Not only are most stakeholders in health care inde- pendent agents, they are also beyond direct observa- tion. Thus one cannot manage their activities but can only assess the value of their outcomes. In a traditional system, one might attempt to optimize efficiency. However, the learning and adaptive characteristics of a complex adaptive system should be leveraged to encourage agility rather than throttled by optimization focused on out-of-date requirements.
Manage the Worldwind
Based on the organizational behaviors for complex adaptive systems described above, information to over- see the system should include the following elements:
- Measurements and projections of system state in terms of current and projected value flows, as well as current and projected problems.
- Measurements and projections of system performance in terms of current and projected value, costs, and metrics (e.g., value divided by cost), as well as current and projected options for contingencies.
- Observations of system stakeholders in terms of the involvement and performance of each stake- holder group.
- Capabilities for measurement, modeling, and display of system state, including agile “What If?” experimen- tation and adaptation.