013 (@Amazon) and in Richard Bacon and Christopher Hope, Conundrum: Why every government gets things wrong and what we can do about it, 2013. (@Amazon)

New Public Management was originally conceptualised by Christopher Hood, in 1991, A Public Management for All Seasons. Public Administration, 69 (Spring), 3-19. Some (Dunlevey et al) argue that New Public Management is dead and that governance in the digital era requires greater, not less, government. That may be the case for some, but if you actually look at the tools that are available to government in a digital world, you’d find that there is little reason for government to own or run very much. See Christopher Hood and Helen Margetts, The Tools of Government in the Digital Age, 2007. (@Amazon)

I have found Leslie David Simon’s book, NetPolicy.com (Woodrow Willson Centre, 2000) an early, and compelling way of laying out the digital agenda in a policy context really well. (@Amazon)

I would also recommend Vito Tanzi, Government versus Markets: the changing economic role of the state, 2011. (@Amazon)

 

Ann Glover, as reported on Euractiv (here):

But it appears she also found it difficult to disentangle the Commission’s evidence gathering processes from what she calls the “political imperative” that’s behind them. …

To back its policy proposals, the Commission often outsources the evidence-gathering part of the job to external consulting firms, which provide ‘impact assessment studies’ or ‘research’ that are often branded as ‘independent’. However, Glover says such consultancies have little incentive to produce evidence that contradicts the Commission’s political agenda. “If they want repeat business, [they] are not going to go out and find the evidence to show that this is a crazy idea,” she says.

Disturbing stuff. In my role as an advisor and having taught policy development to civil servants, I have emphasised their responsibility to “speak truth to power”. If, as Glover says, this isn’t happening within the European policy-making machinery, then that may explain much policy creep at the Commission level.

Giant Squid, Glover's Harbour

The policy process: Not what Ann Glover has in mind? Source: Giant Squid, Glover's Harbour (Photo credit: Product of Newfoundland)

Her characterisation of European civil servants wind-up toys, that just run off and do what they are told suggests there could be some danger to good governance from hyperactive civil servants who unthinkingly do what they’re told with dossiers that should be binned. This suggest two things problems: the first is the quality of guidance on developing policy options itself, how to work with external advisors (carefully by the way) and the second is that the interface between the most senior level and Commissioners lacks candour and the failure of the most senior to truth to power. This is evidence of cowardice. at least, and incompetence at most.

Her remarks suggest that perhaps Glover hasn’t also been particularly effective elevating the evidence base of policy-making itself.  Her solution, though, is seriously flawed. She seems to believe that it is possible to create a definitive evidence base around which all can agree and that it is indeed possible in policy processes to factor out the political dimension. The ‘symmetry of ignorance’ [see NOTES below] explains why a room full of experts don’t usually agree and why it is relatively easy for ‘my’ experts to challenge ‘your’ experts. Policy problems are complex, sometimes called wicked, problems, and that means that one single course of action is unlikely, that interventions may create new problems, and unlike (scientific) problems, you may not know when you’ve solved the problem (called ‘the stopping’ problem).

What science dislikes is absence of agreement (e.g. science is about proof, not consensus), whereas policy is about consensus and disagreement: the result is one of the following: do nothing, act from the precautionary principle (i.e. do something just in case, but knowing there isn’t really any good evidence), guess, compromise or satisficing [see NOTES below].  Scientists often believe that evidence leads unequivocally to specific policy actions, but this is just one view of the world. While Glover has claimed to provide independent advice, she has actualy provided ‘her’ advice, reflecting how she weighs the balance of evidence against her understanding and framing of the problems and choices on offer from what she has read, and the people she has spoken to. One could legitimately ask whether her academic roots and scientific preferences as a biologist have preconditioned her towards thinking about policy problems and evidence in a particular way.That does not detract from her alarm at the policy machinery, but does inform our assessment of her proposed solution.

Hasn’t anyone read Feyerabend?

Therefore, purely technocratic policy governance, as I think Glover is advocating, is flawed and likely dangerous as it replaces the messiness of the real world of policy problems and choice-making with tidy authoritarianism.

Equally worrying is her comment on the quality of advice from paid consultants. I once put a dossier to a DG to be be an advisor, but haven’t been called (we’re up to almost 3 years, so I guess I shouldn’t expect the phone to ring!)  It is the job of advisors to advise, and that means also saying when something is not a good idea. That the European Commission has constructed a giant out-sourced advisory industry is not surprising as it is actually a tactic to cement the European project by creating an advisory system that works in harmony with the Commission’s objectives. That so many consultancies have fallen for this trick and taken the bait is disappointing but not surprising.

