The Polyclinic as a Complex Adaptive Human System

July 14, 2015 by  

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.

Thinking about Occam’s Razor

March 3, 2015 by  

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.

Such is Africa…….

January 15, 2013 by  

“Such is Africa, the flawed beautiful, magnificent, beguiling, mystical, unique life-changing continent – it’s seductive charm and charisma, it’s ancient wisdom so often stained by unfathomable spasms of blood”. I found these words from Lawrence Anthony, The Elephant Whisperer and his journalistic colleague, Graham Spence to be very moving and evocative of the mixed feelings we experienced in South Africa last winter.

It is 5 weeks until we travel back there – this time to East Africa, including Mpumalanga in north-eastern South Africa, Mozambique, and Tanzania. We are busy getting our shots and anti-malarials taken care of, and thinking about packing for cities (Johannesburg, Nelspruit, Nampula, Dar-es-Salaam, Arusha…. ), islands (Zanzibar), tenting in the Serengeti, and tree-top living in the jungle. What can I say? Excited, apprehensive, incredibly fortunate to have this experience ahead of us……

King Shaka International Airport in Durban

February 3, 2012 by  

We woke early and had a delicious continental breakfast on the porch at Makakatana, said our goodbyes and took to the N2 to Durban International for a flight at 130 to Port Elizabeth on the south shore.

The small staff at the lodge provided an excellent example of effective teamwork. Everyone did her or his designated job as well as supporting others and jumping in to do what needed doing. There didn’t seem to be any tension between whites who were rangers and office staff and several Zulu women who were kitchen, meal service and housekeeping. The camaraderie and respectful joking among them was good to watch even though we knew as guests we might not be allowed to see tensions that were under the surface.

The trip south by car is beautiful – everything very green and lush, acres and acres of planted eucalyptus trees and sugar cane, lots of pretty little Zulu villages with their round thatch-roofed huts reserved for the ancestors, and many cows – some grazing too close to the highway! The roads are very good and lots of people are employed repairing the roads and building new lanes, cleaning the roadsides, picking up any garbage. Everything is very clean. Speed limit is 120 km/hr and everyone moves fast, lots of trucks and “taxis” that the blacks cram into – 16 (or more) seater vans that stop on the side of the road to take people to work or shopping or whatever. They look stifling hot but seem to work in this evolving economy with 25pc and more unemployment rates depending on the area. Tourism is down considerably with recession in Europe and USA and people are feeling it.

Bad luck with weather in Port Elizabeth and we’re still here at 630pm waiting in the airport for a flight out which does not look promising but they don’t want to cancel yet. Apparently all flights from Joberg to PE have been canceled so it’s just a matter of time for us to be cancelled as well….

We’ve just changed our flight to an early one tomorrow to Cape Town. SAA was very accommodating. There is a Fairmont Hotel nearby so we will head there overnight.

Interesting story when gasing up the rental car at a Shell station on the highway (BTW the rest stops are the same as ours in Canada with gas, food and drink, cash machines and the like). There was a power outage at the station on our side of the highway so several red shirted employees with the Shell logo directed us to drive into the culvert under the highway to the other side where the power was working in that Shell station.

Getting gas here is a pleasure. Many uniformed employees, both men and women, are at the ready to pump your gas, wash your windows and check under the hood if you wish. They are very grateful for a 20 rand tip (about 2.50) which goes to help feed the extended family.

We are sorry to be leaving Zululand behind. From what we have seen they are a kind and gentle people who are struggling to make it in a rapidly changing world. HIV Aids and unemployment are huge challenges. The men seem to have trouble staying with the family. Many women are supporting their extended families on their own. Two days ago we took a very early morning game drive to Hluhluwe. On the way we saw dozens and dozens of kids of all ages walking along the highways to school, very neatly dressed in clean uniforms despite the fact that living conditions are very rough. It was 630am! We are told that kids walk very long distances (even 10 kms in some cases) and sadly teachers are in very short supply and poorly paid so the kids might get to school and no teacher is there.

Hippo Heaven

February 2, 2012 by  

We’re at Makakatana Bay Lodge in the iSimangaliso Wetland Park near Lake St Lucia in Kwa Zulu Natal province for one more night. Today we took a pontoon boat tour on the estuary of Lake St Lucia and saw many dozens of hippos resting in the water. As we motored gently by, they would lift their heads to look at us, snort a lot to say: dont come too close; and then submerge themselves again. Many had young ones and can be very aggressive towards intruders. Our boat captain, Warwick and our guide Louwrena were both very knowledgeable about the wildlife and could spot interesting birds and lizards from long distances. We didn’t see any crocodiles which apparently is unusual. Gord got an excellent shot of fish eagles sitting regally in the trees or taking flight to get away from the boat.

Our captain was a very respectful and knowledgeable guide who kept away from anything that would be unduly frightened. Our lodge is very wild, elephants come at night to forage, 3 water buffalo spend their time grazing in the front yard, monkeys live in the trees outside the porch where we eat breakfast and race across the rooves at night, and a warthog family come several times every day to drink from the pond.
This was our third day tour in this UNESCO World Heritage reserve. As we drove in the first day we were thrilled to see giraffe and zebra grazing beside the dirt roads. We spent the first evening on a drive with a wonderful young and very knowledgeable guide named Riley who sat with us for an hour watching a bull elephant alone in the setting sun and very close to our truck. Needless to say we have some great photos. We have been using the computers in the lodges to keep our messages going out and the photos are downloaded onto the ipad. Next time we will bring a cell phone and learn how to use it to tether – right, Kirk.
I am continuously blown away by the complex adaptive systems that we are learning about every day here – complexity being a subject I am very interested in!
We leave here tomorrow after breakfast and drive 3 hours to the Durban airport to return our rental car and catch a flight to Port Elizabeth. From there we pick up another car and drive to Cape Town along the famous Garden Route.

