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Sunday, November 8, 2009

Standardization, modularity, and the changing world

Much has been made for the merits of standardization of process within health care environments as a vehicle to improve outcomes and safety. The real power of standardization is when it can be deployed with modular design. Combining these two characteristics allow for safety, efficiency, and the ability to adapt to change.

Modular design allows engineers to tinker with one component without altering the function of a different component. While this is well appreciated within the engineering and software domains, it is not well appreciated within complex human systems. However, when thinking about it within the context of software design, it is easy to see how complex human systems share many of the same characteristics.

When building new software, it is very common to build upon the foundation of old code. Likewise, human institutions are rarely created de novo. They are generally created using older structures and forms and are frequently created using social groups derived from pre-existing structures. When creating new software, the operating units or files may operate in a self contained fashion, may require the function of other programs, or may be required by other programs for their functions. These represent interdependencies.

Modifying operating files which are dependent upon or required by other files creates added complexities. Their interdependencies must be defined if possible and unintended consequences identified. These complications of changing parts of software have uncanny parallels to manipulations of complex human systems. The more modular the software, the fewer interdependencies that exist, and the easier it is to manipulate and change any given component.

Within complex human systems there are a host of interdependencies which exist. Whenever there is a "change order" issued, it is best to understand just how modular your system is. Before you can begin to understand what might happen as a consequence of such a change order, you need to at least begin to understand simply the nature of interdependencies which are likely to come into play. In the health care environment we are only beginning to appreciate what we are up against.

Our present architecture is not standardized nor modular. Our interdependencies are extensive and only minimally defined. Perhaps our greatest interdependencies are financial. Within large integrated health care entities the function of many financially non-viable units is dependent upon financial resources generated by other units. Since interdependencies create non-modularity, it only follows that financial interdependency creates inflexibility. You can't alter one piece without altering the function of other units. This does not bode well for entities engineered this way since the only thing which we can predictably anticipate is a changing world and survival of the most adaptable entities.

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