When I was pregnant with my second daughter, my mother shared with me that having two children was triple the work. Although I was initially incredulous, I soon learned that she was correct. It was not twice the number of diapers or twice the amount of bedding to wash. It was managing their relationship, how they interacted with the environment they were in, and the results of their interactions. From disagreements to shenanigans, the actual and figurative messes were much bigger than those of just two. In addition, their accomplishments were more impressive when they were able to work as a team and accomplish a goal, like making a Mother’s Day breakfast or art projects.
My girls are a great reminder of the difference between systems and complex systems. According to the World Health Organization, systems are any collection of two or more interacting parts or “an interdependent group of items forming a unified whole”. This is different than complex systems. With complex systems, there are so many interacting parts that it is difficult, if not impossible, to predict the behavior of the system based on knowledge of its component parts. Like my children, healthcare systems fit into the category of complex systems.
What makes healthcare systems complex? It is related to all the factors that we experience in our work. This includes everything from the diversity of the people involved in the systems to the variety of tasks to the variation in physical environments. Add onto this the complexity of regulations and the new technology, and it is not surprising that we cannot predict the behavior of the system based upon the component parts. It is still important that we recognize the component factors of the system, including the patient factors, provider factors, task factors, technology and tool factors, team factors, environmental factors, and organizational factors. However, we need to recognize that sometimes, just like with children, 1+1 can equal 3 or even more.
Fortunately, there are experts and tools that can assist in the navigation of complex systems. Individual stakeholders within complex systems are busy accomplishing the work of their aspect of the system. The skills or resources, including time, are often not there to also do the work of complex systems. Team members with expertise in organizational development, change management, and performance improvement can utilize structure and process to help improve a variety of outcomes. This includes key relational factors, including building trust and psychological safety. Additionally, these experts can help build the skills and competencies of leaders and aspiring leaders, so they are positioned for success. Paradigms for accountability can also help to ensure that complex organizations are making needed changes in the service of people.
When we neglect to invest in complex system experts and the support they offer, we develop systemic issues. We can feel this in challenges with electronic health records, scheduling issues, and turnover. We develop additional administrative burdens and build workarounds. We feel loss of control to the system and start assigning blame. These are some of the fundamental causes of burnout within healthcare.
What did I rely upon for help with the complexity of having 2 children? Grandmothers were my experts. They had previously walked in my shoes and had decades of experience. Over the years, they had developed the tools and resources to navigate the complexity. They were outside of the chaos of having two little ones and could assist by creating strategies and providing me tools to help mitigate some of the challenges.
Through my work, I am grateful to be able to help to work with teams to navigate and manage the complexities of healthcare systems. Through tools, resources, and valuable lessons learned, I hope to be able to “take care of the people that take care of the people.” Someday, when I am a grandmother, I will also make sure that I am there to help my girls navigate all the messes and joys that they have in store.