Toward a Complex Adaptive Health Community

The "One-click Download" at this URL will display a paper titled, "The Wiki and the Blog: Toward a Complex Adaptive Intelligence Community" by D. Calvin Andrus of the Central Intelligence Agency. The paper was published in Studies in Intelligence, Volume 49, Number 3 in September of 2005.

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=755904

The essence of the paper is that Web 2.0 tools including wikis and blogs can be used in organizations as effective means of knowledge sharing. The author attempts to make ties to information theory and complexity theory to say that systems (organizations) can be designed to promote the emergence of knowledge from within rather than from above. As I teach courses in Public Administration I try to help my students understand the importance of "connecting the dots," as, for example, in case work. Because of their hierarchical structures bureaucratic organizations often do not facilitate the flow of information throughout and among agencies. Networks can facilitate information flow more effectively, but there is no assurance that information will flow where it is needed without a culture that encourages sharing and some means of shaping information flows. I liken this to hydrology and landscaping. Good landscaping usually does not have to depend upon sump pumps to control the flow of water. Good landscaping "helps" water find where it "need to be" rather than controlling it by force. In organizations there needs to be a means by which people can signal to others what information they need and what information they do not need. Information flows through social networks that are shaped by personal relations as well as defined roles.

Like the CIA and other intelligence organizations, healthcare organizations are information intensive. Decisions must often be made quickly by people who may not have immediate access to all the information available within the system. The flow of vital information is shaped by organizational cultures and by traditional professional roles. Patients are sometimes seen as passive recipients of care rather than as key information resources. In fact, success or failure is largely in the hands of patients who may or may not comply with care directives. Cost containment is also larely in the hands of patients.

I believe the key word in the title of the paper by Andrus is, "toward." Intelligence agencies do not yet always "connect the dots" quickly enough. For all the virtues of emergence, it is a slow path to design. Healthcare institutions are complex adaptive communities. To the degree what we can "landscape the cultures" in which healthcare services are provided we can improve the quality of care. There are multiple kinds of barriers to information flow in healthcare organizations. Design solutions are not exclusively structural or technological. People need to think before they click on the "send to all" button. We need to become more aware of the systemic consequences of how we share (or not share) information. We need to become more aware of how attitudes, professional roles, and other aspects of culture affect informtion flow and health outcomes.