Hi Chris and all,

I have followed this conversation with interest.
As someone with a complexity background (not a 'health care' background
as such) I would like to contribute my penny's worth.

It certainly is useful to look at human organisations and the symptoms
of their issues (like 'waiting lists') as complex adaptive systems
(CAS). But, I would always see this as a metaphor for what they are.
They never ARE a CAS. They may, when one looks at it in certain ways
LOOK LIKE a CAS.

It seems to me that there is a great risk in saying that organisations
(and their issues) ARE complex adaptive systems. They are not. They are,
well, human organisations. This is not a very helpful answer I must
admit. But, by treating them as id they ARE a CAS and then draw
parallels from other CAS so that 'if they are a CAS then (a) or (b) or
(c) must be true takes it to far for me.

Human organisations (I carefully avoid the word 'system') certainly
display complex behaviour. After all, they do emerge out of many. Many
interactions between people. I would NOT dare to say all these people
are 'autonomous agents'. Of course they are not. We all know that some
people are more 'autonomous' than others. This is not the case for the
origins of CAS-theory from molecules, atoms and the like.
Therefore one has to be careful to take the metaphor too far (as with
any metaphor).

What I think is very important, Chris, in what you mention is the idea
of 'equilibrium'. For biologist 'equilibrium' is death.
One cannot ever treat any of the symptoms of human organisations (like
waiting lists) as if they were at some equilibrium. Because of the
dynamics in the organisation the whole is most likely to even function
FAR FROM EQUILIBRIUM. 

So how can we then see the apparent 'stability'? Well perhaps the way to
describe this is as a 'dynamic stability'. This is an inherent paradox,
but that is just what the complexity sciences help us understand!

The way I would like to look at those things is as 'patterns' that
emerge out of all the interactions of all the agents in the
organisation. Not just the people, but also the resources that
'energise' the emergent patterns (like lack of money, for instance).
If we can study the patterns and the self-organising forces that allow
them to emerge we may learn a lot about the dynamics and where we can
and where we can't influence those forces.

Asking, therefore, how we can 'control the equilibrium' to me does not
seem like a proper question, since both the 'equilibrium' (as you say
Chris) and the 'control' are properties I woukd not describe to the
organisation.

What one CAN try to do is look at the emerging patterns, what may
energise them and see how we may be able to influence them. I would
argue (without having done the analysis) that much of the forces are
energise by our own choices!

I hope to see you all in Exeter!

Regards,
 
Frank Smits
Symphoenix Ltd
Tel: +44 (0)1732 450 495
Mobile: +44 (0)7715 423 150
E-mail: [log in to unmask]
Website: www.symphoenix.net
 
 
-----Original Message-----
From: Complexity and chaos theories applied to primary medical and
social care [mailto:[log in to unmask]] On Behalf Of
Chris Burton
Sent: 15 September 2002 18:17
To: [log in to unmask]
Subject: Re: queue theory

Ceri et al

Not sure if this is right or not

If waiting lists are complex adaptive systems (certainly they are nested
within complex environments and they appear to display power law
scaling)

Then they cannot exist in any form of sustained equilibrium (although
that's not to show they can't display stability).

Therefore any attempt to manage them as if they were in equilibrium is
doomed to fail.

Please discuss

(but do it quick because I need the answer for my talk in Exeter on
Tuesday!)

Chris
--


Chris Burton, [log in to unmask] on 15/09/2002


On Sat, 14 Sep 2002 17:01:52 EDT, Ceri Brown wrote:
>In a message dated 14/09/2002 21:34:45 GMT Daylight Time,
>[log in to unmask] writes:
>
>
>
>>Braess' paradox would apply to a system in equilibrium, under
>>constraint or tightly connected (which I guess are different ways
>>of saying the same thing).
>
>Like a waiting list then? Not sure how closely this definition can
>be applied to a CAS but seems reasonable to me, no?
>
>CB replies A system may be internally in equilibrium, or in an
>equilibrium state with respect to its environment, but the
>difference between internal and external can become blurred. Waiting
>lists occur within the context (i.e. environment) of emergency
>surgery, emergency admissions, changes in casemix, availability of
>equipment etc. All are linked.
>
>Is the equilibrium dynamic or static? A CAS, I would venture to
>suggest, is a dynamic state which may, or may not be in equilibrium.
>If it needs to adapt then there has been a change somewhere. A CAS
>copes with the change by diverting "resource" or "energy" (I won't
>be more specific than that) in order to adapt. Adaptation costs. If
>there is no spare "resource" or "energy" then there is no
>generalised adaptation, merely Braess. Was he Peter Braess or Paul
>Breass? One was robbed.
>
>>Changing a "set point" would affect the rest of the system unless
>>other "resources" were available to the system.
>
>and in the case of most tinkering around with health services that
>means .... ?
>
>Chris
>
>
>CB replies - anything to liberate "resource" or "energy." To quote
>that well worn phrase, "a system is designed to achieve the reults
>it gets," any other results require  more resource. Manturana said
>(in essence), "you can only fight chaos with chaos." To get to the
>edge of chaos requires an "energy source."
>
>Of course we must not forget that the waiting lists also occur
>within the context of changing demography and expectations, leading
>to a greater demand on the finite capabilities of the "NHS system."
>Entropy?
>
>I'm straying into unchartered territory here, but note that I am
>conflating three metaphors. Cybernetics/ hard systems (Braess),
>CAS, and thermodynamics. Is Braess the second law writ large?
>
>Is there a Maxwell in the house?
>
>(NO yacht jokes please)
>
>Ceri Brown Critical Care Programme Project Development and Research
>0161 720 2342 (Secretary) 07659 120 038 (pager) 07876 230 561
>(mobile) Thanks to my variable clinical commitments, calls to my
>mobile won't be answered promptly. Please leave a message, or page
>me.
>
>I'm based at North Manchester General Hospital but my postal address
>is:
>
>c/o Critical Care Programme, 4th Floor, St John's House, Leicester.
>LE1 6NB