The Polyclinic as a Complex Adaptive Human System

As well as supporting my country and city – and the benefits of international Sport in general – I love my volunteer gigs at the Games (2010 Olympics and 2015 PanAms) for 3 main reasons: i) it keeps me in touch with what’s new and different in clinical practice in healthcare; ii) helps me understand how younger, newer practitioners are the same or different from my demographic group, and iii) fuels my curiosity and understanding of complex human systems and how they operate and learn.

Thus this blog, which I’m using as a personal discipline to categorize my learning in some meaningful way. Putting pen to paper – actually fingers to keyboard – forces me to clarify for myself, and for you the reader, some of what is swirling in my head about systems, how they develop, learn and change, and hopefully continue to grow and improve.

I love watching complex adaptive systems in action – how the many parts of a rich, intricate and complicated system make the whole, how the system’s purpose – in this case to provide welcoming, meaningful healthIMG_4408care to the athletes and team members of the Toronto Pan Am Games – is played out by hundreds of people learning how to work in concert with others to make it happen.

The Polyclinic pictured here is a temporary structure located in the centre of the Athletes Village in the Donlands in Toronto. It is surrounded by Athletes’ living areas that will be turned into beautiful condos after the Games. It is a really nice part of town, easily accessible public transportation, easy access to lots of great spaces, with a brand new YMCA on site, and I’m told most of the condos are already sold.

Volunteering in the Polyclinic Pan Am Games Toronto 2015

Canada Day was my first volunteer shift in the Polyclinic in the PanAm Athletes Village Polyclinic. If you don’t know what a Polyclinic is, you’re not alone. My understanding is that it is a European term that denotes a health/medical clinic that provides a wide variety of services – thus “poly” from the Greek meaning “many”. In this case, many services.

The PanAm Polyclinic provides all kinds of services from Family Medicine to a fully-stocked ER, Specialty Services such as Dermatology, Cardiology, Dental, Optometry – Bochner Eye Institute and Loblaws are donating time, expertise and hundreds of pairs of glasses for the teams – and of course, full Sports Rehab Services (Physio, Massage, Chiropractic, and Sports Medicine, Physiatry).

There is also a Public Health office staffed with City of Toronto nurses to deal with any outbreaks or other public health concerns – there are thousands of condoms on all the services desks for the taking – they are snapped up quietly by many – and not just the athletes!

I am one of 3000 volunteers in the Health/Medical Services at the Polyclinic and the many Competition Venues and Fields of Play across the Games. There are about 6500 participating athletes from 41 different Pan American countries, competing in 36 different sports.

Planning has been in the works for 6 years and has involved 16 different communities surrounding Toronto the north, west and east. According to the Chief Chef for the Games, 500,000 meals will be served in the Athletes’ Village alone. These Games are the largest multi-sport event ever hosted in Canada. The cost for public security and traffic management is in the neighbourhood of $250M.

If you watched the Opening Ceremonies Friday night – or better still were actually there, you’ll know that it’s all very exciting for Toronto!


Thinking about Occam’s Razor

While watching an episode of Madame Secretary the other night, I was interested to hear the main character mention Occam’s Razor as she wrestled with a complex issue and the need to get at the variables, understand them and make decisions about how to proceed. Knowing my interest in complexity and complex adaptive systems (CAS) theory, a friend told me about Occam’s Razor awhile ago. I had never come across it before, despite lots of reading about complexity and complex systems – obviously not reading the right things, Ann! Thanks.

Wikipedia tells us that Occam’s Razor (which is also sometimes written as Ockham’s Razor) is a problem-solving principle devised by William of Ockham in the 13th C – believe it or not. William was a respected English Franciscan friar, philosopher and theologian.

The principle of Occam’s Razor states that among competing hypotheses which predict equally well, the one with the fewest assumptions should be selected. Other, more complicated solutions may ultimately prove to provide better predictions, but—in the absence of major differences – the fewer assumptions that are made, the better – according to the theory.

