HealthcarePapers 17(1) July 2017 : 38-43.doi:10.12927/hcpap.2017.25335

Understanding the System You Are in Is Key to Improving It

Paul Plsek


Front-line ownership (FLO) is an approach to change that is consistent with what we know about complex adaptive systems (CAS), such as a healthcare organization. Traditional change approaches can fail because they are based in the "organization as a machine" metaphor of traditional, scientific management. Both metaphors have their application. It depends on how closely the work naturally resembles a predictable machine. Often, the drive for detailed standardization is a misguided effort to make a human CAS behave more like a machine, so that our traditional approaches to change will work. FLO is a more appropriate tool in a CAS, where shared agreement at the level of a few simple rules (minimum specifications) and allowing flexibility for adaptation within local context is more appropriate than detailed standardization. Because humans in a CAS maintain some control over their discretionary effort, change advocates desiring sustainable change must work with stakeholders to co-create cases for change that resonate with the values of those being asked to change. FLO facilitates the emergence of this level of understanding of shared values.



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