Braha: Addressing Complexity in the Interconnected World

This should be very interesting:

From Politics and Finance to Power Grids and Products: Addressing Complexity in the Interconnected World

MIT SDM Systems Thinking Webinar Series

Dan Braha, PhD
Visiting Professor, MIT Engineering Systems Division

Date: February 11, 2013

Time: Noon – 1pm EST

Open to all

Register

About the Presentation

 

How can we manage the financial crisis? How do civil unrest, religion, and rumors spread, and how is that related to epidemics and earthquakes? Can human behavior and societal systems be studied in the same way as biological systems and complex man-made systems?

In this webinar, Dr. Dan Braha will demonstrate how the field of complexity research provides clues to these intriguing questions. He will focus on why and how complex socio-economic systems evolve and why these large scale engineering systems fail and offer guidelines that can be applied across industries and organizations around the world.

UK:US::Staffordshire:?

My UK colleagues have had two reactions to the horrors revealed in the recent report about Staffordshire Hospital.  Some have said that, while terrible, it was an isolated and unusual set of circumstances.  Others have said, that while less extreme, the conditions underlying the degradations of clinical services at Staffordshire exist throughout the country.  From here in the US, it is hard to judge, but I'm guessing that both views are correct.  The degree of harm to patients at Staffordshire was, indeed, appalling.  The level of more subtle, but real, harm at other hospitals remains.  Let's look at two quotes:

The New York Times reported:

The report into what has been called the biggest scandal in the modern history of the health service found that many of the problems were due to the efforts of the hospital to meet health-service targets, like providing care within four hours to patients arriving at the emergency room. It also said that in its efforts to balance its books and save $16 million in 2006 and 2007 in order to achieve so-called foundation-trust status, which made it semi-independent of control by the central government, the hospital laid off too many people and focused relentlessly on external objectives rather than patient care.

The Huffington Post UK reported:

Robert Francis QC, who led the public inquiry into Mid Staffordshire NHS Foundation Trust, uncovered failings at every level of the NHS and said the culture among healthcare staff must change. His comments come as it emerged there were 3,000 more deaths than expected at another five NHS trusts between 2010 and last year.

Mr Francis, speaking ahead of a public meeting with the families of former patients at Stafford Hospital, said: "What we need to avoid is yet another wholesale reorganisation of abolishing organisations and creating new ones.  This is about how people behave when they go to work and their ability to raise concerns and be honest about what's going on in their hospitals."

He said the change would only happen when NHS managers, clinicians and staff started to address the failings "rather than waiting to be told what to do from Whitehall, or by the top of the NHS".

I can almost hear many of my US colleagues say, with self-satisfaction, "This kind of thing could never happen here."  But I can hear my more thoughtful colleagues saying, "It is happening here."

In the US, we start with a baseline of about 100,000 people being unnecessarily killed each year in hospitals, and many more suffering from unnecessary complications, infections, and other morbidities.  In the US, we have introduced a set of metrics about clinical care, generated by bureaucratic forces, that are often arbitrary and have the potential for unintended consequences.  Our accreditation process encourages "teaching to the test" as opposed to evaluating systemic issues within institutions.  Likewise, our review process for graduate medical education programs fails to enforce standards of competency that ostensibly are required for residents.

In the US, we have engaged in a restructuring of the industry that shifts financial risk to doctors and hospitals and that encourages consolidation and reduces competition.  Repeating our failures in investment markets, we fail to regulate providers to see if they are financially capable of absorbing risk.  We celebrate the expanded role of private equity firms in owning and operating hospitals, with an ostrich-like approach to understanding how such firms create profit.  The potential for short cuts and under-treatment and degradation of clinical equipment and hospital infrastructure arises in these circumstances.  Meanwhile, we fail to provide the kind of real-time transparency of clinical outcomes, pricing, and financial results that would help hold institutions accountable to themselves and to the broader community.

All in all, it sounds like a setup for the kind of problems experienced by our friends across the Pond.  So, let's not be so self-satisfied.  There is at least one Staffordshire in our midst, and there are hundreds of other hospitals that do not make the grade for the kind of quality, safety, and transparency that you would want for members of your own family.

Dilbert's creator offers predictions on robots

Scott Adams, best known for Dilbert, offers a view of how robots will reduce health care costs.  Does he mean it to be humorous or real or both?

Here are some excerpts:

One of the many future benefits of robots will be a dramatic reduction in healthcare costs. In the near term, medical robots will be little more than search engines with excellent eyesight. They will look at your wounds, ask questions about how you feel and then use the Internet to determine a diagnosis and treatment strategy, just as a human doctor does. 

Now imagine a future in which household robots are the norm. Your personal robot has far better eyesight than you, incredible pattern recognition for diagnosing problems, and potentially more manual dexterity than you. Your robot might have a keen sense of smell, and it might hear so well that it can detect your pulse. I can imagine all household robots coming equipped with medical sensors as standard equipment, including everything from blood oxygen sensors to shock paddles. Someday the household robot might be capable of handling 95% of all medical problems.

