capstone slide 7

McGreggor's Theory X and Theory Y reference will go [here].
Barbara Fredrickson's Positive Psychology reference will go [here].

Discussion of High-Reliability Organizations and the role of mindfulness (Karl Weick, Patient Safety and Peter Pronovost, Threat and Errror Management, etc.) goes [here] and all have links to the literature at the bottom of this post.

Discussion of Institute of Medicine's MICROSYSTEMS and references (below) goes [here]

Role of integrity, honesty, and virtue in all of the above: see my early post Virtue drives the bottom line with many links at the end to such literature. (excuse the formatting near the top of that post - it fights back.)

Discussion of authority structure versus open structure trade-offs in agility
and ability to react rapidly in a crisis goes here. Compare Oxford University's inability after 1,100 years to agree on a mail system to FedEx ability to turn on a dime. When is there "too much" collegiality? When does a "crisis" justify over-riding "personal liberty" in the interests of "national security" for "the duration of this crisis" and how has that played out all the last 20 times it was tried?

The Current US Army solution - Leadership Doctrine (Basically theory xYx', "ex-why-ex-primed"). Same as Karl Weick's fire-fighter solution. Theory Y during peacetime as establish valid command channels, with theory X (informed eyes open) during a crisis, (the exact opposite of FEMA during Katrina). See US Army Leadership Field Manual FM22-100
and What relates Public Health and the US Army?

Same problem that hospitals have - how to keep CONTROL OF THE MISSION, not have substantial loss-of-life during the learning period, and yet otherwise keep the structure open, flexible, agile, responsive to the environment, eyes-open, and a cybernetic "unit" - which is the "unity amid diversity", the "e pluribus unum", the "specialization and reintegration", the "silos and single system" and the core problem of "democracy" and "corporate governance and decision-making."

Key - whatever else happens, you can't violate:
* the laws of thermodynamics
* the laws of cybernetics and control system engineering

Which says this: if there is not a COMPLETE LOOP between the bottom and the top, that allows commands to flow downward and NEW, surprising, model-changing DATA to flow upwards, it will crash and burn.

Also, as shown in FEMA, in any organization it is ultimately fatal to use a "star" architecture and have all decisions made "at the top", especially in a crisis. The model that works, and worked in Katrina, was the Coast Guard, where decision-making had already been delegated downward to each ship's captain who had authority to take sensible action on their own in a crisis, particuarly if communications with "the top" were cut off. So, if the top is functioning, listen to the top ("x"), if it's not, listen to own judgement "Y", but judgment that has been formed by previously listening to the top that, in turn, had been actively and adequately listening to the troops at the front "x-prime", which gets me model xYx' .

In any true crisis, the top command will be completely preoccupied with a few huge questions and 100% unresponsive to "small problems" from the front, so, as in New Orleans, the guys at the front will be "on their own" anyway, cut off from communications with the top - or, more precisely, it doesn't matter if the phone lines are up, because no one there will be answering the phones - they're all off in a meeting deciding something of cosmic importance and can't be bothered to take your call.

So you better have an action-based method that doesn't depend on the "top" being useful at all during a crisis,which means you better practice that most of the time so you get good at it, which means that Microsystems need to get by on their own anyway.

Interestingly enough, the human body delegates as much as possible downwards. It's not actually possible to touch-type, as I am doing at this second, under brain "control", because it takes 100 milliseconds for the neural impulse to go round trip from the finger to the brain and back, and the inter-key interval is often down to 15 milliseconds.

So, with 100% certainty, we can predict that the "control" exercised must be a more general "feed forward" control, which I need to have a link to [here]. In any case the whole concept of "time" and "causality" becomes smeared out in a multi-pass feedback loop with phase-locking, which means that the directions "forwards" and "backwards" lose their typical meaning, and every loop becomes an M.C. Esher staircase or a Richard Hofsteader's "Strange loop" (Esher, Godel, and Bach) where "up" and "down" take you to the same place and non-transitive links are the norm, not the exception. (link needs to go [here]).

========================

References and further reading

High-Relability Organizations and asking for help

Secrets of High-Reliability Organizations (in depth, academic paper)

High-Reliability.org web site

Threat and Error Management - aviation and hospital safety

Failure is perhaps our most taboo subject (link to John Gall Systemantics)

Houston - we have another problem (on complexity and limits of one person's mind)

Institute of Medicine - Crossing the Quality Chasm and microsystems (small group teamwork)

Pathways to Peace - beautiful slides and reflections to music on the value of virtues

A User's Manual for the IOM's 'Quality Chasm' Report
Berwick
http://content.healthaffairs.org/cgi/reprint/21/3/80.pdf

Executive Summary for Health Care Leaders
Microsystems in Health Care
Robert Wood Johnson Foundation
Dartmouth

Microsystems in Health Care, part 2:
Creating a Rich Information Environment
Joint Commission Journal of Quality and Safety

IOM's "Executive summary

Entire IOM "Crossing the Quality Chasm" book (readable on-line)
http://www.nap.edu/catalog/10027.html#toc


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