Edgeware: Insights From Complexity Science for Health Care Leaders, Brenda Zimmerman, Curt Lindberg, and Paul Plsek; VHA Inc., Irving, Texas; 1998; 2nd ed 2001.
Challenges of the 21st century lie in its escalating complexity. Actually, the phenomenon of complexity is not new; what is new is that leaders have to make decisions in a faster-paced world, and they must increase their adaptability to turbulence, knowledge breakthroughs (this is a particular issue to evidence-based health practice), globalization (eg, SARS), etc. The purpose of this book is to show managers how they can cope more effectively with the demanding, rapidly changing environment they are facing.
The health system is embedded within a wider social system. Since it is difficult to fully understand any system without reference to others that are linked to it, it becomes necessary to approach the health care system within a broader social context. Current management practices in the health sector take the view that a well-functioning system is similar to a machine, a well-oiled mechanical device. However, because of the rising number of interactions and interdependences of health determinants, the health system does not follow such a simple linear model. Most agree that the processes through which the health determinants operate are complex and that health programmers should adopt new methods that encompass all critical parameters in order to better plan their interventions.
In this context, health leaders who learn the lessons of complexity theory, understand it, value it, and manage it at different levels will develop better insights to respond to the health system's issues and will be better skilled to establish a more efficient management style for the health sector.
Complexity science gives us a new approach that looks beyond apparent structures. Traditional management perspectives assume that the health system can be broken down into units and planned in details; indeed, budgets are separated and operationalized for primary care, secondary care, and social services. Since these units are constantly interacting across the system, complexity science suggests that goals and resources be allocated, taking into consideration the whole system rather than allocating them into parts.
This book examines how leaders and managers in the health system are starting to use complexity science to discover new ways for planning public health programs and organizing health care services. The authors portray different applications of complexity thinking in understanding and addressing the challenges of rapid change and the necessity for adaptation.
The book is unique in several respects. It is organized in a hypertext fashion, which makes it user-friendly, extremely thorough, and practical with real "how-to"s and case studies. In fact, the reader does not even have to go through the sections sequentially, as the book is not made to be read from beginning to end. It is a collection of aides, ideas, and resources that allow people with different learning styles and in different contexts to grasp and apply the lessons of the science of complexity. Furthermore, Edgeware is an integral part of the Plexus Institute Site (http://www.plexusinstitute.com), where additional in-depth articles, tools, and a comprehensive library are available. The authors structured the content into four sections and a detailed glossary.
Though solid on the theory of complexity, this book's real originality is in its remarkable practicality for leaders. Edgeware is an excellent read and a good reference to examine management methods in designing and implementing public health programs, as well as to provide guidance for achieving more efficient methods of operation.