Healthcare’s Wicked Problems Can Only Be Managed Not Solved

Strategic management guru John C. Camillus wrote an excellent description of “wicked problems” in his article† about strategy for the Harvard Business Review in May 2008. Separately, in his book “Systems Thinking Made Simple”,†† system scientist Derek Cabrera says that “Wicked problems result from the mismatch between how real systems work and how we think they work”. Both our strategy confronting the reality of healthcare’s complexity and Cabrera’s observation directly apply to how we approach the wicked problem of delivering high quality at affordable cost. The most important thing to know, is that there is no static solution. But there is a better way.

Consider first that our current strategy to manage healthcare follows a traditional scientific paradigm. We break a problem or process into its component parts and study them. We believe that knowledge of the parts provides an understanding of the whole. Yet, this knowledge only enables improvements and efficiency leading to a better understanding of each part. We have different methods to limit the scope of our observations and control for external influences enabling more reliable observations. The business management strategy of this approach creates structures and rules that control system behavior to ensure organizational stability and a standardized approach. This isn’t working. 

This wrong strategy is an example of Cabrera’s description of how wicked problems come to be. Understanding the parts doesn’t lead to understanding or an ability to manage the whole in a Complex Adaptive Environment. Trying to manage the whole with a view of the parts is impossible because the whole is always more and different. None of the parts exist in isolation. All are involved in more feedback loops than we can know and the full nature of that feedback is dynamic and equally unknowable. The problem is not a lack of scientific knowledge or poorly engineered process. What is needed is a new paradigm for strategic management. We need to play a different game.

The Curandi Model® is based on a new Systems science to manage healthcare from its whole. It uses the simple rules that lie at the heart of complex behavior to continuously find better solutions to improve the healthcare value delivered to each person. 



† John C Camillus; Strategy as a wicked problem; Harvard Business Review; 2008;

†† Cabrera, Derek; Cabrera, Laura. Systems Thinking Made Simple: New Hope for Solving Wicked Problems (Page 13). Kindle Edition.

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