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Amazing Sights at Makakatana Bay Lodge

February 1, 2012 by  

We’re at Makakatana Bay Lodge in the northern part of Kwa Zulu Natal on the banks of Lake St Lucia not far from Swaziland. Having some wonderful viewings of giraffe, water buffalo, zebra, rhino, warthog families and many kinds of antelope with a fantastic guide named Riley who is both very knowledgeable and excited about his work. He’s also a great bartender and cook. We’ve had evening drinks with him on the savannah as well as a fantastic outdoor breakfast at the Hluhluwe Imfolozi Park north of the Lodge in Zululand and surrounded by lovely hillside residences and small villages. We left the lodge about 5 this morning to travel to this famous park where there is lots to see.

On the day we arrived at the lodge we took a wrong turn and before we knew it we had glimpses of giraffe, zebra, warthogs and tons of colourful birds. It was very exciting to see these animals in the wild and protected. We spent one evening with this large lone bull elephant just watching him as the sun set and he wandered the plains. At a couple of points you’d swear he knew he was giving us a thrill – he was only 20 feet from our truck – and he seemed to pose for us. Riley was full of interesting information and knew just how close to get so as not to scare or disturb him but to give us a good sighting.

One of the pictures below is of Dung Beetles which live in elephant dung. Thanks to Louwrena, Riley’s colleague who taught us about these interesting creatures and actually had us hold them and their dung balls. The elephants wander the roads at night near the lodge – they come to eat from the trees and one night devoured the year’s crop of mangoes! By morning their dung is full of beetles which will live and reproduce in the dung – as well as recycle the dung into useful products for the ecosystem…a form of symbiosis. They are extremely efficient. Researchers found that a 1.5 km of dung attracted 16 thousand beetles who disposed of it in under 2 hours.

Having a wonderful trip and meeting many interesting people with lots of insight in to this wondefully complex country.

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Most Amazing Soweto Tour Today

January 27, 2012 by  

We had a fantastic day today. After a very good sleep and a wonderful breakfast overlooking the city of Johannesburg we headed out on a tour of Soweto, starting with the Apartheid Museum and ending with the Hector Pieterson Museum. In between we visited Mandela’s home, which is now a small museum, and we had a local lunch with our guide. There is so much to tell that we will do it in stages today and tomorrow so please check back on this post as we put it together. It’s almost dinner time so we will publish it as we add information.

We left the hotel with Ben, our excellent tour guide at 1030am and returned at 5pm. We were concerned that much of what we would see would be very hard to take in. Ben started the tour by saying “I am going to show you the good, the not-so-good and the ugly.” And he did – all while answering our many questions with honesty, humour, grace and pride. He has many good reasons to be proud, he has lived in Soweto all his life – he tells us he is 40 and the youngest child of 4. His mother is 75; his father left when he was 6. Their household also consists of his two nephews, 21 and 17 (as their uncle he has resposibilities to see they are raised well) and his own 2 children on weekends. He is a very conscientious and kind man. We know this by the respectful and kind way he treats the many people – both old and young – that we come in contact with over the course of the day. He tells us he has just finished paying the bride price (dowry) for his second wife. He is proud to tell us she is a teacher. We are sorry to learn that his mother has just been diagnosed with TB. Happily she is being well cared for in a local hospital. He tells us that healthcare Is provided for all South African citizens. We later learn that TB is often used in Africa as a euphemism for AIDS, which has a significant stigma attached to it. We also learn from reading the newspapers that although health care is provided for all, the quality is not at all what it needs to be. We hear – although we don’t see it – that thousands of people wait in the fields surrounding hospitals, hoping to be cared for at some point. This is a third world country for many of its citizens and a wealthy first world country for others – not unlike Canada with its challenges in First Nations communities. The significant difference here is that the African majority of many millions of people is by far the poorest and the least educated.

A little about Soweto: It stands for SOuth WEst TOwnship and is about 30 minutes from our hotel. The population is estimated to be about 3.5 million but no one really knows how many people actually live there. Apparently the government conducted a census last year, the results have not been released yet. Both Archbishop Tutu and Nelson Mandela lived there for many years. In fact Bishop Desmond Tutu still has a house which his son keeps for him and he stays there when he is in Johannesburg. The restaurant where we were invited to have an excellent local buffet lunch was beside his house.

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Leading in Complex Systems

November 10, 2009 by  

Health care leaders have begun to adapt to the complexities, ambiguities and paradoxes that are now the norm in healthcare.

It is more and more apparent that the emerging field of complexity science offers important strategies for leading in chaotic, complex healthcare environments. A 2001 survey by Burns found that healthcare leaders intuitively support principles of complexity science and understand the value of complex adaptive systems as a model for leading and managing in healthcare environments.

Leadership that uses complexity principles offers opportunities to focus less on prediction and control and more on fostering relationships and creating conditions in which complex adaptive systems can evolve and produce creative outcomes.
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