From the September/October Issue...
There is a difference between chaos and complexity. Chaotic systems are driven by simple rules that, when applied repeatedly, tend to increase disorder. Moreover, chaotic systems are difficult to influence because the rules are fixed. Complex systems have multiple parts that interact to influence the environment. These features create system properties that can be observed and modeled. Several authors in this issue of the Journal of Healthcare Management find that the ideas used by people who study chaos theory are applicable to our healthcare system.
The Diversity and Inclusion column starts out with a classic example of chaos theory—the “butterfly effect.” Ernie W. Sadau, FACHE, and Tiffany Capeles describe how our implicit biases (yes, dear reader, we all have them) build up to diminish our organization’s adaptability and competitiveness over time. The solutions applied by Sadau, Capeles, and their colleagues at CHRISTUS Health create a change model that addresses the small features of decision-making that may accumulate in either a positive or negative way.
The Managing Risk column by consultants Simon Mawer and Barry Katz makes explicit references to complex systems—in particular, how design thinking can be used as a problem-solving tool in complex social and technical environments. The end-user focus of design thinking is consistent with other large-scale programs in healthcare today, such as patient-centered medical homes and accountable care organizations.
The empirical research article by Danielle J. O’Laughlin; Jennifer A. Bold, APRN, CNP, DNP; Darrell R. Schroeder; and Petra M. Casey, MD, looks at the professional satisfaction of advanced practice providers (APPs). They find that APPs who work in environments that are more complex achieve higher levels of professional satisfaction. It is gratifying to learn that the human condition contains the desire to both thrive and excel in challenging settings.
When I was an undergraduate, back in simpler times, two classes were required: Accounting 1 and Accounting 2. The professor who taught them joked that Accounting 1 was what you showed the Internal Revenue Service (IRS) and Accounting 2 was how you made money. The article by Darrell J. Gaskin, PhD; Bradley Herring, PhD; Hossein Zare, PhD; and Gerard Anderson, PhD, examines how hospitals report their charity care to the IRS and Centers for Medicare & Medicaid Services and seems to find the same vein of bookkeeping. I will not spoil the ending, but it is fascinating how small differences in government organizations’ definitions of charity care can lead to wildly different reporting norms.
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