Called also the Law of Parsimony, it tells us to KISS or keep it simple, and not over-complicate. This of course makes a lot of sense and it also reminds us to quantify, qualify and verify our assumptions. Wikipedia goes on to say “ For each accepted explanation of a phenomenon, there is always an infinite number of possible and more complex alternatives, because one can always burden failing explanations with ad hoc hypothesis to prevent them from being falsified; therefore, simpler theories are preferable to more complex ones because they are better testable and falsifiable.”

The fact that we are still considering William of Ockham’s ideas, 7 centuries later boggles the mind, and makes me question how much more we know or don’t know today than we did centuries ago.

It also makes me wonder about the fit between Occam’s Razor and complex adaptive systems’ theory. This is for another time.

Situational Leadership and Complexity

Andrea writes: Recently I had the opportunity to attend a workshop given by the Canadian Institute of Organizational Development (CODI) facilitated by Marilyn Laiken about Leading Teams in Change Environments. The workshop focused on Situational Leadership theory developed and published originally in the 70s by Hershey and Blanchard.

The fundamental underpinning of the theory is that there is no single best leadership style and that different situations require different adaptive leadership responses. What counts most is the ability of the leader to read the situation – including both the work to be done, and the maturity and experience of the team – and make an appropriate leadership response. The theory proposes a series of stages of development of the individual and the team, and identifies ways leaders can adjust their leadership responses to each stage. The model has endured. I asked myself why AND could it have anything to add to leadership in a complex environment?

I originally learned about Situational Leadership while developing a workshop with Dr. Raye Kass at Concordia University in Montreal. Her synthesis of what the model says about leadership was that it is “the capacity to observe and the willingness to react.”

What makes this a useful definition is that it takes the emphasis away from the leader and the style, and instead it stresses the leader’s ability to question, observe, and respond effectively. What is the context? Where is the need? What is the basis for the response I am considering? Am I ready to respond to what is going on using the best of my leadership skill?

Knowing the different stages of Situational Leadership (Telling, Selling, Participating, Delegating) and my own personal preference (Participating) is an important self-awareness skill. The leader’s requisite tools are the ability to observe, assess and diagnose the situation, react appropriately and learn. The act of leadership is based in inquiry (what is going on right now? what does the situation need from me?)

The goal of leadership in complex systems is to develop people and teams so they become self-organizing, autonomous contributors. The very act of leadership shifts from a command and control model to a dance of influence that anchors on both relationship and task. A stage theory may seem the antithesis of a complexity lens perspective – and I’m not sure that each stage is as linear and progressive as one might expect.

The theory endures because it offers new perspectives on leading in complex systems, which few leaders today can avoid. By focusing on the context, the goals, the people and their needs, Situational Leadership has something special to offer anyone trying to grow as a more effective leader in a complex adaptive system.

Sometimes command and control is exactly what makes it all work

Andrea writes: Last weekend I attended The Masters at the Augusta National Golf Club in Georgia with my Mom and some close friends.
Other than the trees, the beautiful azaleas, and of course the golf, at The Masters you can’t help but notice the fluidity and order that ensures everything gets done in a certain way.
No one runs. No one shouts, “Get in the hole!” There is no autograph-seeking. If you place your chair at the 18th hole, it will be there, untouched, when you return. When you line up in a very long queue to buy lunch, it all works incredibly smoothly.

It’s estimated about 35,000 people attend on each of the 4 days, and it is ever so orderly. Observing the thousands of attendees –it struck me that sometimes Command and Control, and its orders of hierarchy, can really work. As I watched what is arguably the most prestigious golf tournament in the world I asked myself: So how does it all work?