Many of the Commission-funded consultancy reports I have read have started and ended with the merits of the proposed Commission actions. I can’t recall a report that said something shouldn’t be done. It is also a tactic in assessing policy options (what Glover refers to as risk assessment) to write the most about the favoured option and less about the least favoured option.I blogged here on a Commission consultancy meeting, the cost of which was no doubt staggering; the Commissioner spoke on what she wanted, everyone agreed, the presentations showed how Europe would be a better place if this were done and everyone agreed with everyone, had a nice lunch and the many unpaid interns took notes for their CVs to PR firms or consultancies so they could get more work. And so the system feeds itself by indoctrinating people into the world of uncritical agreement.

Now, for disclosure, I have been ticked off by Commission civil servants for things I’ve said that were not European Commission

doctrine. Perhaps that explains why my dossier is in a box on the bottom shelf.

NOTE:

Symmetry of Ignorance: The expertise and ignorance is distributed over all participants in a wicked problem. There is a symmetry of ignorance among those who participate because nobody knows better by virtue of his degrees or his status. There are no experts (which is irritating for experts), and if experts there are, they are only experts in guiding the process of dealing with a wicked problem, but not for the subject matter of the problem. Source: Horst Rittel, 1972 “On the planning crisis”.

Satisficing is a decision-making strategy that attempts to meet criteria for adequacy, rather than to identify an optimal solution.

Group Shot

So we all agree? (Photo credit: Jayel Aheram)

“Linda Sanders, director of social care at Hillingdon, accepted that Steven and his father had been let down by collective errors of judgment.” [from the UK Telegraph]

There is a court in the UK that belies belief that such an authoritarian and secretive judicial entity could exist in a democracy. Away from public scrutiny, legal injustices occur in the name of protecting the interests of vulnerable people. Maybe.

But what this particular case indicates, and the quote is not the whole story, is that vulnerable people can be held essentially captive (the court ruled that his human rights had been violated and he had been ‘unlawfully detained’). It is further evidence that vulnerability and disability lead to a net diminution of an individual’s rights. I worked on the legal rights of disabled people at the beginning of my career, cataloguing one of the first directories of how officialdom removes rights from individuals through a systematic and bureaucratic process, sanctioned by law, and in this case enforced by all the power of the state.

What is worrying is the director’s comment that it was ‘collective errors of judgment’.  This is grovelling code for ‘group think‘.

Group Think is a deadly force that infects organisations, and allows bad things to happen because people fail to challenge injustices, go along with the crowd, or ignore their ethical and moral compass.

Collective errors of judgment are not accidents of nature either. They arise from systemic elements in organisational design and structure, reinforced by leaders that see dissent as evidence that someone is not a team-player, where deep ethical issues are viewed as interesting but not relevant to the task at hand. It emerges when no-one looks at a situation as a whole, and asks what is going on here, and why. The old adage, would you like to see your decisions on the front page of the newspaper, on Facebook or Twitter, apply.

It is hard not to blame the culture and management of social care organisations, as this is not the first case where there is evidence of systemic failure. It revolves around how organisations form opinions about the care needs of individuals, how individuals (not collectives) arrive at those decisions and in what way, how they discourage alternative perspectives, and fail to change their views when confronted with new evidence, evidence to the contrary, or as in this case, a clear challenge to their authority. A patronising organisational response no doubt prevailed.

Group think also infects decision-making in any organisation where actions are based on an hypothesis about what needs to be done, and from which various actions flow. Getting that initial starting point wrong, means actions flowing from it are wrong. This is not a collective error of judgment, it is evidence of deep failure of decision-making processes. Other social organisations work in this way.

The way forward includes directors of social work not blaming some vague collective, but examining how decisions are made, how challenges to decisions are received and their attitude to dissent. A clue is here: an organisations that describes itself as a ‘family’ is likely authoritarian. Family language means dissent is suppressed within an organisational type that is either matriarchal or patriarchal in form.  And you know what it means to disagree with your parents.

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Dead End - mid

Is this the way to the future? (Photo credit: bennylin0724)

The World Economic Forum meeting in Vienna this week will be grappling with the challenging problem of European innovation. The evidence is suggesting that rather than leading the world, Europe is worryingly backsliding. Worse, of course, is the public rhetoric is not backed up by actual real-world action by governments, who persist in the old ways. This has produced the current complex mix of disincentives for risk-takers with governments fearful of the disruptive impact of innovation on European preferences (ranging from employment to lifestyle), coupled with frequently ineffective and unreformed public sector organisations. This has been admirably addressed, too, in the WEF report on the future of government.

