Complexity Creeps Up On You

Joseph Tainter, author of "The Collapse of Complex Societies," was recently quoted in the New York Times as saying, "Complexity creeps up on you." Drawing from his research of ancient civilizations, including the Roman Empire, Tainter concludes that leaders generally make reasonable decisions based on the facts known to them at the time. However, it is simply not possible to predict how actions today will play out in complex environments. There are simply too many variables. As the effects of actions cascade through multiple layers of human and environmental systems, what seemed unthinkable yesterday becomes the new reality today.

Which gets me to our healthcare system. The Healthcare Reform Bill may well be the straw that finally breaks a system that is alrady near collapse from its own complexity. A more complex system is hard to imagine. Doctors, patients, hospitals, specialty providers, nursing homes, home health and hospice, insurance companies, Medicare, state-run Medicaid, regulatory agencies, patient advocacy organizations, legislators, medical malpractice insurers, media organizations, special interest groups, pharma companies, medical device and equipment manufacturers, and more, all interact in a complex system threatened by out-of-control cost increases and demands for higher quality and transparency. Accountable care organizations may well be the answer to at least some of the current problems, but their impact on this complex system cannot be foreseen by mortal man.

One thing is clear. Participants in this system cannot assume any future based on trend lines drawn from the past. Every assumption needs to be challenged and business models need to be rebuilt from the ground up. In other words, we should all be feeling we're not in Kansas anymore.