The Masters, like golf itself, is heavy with rules, etiquette, and expected decorum, most of it in place for decades. For instance, there are only certain places you can walk, times you can move, strict rules about when silence is required, and when and how you are allowed to cheer.
Occurrences such as cheering at the wrong time, are rare at The Masters “but we must eliminate them entirely if our patrons are to continue to merit their reputation as the most knowledgeable and considerate in the world.” This 1967 quote is from Robert Tyre “Bobby” Jones Junior, President in Perpetuity of the Augusta National Golf Club. Little has changed since then and the expectations for certain behaviours carry over generation after generation.


There are clear and unwritten yet well-understood agreements among all the stakeholders in the world of golf. Although Augusta National is arguably among the strictest arbiter of rules and decorum, all private clubs (and many public ones) expect a certain level of customized behaviour that is agreed on culture in the sport. Agreements among the stakeholders uphold the expected customs, etiquette and decorum.


As well as unwritten agreements to follow the rules, and the many polite and cheerful staff moving everyone along (even through the restrooms), there are carrots and sticks to ensure compliance.
Tickets to The Masters are won, through a carefully managed lottery. If you follow the rules you can attend the most celebrated golf tournament in the world, at one of the very best clubs in the world, and take your friends and family as guests, for life. Extremely prestigious as a public sporting event, tickets are much sought after.

If you don’t follow the agreed upon rules and etiquettes, your tickets are forfeited forever.
When at Augusta for The Masters, without your prohibited cell phone, eating your egg salad sandwich on soft white bread with a cup of pink lemonade, you can’t help but feel you have been transported back in time. Certainly no one would suggest that there is a modern or “moving with the times” feel to Augusta and The Masters – which is both remarkable and somehow quite lovely.


The benefit is that thousands of people, circulating in a coordinated and orderly fashion, navigating fast food lines, and quick restroom breaks, enjoy for a brief time a revered and time-honoured institution that has managed to resist most calls for change – at least for now.

What is the cost for such order? The need for incredible manpower – a very large number of staff members monitoring and controlling patrons and ensuring compliance – is evident. Strict adherence to rules, and immediate consequences for rule breakers is mandatory. Emergence and creativity is left to the golfers.

In a complex and dynamic world, a VUCA world (see previous post) golf clubs still have the luxury of control that few organizations, try as they might, can afford to keep.

Why Wicked Problems Need a Complexity Lens

Andrea responds: Wicked problems are like complexity. They have interdependent agents that interact in unpredictable ways and produce a pattern or emergent trend. They are non-linear, their “cause” and “effect” can be simultaneous (does eating too much cause you to be obese? OR does being obese cause you to eat too much?). The solutions can therefore have unintended consequences (does forcing kids to exercise make you more stressed? and more likely to eat? less likely to exercise?).
Each linear solution is wrapped up in contradicting forces and opposing perspectives that keep the current status in place. Some of the solutions to a Wicked Problem can emerge from seeing it through a complexity lens, and using lessons learned from complex adaptive systems.
I first ran into the term “wicked problems” at an Art of Hosting seminar in Pembroke in 2009. The Art of Hosting brought together professionals who wanted to tackle Wicked Problems in the world by hosting conversations that matter.
The people at Art of Hosting and other groups using whole system semi-structured conversations believe that there is no simple solution to a Wicked Problem. They hope that getting as much of the system – and as many stakeholders as possible – in one space, and asking “Wicked Questions” may provide the beginnings of a solution. Wicked Problems can involve many stakeholders with competing and complementing information, values and perspectives. The solution involves unlocking as much new and diverse information as possible in order to find new and generative patterns in the system.
This is not to say there is no solution to Wicked Problems. For example, childhood obesity has begun to drop in the last couple of years.
Viewing the Wicked Problem as a whole system issue, and inviting as many stakeholders as possible to the table, can bring greater clarity to system mapping, and enhance the possibility of enabling potential solutions to emerge.

Complexity and Wicked Problems

We hear people talking about “wicked problems”. We’re thinking that global warming is a wicked problem but is the conflict in Syria and the Ukraine? Is the missing Malaysian airliner? Is the growing gap between rich and poor in Canada a wicked problem? Is the extreme poverty in developing countries positioned alongside extreme wealth and waste in the developed world a wicked problem? Is traffic gridlock in major cities like Toronto a wicked problem? So we asked ourselves – what exactly is a wicked problem anyway?