Rather than FAST government (flatter, agile, streamlined, tech-enabled) as the WEF calls for, we find hierarchical and bureaucratic, slow and sluggish, complex and unreformed, tech-naive government — these are hardly attributes needed if the public sector is to play a role in public/private partnerships to drive forward innovation. Our innovation culture instead gets:

  • social costs that burden small and medium businesses with a disproportionate share of social costs, which kill off risk takers because they can’t even afford the first day of business; this includes unreasonable start-up capital requirements (1€ should be enough), pointless company start up procedures, wrong-head bankruptcy laws, and inflexible employment laws;
  • unreformed central governments, which absorb productive capacity , require very high levels of tax funding to support, and which generate administrative and regulatory red-tape to little end other than to control;
  • public ownership of intellectual property as the default position for publicly funded research, coupled with the poor commercialisation record of state-owned research infrastructure, leading to hoarding of innovations within bureaucracies, and not accessible to risk-takers;
  • weak academic performance amongst the universities, with little competitive forces within academe to encourage researchers to move outside the university to become entrepreneurs, or to work with investors to generate new ventures, as it frequently jeopardises public sector employment contracts as in many countries academics are civil servants (that is itself is undesirable) — there are very few world-class European universities, based on recent global rankings.

I have some experience here, and while governments value stability in their civil services, what they often get instead is classic ‘rent-seeking’ behaviour, whereby civil servants seek to monopolise whole areas of the economy, ranging from failing to control regulatory creep, to governments having all sorts of pre-emptions rights over private arrangements. This latter point is particularly concerning when it comes to pre-emption rights over intellectual property created with public funds — as the Commission has noted, Europe badly needs its equivalent of the US’s Bayh-Dole Act.

I put my money in a few areas, not just because I know a little about them, but because they have the benefit of driving wider benefits — they act like breeders for other innovations, as well as magnets for innovations developed in other areas:

  • health technologies, including life sciences, devices, new materials, nano-tech, imaging, remote monitoring;
  • information technologies, including the internet (many governments are fearful of the disruptive influence of the internet);
  • new media as the convergence of technological delivery systems (potentially disruptive and problematic when the state is an owner of media).

There are no thousand kilo gorillas in Europe because Europe’s governments have become authoritarians that fear disruptive innovation that may challenge deeply held beliefs and challenge the European model. This is the type of pride that goes before a fall.  So, action is needed in at least four areas:

  • liberating the investment climate to encourage a higher tolerance of risk and acceptance that higher risks should lead to higher rewards, which has implications for taxation, capital gains/losses and bankruptcy;
  • liberating labour markets, to incentivise business to create experimental forms of employment, whereby firms in acknowledged startup situations can have greater flexibility retaining and rewarding staff without being confronted with first euro social costs and minimum wage regimes;
  • understanding the tremendously heavy burden unreformed government and excessively zealous taxation has on entrepreneurs and the need to liberate the entrepreneurial system from official structures as much as possible; this also means that government needs to understand what it can and should do (and of course what it shouldn’t do);
  • placing publicly funded intellectual property on the open market — I would suggest even creating an auction market for publicly funded IP.

The European Innovation Road is not a paved autobahn; it is full of holes, and in some places just goes over a cliff, but it has the potential to be a superhighway if we get the fundamentals right.

Uncertainty can never be removed from the innovation process. We shouldn’t act as though it can.

Want to know more?

Just searching on the internet will produce an avalanche of information. Regretfully, much academic research is still published in journals that are not open access which means accessing them requires either a subscription or the payment of a fee, despite the vast majority of this work having been publicly funded. These articles are not listed. However, authors of papers who would like to have their papers listed here, and provide a pdf for download are encouraged to provide a paper for listing here.

Also consider:

Martin Fransman, The New ICT Ecosystem: implications for Europe (Kokoro, 2007) presents a thoughful policy framework.

Anything by Annalee Saxenian, but her The New Argonauts: regional advantage in a global economy (Harvard 2006) is worth reading in the context of European regional development.

Josh Lerner, Boulevard of Broken Dreams: why public efforts to boost entrepreneurialism have venture capital have failed, and what to do about it (Princeton, 2009) offers a research-based critique of the role of government and why for every dollar/euro/pound government puts into commercialisation of research, the private sector takes one out.

The new report from NESTA, Atlantic Drift [here] is worth reading for its US/UK investment comparisons with important insights for other countries.  It is authored by Josh Lerner, Yannis Pierrakis, Liam Collins and Albert Bravo Biosca.

