Systems Are Everywhere

Dear Friends,

What is a system?

Making systems visible: As I mentioned earlier, I had to completely re-learn my concept of what a system or a process is. I always thought of a system as something that was “out there” that I had to access in order to take care of my patients – the computer system, the blood bank, pharmacy, blood bank, the paging system. These are indeed all systems and what I slowly started to appreciate was that systems and processes vary in size and shape and that most importantly I was intimately involved in numerous systems myself. A system or process is a way that we do things in a repetitive manner to accomplish tasks at hand. Whether large or small, what’s amazing is how invisible they become once they are in place. Here’s an example: Every one of us has a specific way that we start our work day, every day, but how many of us recognize this and actually think about what we’re doing? How many times do you hit the snooze button before getting up? What’s the first thing you do when you get into the bathroom? You brush your teeth the same way every morning without thinking about it and if you want to challenge this idea, try brushing with your opposite hand or start the brushing at a different tooth location.

Formal vs. Informal systems: Another fundamental system concept that I had to acquaint myself with is the difference between formal and informal systems. The formal system is how the process is supposed to work; the informal system is how the process really works. The formal system is the one in the written manual, instructions and guidelines; the informal system is the one based on what actually works. It’s very rare that a formal and an informal system are the same. How many of us brush our teeth according to the instructions on the toothbrush box and on the tube of toothpaste, or the way the dentist tells us to? What’s important to note as well is that while the formal process is documented, the informal process usually isn’t – it gets passed on and modified by word of mouth. Two things happen to informal systems or processes as a result: each individual modifies them and they become invisible!

Why are these things important? What I realized is that just about everything I do has some sort of an informal process associated with it that has become invisible; in fact, I can run most of my daily routine on autopilot! This is all well and good if things are working well, but what if they aren’t? If I can no longer see the process because it’s become routine, how am I going to make an improvement that sticks? Chances are I’ll go back to the formal process and focus on making the changes there because it’s documented! But this isn’t going to do a great deal of good is it because the formal system isn’t the underlying process that’s driving the activity – it’s the informal process! The first order of business is to recognize that there is an informal process running the show and that is needs to be made visible in its entirety or nothing will change!

I can imagine what you’re thinking. “What does this have to do with improving healthcare?” We need to start seeing systems and processes in our non-work environment to appreciate the intimate pervasiveness that they have on our daily lives. When we recognize that we perform most of our daily routines on autopilot (invisibly) then we can start to look at what we do on a daily basis at work. So here’s your homework: look at a particular aspect of your daily home routine and write down how you do it – it’ll open your eyes!
Next time we will start looking at healthcare.

With love and respect,
Rick