Horst Rittel, Professor of the Science of Design, and his colleague Melvin Webber, Professor of City Planning at Berkley are said to have coined the term in a 1973 paper titled Dilemmas in a General Theory of Planning.

A wicked problem, they wrote, is one for which each attempt to create a solution changes the understanding of the problem. Wicked problems cannot be solved in the traditional linear fashion, because the problem definition evolves as new possible solutions are considered and/or implemented. They are said to be stubborn, intransigent and even hard to describe. It is difficult to actually define “the problem” because there are so many factors to consider.

Lawrence J. Peter (a Canadian scholar famous for describing the Peter Principle) once said, “Some problems are so complex you have to be highly intelligent and well-informed just to be undecided about them”.

Wicked problems are said to be tough or even impossible to solve because of incomplete, contradictory, dynamic and interlocking factors that are often hard to recognize and describe. Wicked problems resist being de-constructed or de-layered (people refer to the analogy of peeling an onion). Solutions are rarely right or wrong but better, worse, good enough or not good enough, say many social complexity theorists.

So it’s likely that global warming can be considered a wicked problem and maybe the conflict in Syria. The situation in Ukraine seems more straightforward as does the missing Malaysian airliner? The growing gap between rich and poor in Canada is solvable with social policy so maybe not a wicked problem? The global equivalent probably fits the criteria because the solutions are less obvious and more diverse people, cultures, governments and societies are involved and must be engaged to care. Traffic gridlock in major cities like Toronto probably not, since solutions are quite clear – more transit and bike lanes, with incentives not to travel alone by car.

We’ll be watching for more on “wicked problems” and likely revisiting this topic again. We’d love to hear what you think?

When collaboration isn’t the best option

Andrea writes: Last fall, I saw Vivien Twyord speak, promoting her book The Power of Co about the preconditions for collaboration. Vivien is a seasoned collaboration facilitator, who works to solve large, seemingly unsolvable projects like local communities and electrical companies deciding where to put unwanted towers. She has used her vast experience to bridge years of distrust and paralyzing inertia and make collaborative decisions.
The first and most powerful thing Vivien taught me is that collaboration can sometimes cause more problems than it solves. Her key take-away lesson for me was that you need to understand the difference between a simple problem, a complicated situation, and a deeply complex issue. Making the right initial diagnosis can make all the difference.

A simple problem has few factors and the outcome is predictable. Cause leads directly to effect, and the answer is knowable. Example, your car needs gas to run. If you run out of gas, your gas gauge will light up. The solution doesn’t require a collaborative intervention to find the solution.

A complicated situation has many factors but the solution is still predictable. Cause leads directly to effect and the answer is still knowable. A noise in your car that you describe to your mechanic, but aren’t sure where it’s coming from, is more complicated than a gas gauge on Empty. Still, talking to an expert – in this case a good mechanic — would be a much more efficient use of time than initiating a collaborative conversation on potential solutions.

A complex issue: The solution or outcomes are not known. For example, changing the behaviour patterns of car users and encouraging a bike lane in a divided community has a number of complex issues, environmental, safety, distrust, misinformation, cultural convention etc. An expert might be able to suggest potential solutions and therefore contribute to a good outcome but a simple answer to a complex problem is bound to create unintended reactions and responses.

Complex systems have interdependent agents. Removing one piece or inserting another will not fix the problem or create a sustainable solution. A complex lens allows us to see a system with underlying connections and values that can both nullify big changes (see Senge “the harder you push, the harder the system pushes back”) or have a large response to small changes (see the power of butterfly wings flapping).