Lawton Burns, The Business of Healthcare Innovation (Cambridge, 2005), explains important innovation drivers in healthcare, which offers some thoughts on how Europe can succeed here, despite widespread government control of healthcare systems. It is worth noting that virtually all EU countries and their regions have prioritised biotechnology/healthcare/life sciences in at least their top 5 areas.

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The nest architecture of the Florida harvester...

Learning system design from ants

How ARE we to think of healthcare systems? It has been fashionable to think of them as supertankers — the images conjured up of something big, slow and as the politicians and managers were wont to say, slow to turn, so (to cite Piet Hein’s TTT) things take time. But such thinking is wrong-headed and always has been — it reflected a top-down technocratic mind-set that saw healthcare as rational and plannable.  I have never bought this argument, and argued that healthcare systems should be conceptualised as a school of fish, as they can turn on a dime! We have much to learn from a swam of bees, a colony of ants or a flock of birds. (and even a school of fish). The bigger and more complex a system becomes (like healthcare systems) the least likely it is to be amenable to notions of levers to push or strings to pull type thinking — but such thinking veritably oozes from academe where reductionist and linear analytical models are easier to research, but fail to take account of reality itself.  (The academic group that seems to consistently get things wrong for similar reasons is economics, and surprise, surprise, many people think that health economics has something to tell us about health reform — but similar models and thinking are pervasive!)

Now, Peter Miller’s book, Smart Swarm has received laudable coverage in the Economist newspaper. The book and many articles in the popular press have highlighted the efficient design that comes from the apparently unplanned but linked behaviour of individual generally unintelligent ants or bees, which collectively bring order to complex natural environments.

For our cherished health system planners, it suggests that they have overstated their impact and relevance, if indeed they ever were really effective. For me, it suggests that health policy has become a bit too much like the old Soviet bread planners, thinking that since people needed the bread, planning for it would ensure is got to people’s table, but of course the planning was part of the problem, not the solution. (I’m trying not to make the bread an issue of markets but of coordinated behaviour of linked systems.)

The best way to understand complex systems is to embed intelligence within the behaviour of the bits that make it up, rather than impose it from above, or fruitlessly planned in. The key factor which makes these distributed systems work is the ability to exchange information — planners create funnels through which information flows and if you get the funnels wrong, the system fails to optimise, or indeed work at all! By allowing parts to exchange information easily, on an as-needed basis and act accordingly, coordinated behaviours emerge, which effectively bring the desired order without some remote planner deciding how it should work. It all comes down to information flow and exchange.

And so to health systems.  We all want joined up, linked, coordinated healthcare; that patients seen in clinic A who go to clinic B can be seen by people who have information about you; that when you show up for your operation, they know you’re coming, and so on. Healthcare systems are really all about patients, but we plan them on the basis of the behaviour of health professionals, who actually communicate with each other quite a lot — and indeed, construct informal systems to make the healthcare system work better often despite formal planned structures. One might say they behave like the bees and ants by simply getting on with things. It does raise the question of what roles are needed within healthcare systems to ensure the flow of information — this is usually seen as a reason for managers, but managerial models frequently fail to understand the purposeful behaviour of interconnecting systems as management is a reductionist organisational notion.

The information that patients carry is critical, but generally not accessed — it is important to realise that only the patient has experience of the whole care pathway, not the health professionals within it. This is important information that is lost within formally planned systems, which focus on structuring care, rather than the flow of information that links the bits together. I call this information structure the “healthcare information value chain” and it is the most important, but generally least understood, aspect of healthcare systems, as embedded within this value chain is the information needed for the various components of a healthcare system to coordinate their activities, without the great planner in the sky. This information value chain is not some construction of an IT system, it is information used in the course of people going about their work — of the ant hill at work. It is worth noting that ants or bees manage complex systems without IT systems, but researchers have needed IT systems to understand them!

Want to know more?

Ants may have an edge when designing efficient systems, a commentary on US health system reform, by  Joseph Reisert.

Emergence: The connected lives of ants, brains, cities, and software, a book by Steven Johnson.

It may also be helpful to understand how complex adaptive systems work: for instance,

The US National Academy of Medicine has thought about healthcare as a complex adaptive system in “Health Care as a Complex Adaptive System: Implications for Design and Management”. [here]

Implementation Science is an open source journal that has articles on this subject, including this example [here] on making change in healthcare settings.

Regretfully, much useful literature is not available to the informed or interested public, as it is squirrelled away in the academic journals for which the publishers require passwords, subscriptions etc. in order to access.  Any research that has been funded from public sources should be available for public access in open source locations or journals. I will not cite reference material that is not generally available to the public. If authors have material on this subject that they would like to enable public access to, please send me the links to be added to this (very) selective list.