The first surgical robots might cost tens-of-millions. But if a robot can work 24-hours per day without breaks, and robot prices drop with volume, robot surgeons will quickly become competitive with human surgeons who earn big paychecks while working only a third of the day. The biggest savings from robots might be an end to human errors and the resulting reduction in medical insurance premiums, assuming robots make fewer bad decisions.

Robots are the budget wildcard for the next generation. There's a good chance it won't matter how much national debt we pile up today so long as robot technology keeps improving. At some point the real cost of healthcare, energy, construction, transportation, farming, and just about every other basic expense will fall by 90% as robots get involved.

So don't worry about medical costs in thirty years.  By then the phrase "going to the doctor" will sound like a quaint phrase from the past, like churning butter.

“We’re talking about a hamster, for God’s sake!”

Janice Lynch Schuster of the Altarum Institute has written a warm and delightful article for Aging Today, the newspaper of the American Society on Aging.  It's called "Goodbye to Jumpy: Lessons for the health system."  Using the example of the family's pet hamster, she draws some good lessons about end-of-life work.  Excerpts:

In the early days of what would prove to be, in hamster years, a long illness, Jumpy just didn’t look right: his ears were swollen and he scratched incessantly. Diagnosing either a parasitic infection or an allergic reaction, our vet treated Jumpy with the full arsenal of veterinary weapons: an antiparasite medication, along with antibiotics and painkillers.

For two weeks, twice a day, one of us held the hamster while the other administered minuscule doses of what we hoped would relieve and cure him . . . but Jumpy did not improve. His ears swelled, his belly was distended and he spent most of the day huddled in his hamster castle. His treadmill never moved.

I took him back to the vet, who explained our options. We could continue to treat Jumpy, every other week for the rest of his life, to the tune of some $200 per visit. Or we could end treatments—and Jumpy—with an overdose of some drug. It was left to me to decide.

The irony of my situation was not lost on me. I have spent years writing about how families contend with decisions just like this: Insert a feeding tube or not, try a ventilator or let nature take its course. In the hypothetical world of writing, the answers always seemed plausible and I seemed confident.

In the real-world situation in which I found myself—with a sobbing 9-year-old boy and a quaking hamster of indeterminate age—it was less straightforward. Eventually, we agreed that it was time to end Jumpy’s suffering, that he would be cremated and that we would acknowledge and celebrate the happiness he had brought to my son.

...I would like to write a thank-you letter to the vet, acknowledging him for the compassion and human touch he showed to my little boy, who had just confronted the first of what is ultimately a lifetime of loss.

WIHI presents stories from employers and employees

February 7, 2013: Employers and Employees Can Improve Quality
and Lower Costs – Stories from the Frontlines, Part One
(2:00 – 3:00 PM Eastern Time)

Featuring:
Trissa Torres, MD, MSPH, Senior Vice President, Institute for Healthcare Improvement
Xavier Sevilla, MD, MBA, FAAP,Vice President of Clinical Quality for Physician Services, Catholic Health Initiatives
Lindsay A. Martin, MSPH,Executive Director and Improvement Advisor, Institute for Healthcare Improvement
Randy Van Straten, Vice President Business Health, Bellin Health; Executive Director Bellin Run

US employers have had a lot to say about health care costs the past several years. Large and small companies alike have openly complained about the apparently inexorable rise in health care spending, skyrocketing insurance rates, and the degree to which both trends have threatened bottom lines, restrained wages, and eroded benefits for employees.

WIHI Host Madge Kaplan hopes you’ll tune into the February 7 WIHI, Employers and Employees Can Improve Quality and Lower Costs – Stories from the Frontlines, Part One, for a discussion of what promises to be the next wave of employer engagement in improving health and controlling health care costs in the US.

As we've seen, some of the most vocal businesses have been determined to remedy the situation by exercising their purchasing clout to get better deals from insurers and by shifting more costs and co-pays onto the workforce. The most enlightened have also ramped up their wellness programs. But these “solutions” are short-term at best, and efforts to encourage employees to get to the gym and adopt healthier lifestyles are proving insufficient. So, what to do instead?

We'll take a deeper dive into the underlying, often chronic health conditions affecting today’s employees. And, in a growing number of cases, partnering and learning from health care delivery organizations working on the very same issues — heavy health care utilization and high costs —with their own staff.

IHI’s Trissa Torres and Lindsay Martin have the big picture of these exciting new developments. The February 7 WIHI will also feature leaders from Bellin Health Care Systems and Catholic Health Initiatives who are at advanced (Bellin) and early stages (CHI) of “walking the talk” with their own employees. Among other things, these providers are committed to redesigning systems to deliver better care and better value to the community and all those paying the bills: employers, public and private insurers, and patients themselves.

Please join us on the February 7 WIHI. Click here to enroll.