Our Biggest Problem Is Linear Management in a Non-Linear World

Surgical care providers across the U.S. are rapidly embracing the fundamental tenets of the Perioperative Surgical Home (PSH) model of care: coordinated global care of the surgical patient and standardized, evidence-based, interdisciplinary care pathways. Unfortunately, instead of seeing their expectations logically borne out as performance improvement success stories, advocates of surgical care improvement are often frustrated by unrelenting bureaucracy, persistently unfocused care coordination and suboptimal outcomes. This situation might be considered paradoxical, but in reality it is entirely predictable. Highly hierarchical organizations with centralized command-and-control are well-suited to structured, static environments and to centralized decision-making that produces predictable outcomes. Mathematicians, physicists and engineers use the adjective linear in describing such environments: linear equations, linear systems, linear thinking. However, frontline health care providers work in complex non-linear systems in which...

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