Complexity

A man goes out on the beach and sees that it is covered with starfish that have washed up in the tide. A little boy is walking along, picking them up and throwing them back into the water. “What are you doing, son?” the man asks. “You see how many starfish there are? You’ll never make a difference.” The boy paused thoughtfully, and picked up another starfish and threw it into the ocean. “It sure made a difference to that one.”

This parable features in “Half The Sky, How to Change the World” by Nicholas Kristof and Sheryl Wudunn, which is an incredible book that makes a powerful case for investing in women and girls in order to address inequity and poor public health (especially of children). The authors refer to it as a Hawaiian parable told to them by a friend, although I’ve also seen it credited as adapted from “The Star Thrower” by Loren C. Eiseley. Maybe it’s both, but either way, I love it. They use it to highlight the need for action even when it seems it futile in the face of great challenges.

Sometimes complexity and scale can mean we see a problem as so big, so difficult, that we are put off even trying. We may feel that a single psychological safety practice isn’t going to transform an organisation, so why bother? But just like the starfish being thrown into the sea, that practice, exercise or small change may make a positive difference to some people, and that makes it worthwhile. Plus, we never know – sometimes the smallest acts can catalyse self-sustaining movements.

Models such as Cynefin (above) and Ralph Stacey’s Matrix (below), show us that we cannot pre-plan our whole way through complex organisational change. We can only take intelligent actions, experiment and learn: probe-sense-respond. We can plan, of course, but what we need to plan is a series of experiments.

Additionally, in a large, complex system, it’s often impossible to distinguish the effect of any one particular action or actor on the overall system, because there are too many variables at play. This can make it impractical to gauge the impact of a specific intervention. So maybe the best thing we can do is to act and try to help, in potentially small ways, and learn from the process of doing so. We can make small improvements to the organisational substrate. We can’t prove that a single practice transformed the organisation, but we can know that it made a difference to some people. This may also just become the thing that pushes the needle far enough for a great transformation to begin.

Credit: Virpi Oinonen

I’ve always liked the saying, “The person who says it cannot be done should not interrupt the person doing it.” (Often misattributed to George Bernard Shaw). Just because we can’t know for sure that we’ll be successful, or even be able to measure the impact of our actions, doesn’t mean we shouldn’t act. To loop back to our parable, we absolutely should throw the starfish into the sea.


As a demonstration of the power of small changes to have a large impact, I was thrilled to hear recently from Eileen McCarthy, who has now attended two of our Psychological Safety “Practice Masterclass” workshops. After attending last year, Eileen implemented a number of the practical ideas she took away from the session about improving psychological safety, one being the Andon Cord practice. You can read below her account of the incredible impact that it had on culture and patient safety.

After learning about the Andon cord story, I was awestruck.  The thought that an organization could be so immediately responsive to a defect changed my perspective on how we deal with patient safety issues in healthcare.  If a car manufacturer could respond so quickly and positively to an issue, why couldn’t we do the same in an industry where people’s lives are at stake?  I felt compelled to bring this practice to my organization as part of our journey to a Just Culture.
 
Over the course of a year, we introduced the Andon cord concept and worked with managers and front-line teams to develop similar practices in our Ambulatory Surgery Centers. Our key focus was creating a speak-up culture and immediate, positive team response.  As a result of our efforts, we have seen improvement in every domain of our Just Culture Survey from the previous year.  In some areas, we saw as much as a 30% improvement. 
 
Many of our staff and leaders reacted similarly to the Andon cord story as I did.  Staff are excited about the idea of a swarm response to a safety issue.  Imagine if we could provide the same safety net to our teams in the healthcare industry.  It could transform patient safety.

Eileen McCarthy, Patient Safety Program Manager at Kaiser Foundation Health Plan of the Mid-Atlantic States

Psychological safety and complexity

As you’ve probably gathered by now, the theme of this newsletter is not allowing complexity and scale to become a barrier to action – these articles and resources all speak to this idea… 

This is fantastic: “Explode on Impact” by Toby Lowe. In complex environments such as public service and social action, it is practically impossible for organisations to demonstrate their unique impact due to the intricate and interconnected nature of complex systems. When organisations (or people) are asked to quantify or justify their impact, it often leads to a ‘corruption of data’ or a false narrative that we tell ourselves and others, creating an unrealistic portrayal of our role in generating change. We make up a story – one that makes sense to us and others, but one that is ultimately not true. This can hinder further work rather than improve it. Instead of asking organisations to demonstrate their impact, we should experiment, learn, and adapt collaboratively. This more accurately represents how impact is achieved in complex environments and is also likely to lead to healthier systems and better outcomes.

This systems map of the outcome of obesity attempts to illustrate complexity and causality — however, it remains a narrow field representation of linear causality. A better visual representation of a complex system would probably be the below:

In this post, Tanmay Vora explores seven key aspects of Da Vinci’s mindset, inspired by a book by Michael Gelb, “How to Think Like Leonardo Da Vinci”. Aspect 4 is particularly relevant: Sfumato (Being Comfortable with Ambiguity).

Here, Greg Satell challenges the idea that we need to “break down” silos and hierarchies. Hierarchies can be a force for good (indeed, they often are), and silos can be too. “…instead of trying to break down silos, we need to connect them. Network science tells us that it takes just a small amount of boundary-spanning “random connections,” in order to bring social distance crashing down. We can’t just look at organizational charts, but need to focus on how meaningful relationships form in the real world.” Just as Toby Lowe describes, it is no longer possible to achieve results by simply planning and directing work; instead, we must empower, experiment, learn, and adapt.

Of course, the way we think a hierarchy works is rarely the way it works in practice. Commonly this is known as the difference between “formal structure” and “informal structure”. In this LinkedIn post, Valdis Krebs shares the difference between how an organisation might map or plan a formal structure, and how the emergent structure actually works in practice.

I love this piece by J. B. Rainsberger about false dichotomies. In this case, they explore the false dichotomy between leadership and management, which are interrelated and interdependent of each other, particularly in complex systems. J.B. highlights a way to look for alternative interpretations in order to identify false dichotomies like this, and also points out:

• Lead when you can, manage when you must.
• Manage systems, but lead people.

Finally, one of the best pieces about actually working in and with complexity that I’ve ever read, by Fred Hebert, staff SRE at Honeycomb.io. Fred touches on nominal and emergent structures (as Valdis alludes to above), work as imagined vs work as done, cognitive load, local rationality, feedback loops, and notes that none of this is possible without psychological safety. Basically Fred’s article is everything that we geek out on in this newsletter, wrapped in a blanket of complexity.