In her talk Vivien stressed the point over and over: Do not collaborate if your problem is simple or even complicated – it will frustrate and exhaust you and your system. What’s worse it will build distrust and undermine the faith or willingness to collaborate when necessary. Even if the problem is complex, if you think the problem is simple, i.e. you are pretty sure you know the right answer before you start, then collaboration will be a frustrating, drawn out experience and harmful to the project.

If your problem seems intractable, unknowable, and maybe even unfixable, you need to look up Vivien and learn the Power of Co.

Another view of simple, complicated, & complex is the Cynefin model, an interesting framework developed by Dave Snowden, which also includes a 4th possibility the Chaotic. Go there if you dare!

Jazz vs Orchestra: A question of control?

Andrea asks: Is it control that best defines the difference between leader as Symphony conductor or Leader of a Jazz Quartet? Or is it something else? Let us know your thoughts.

When a jazz leader sits down to count in his band: 1, 2…. 1, 2, 3, 4 he or she doesn’t really know what is going to happen. Once he counts in and then sits back among his band members, he has faith that he has talented musicians and that they will produce a quality show. Unlike a classical orchestra or a pop musical group, each performance of a jazz standard is a unique and emergent creation. The Orchestra Conductor, standing at a pedestal with a baton, is unquestionably the in-the-moment leader. He stands at the front, everyone watches him, the hierarchies are clear, the lines of decision-making are coherent, and the goal is replicable and precise.
The Jazz Leader, sitting with his musicians, sets the stage for the performance, but then becomes a contributor. There is much agreement that happens before the performance can start – the song, the key, the tempo, the feel or type of jazz, and a huge nod to tradition and history – yet the performance is improvised and new each time.
When thinking of complex adaptive systems, there are many aspects of Jazz that are fascinating and created fresh in the moment – including leading with less control but full responsibility, following while leading, listening with presence, and living with ambiguity.
Think of this — the Jazz leader and the Classical conductor have many different skills. The Classical conductor is an exquisite example of a great hierarchical leader. There are times in our organizations that we require replicable and precise results, and need a leader who has been accorded the control and unquestioning followership similar to an orchestra conductor. But there are also times when there are several agents all with something new to say, when listening and building on each other generates necessary innovation and creativity, and where the leader needs to set the necessary agreements and then get out of the way of the music.
Leadership is emergent. Different scenarios require different behaviours from both leaders and followers. It’s important to be both aware of the situational requirements of leadership and followership, to be able to move smoothly between those two roles, and flexible enough to be able to change course as the situation requires.

Andrea’s YogaClass: BOTH Soft AND Strong

During my first yoga class, I sat on the floor with my borrowed mat in my baggy sweat pants watching a 65 year old man balancing on his head. My friend, a type A person, who had brought me to her studio – leaned over and said, without hint of apology: “this is probably a pretty advanced class.” I nodded. Then a moment later, she leaned over again, and casually said: “this is a two hour class.” I laughed out loud into the quiet meditation of a pre-yoga studio. She looked back at me as if to say: “is that a problem?”

I powered through the class, proudly complying with all of the complicated and new instruction. It wasn’t till years later, when I had been practicing for a while that I realized that I was rigid, muscling through by gritting, over compensating for muscles that weren’t strong enough to hold me up. I was weak in my rigidity.

Yoga is constantly teaching you to balance effort with ease, to build strength so you can soften. …… so you can develop the muscles, the endurance and the flexibility to give you awareness and choice.
The stronger I got, the softer I could be. Complexity, like my yoga practice, marries seemingly opposite or paradoxical ideas. It leaves behind an “either/or” thinking and necessitates a “both/and” thinking — soft/strong, effort/ease, focused/unfocused.

As we explore ways that a complexity lens can help open the world, as individuals and as teams and organizations, we hopefully will embrace BOTH knowing and learning AND not knowing or constant curiosity.

What are the polarities – or apparent opposites – that seem contradictory but need to be reconciled — that come up in your life? What have you had to see as Both/And to help you move forward in your thinking, reconciling, learning?