tag:blogger.com,1999:blog-175259622012-01-25T13:07:24.128-05:00A forum where Public Health runs into hospital care, alternative medicine, systems thinking, religion, public policy, management, simulation, and education.Wadenoreply@blogger.comBlogger3211100tag:blogger.com,1999:blog-17525962.post-1164803352907153332006-11-29T07:26:00.000-05:002006-11-29T07:29:20.586-05:00

Emergent solutions are good, but some are way better than others. This post is an academic musing on why that is and what solutions it suggests to many organizational problems.See that poston my replacement weblog at http://newbricks.blogspot.com

Wadenoreply@blogger.com6tag:blogger.com,1999:blog-17525962.post-1164099405190237582006-11-21T03:53:00.000-05:002006-11-21T03:56:52.846-05:00

Due to technical difficulties with this site,after November 19, 2006 I am putting all new posts ontohttp://newbricks.blogspot.comCome visit!

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1163944823083567192006-11-19T08:38:00.000-05:002006-11-19T09:31:44.206-05:00

Across all scales of life, a pivotal feature is "unity with diversity."This problem is a recognized central problem in health care systems, for example, where there is a visible tendency for specialization to break the world up into "silos" of expertise and common world-views. The silo form is critical to establishing a small context within which a huge amount of information is shared and

Wadenoreply@blogger.com3tag:blogger.com,1999:blog-17525962.post-1163939276907403652006-11-19T06:50:00.000-05:002006-11-19T07:27:57.473-05:00

The Washington Post had this forum topic this week:THE QUESTION If some religious people believe they have a monopoly on truth, then are conversation and common ground possible? If so, what would be the difficulties and benefits of such a conversation? Posted by Sally Quinn and Jon Meacham on November 10, 2006 8:34 AM I posted this comment:

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1163772219907975182006-11-17T08:16:00.000-05:002006-11-17T09:30:00.050-05:00

The USA seems to be the world leader in both incidence and prevalence of major depression, and if anything, the rate is increasing.In an Op-ED piece in today's New York Times, "Our Great Depression", Andrew Solomon argues that "We need a network of depression centers, much like the cancer centers established in the 1970s." He says:DEPRESSION is the leading cause of disability worldwide,

Wadenoreply@blogger.com21tag:blogger.com,1999:blog-17525962.post-1163677919006017052006-11-16T06:47:00.000-05:002006-11-16T08:02:09.173-05:00

From today's Washington Post:Some Americans Lack Food, but USDA Won't Call Them HungryBy Elizabeth WilliamsonWashington Post Staff WriterThursday, November 16, 2006; A01The U.S. government has vowed that Americans will never be hungry again. But they may experience "very low food security."Every year, the Agriculture Department issues a report that measures Americans' access to food, and it has

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1163587117054942832006-11-15T04:02:00.000-05:002006-11-15T06:22:45.543-05:00

Speakers at the National Press Club presented new initiatives by the Center for Inquire-Transnational, according to an article in today's Washington Post. I'll summarize the article here and go on below to comment on the philosophy.Think Tank Will Promote ThinkingAdvocates Want Science, Not Faith, at Core of Public PolicyBy Marc KaufmanWashington Post Staff WriterWednesday, November 15, 2006;

Wadenoreply@blogger.com1tag:blogger.com,1999:blog-17525962.post-1163501606034769092006-11-14T05:45:00.000-05:002006-11-14T16:05:08.556-05:00

You have a lot more control over the people around you than you might think.All living systems must survive the regular death and rebirth of their components.This is true for cells, for people, for relationships between two people, for families, for workplace teams, for companies, for nations, and for cultures or religions. It's universal. It's also a tremendous opportunity for change, because it

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1163341646542674722006-11-12T09:08:00.000-05:002006-11-12T09:27:26.963-05:00

Today, November 12th, is the celebration of Baha'u'llah, the birth of the founder of the Baha'i Faith. Baha'u'llah was born in 1817 in Tehran in what was at the time called Persia.Here are links to the US and International Baha'i Community websites.Many of the tenets of the Baha'i Faith, such as equality of women, rejection of racism, and quest for peaceful relationships between different

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1163255870273803532006-11-11T09:18:00.000-05:002006-11-11T09:37:51.016-05:00

Mark McCormack, in What They Don't Teach You at Harvard Business School - Notes from A Street-smart Executive, provides a perfect example for the distinction I was making in my last post.There is the old tale of two friends who met on the street after not seeing each other for twenty-five years. ONe, who had graduated at the top of his class, was now working as an assistant branch manager of the

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1163249615685838662006-11-11T07:22:00.000-05:002006-11-11T07:53:36.443-05:00

Science, religion, and business may capture three different ways of knowing about life. They seem to correspond to the "near field", "far field", and "intermediate field" properties of a radiating antenna.What does that mean and how is it helpful? This isn't a math lesson but one example may be useful, so here it is:When physicists or engineers analyze electromagnetic waves radiating from an

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1162987245789834682006-11-08T07:00:00.000-05:002006-11-08T07:13:01.580-05:00

The nature of power is changing. Through most of our planet's formative history, it was possible to become ruler of the domain, exploit the masses and be home free -- aside from pesky rebellions outside and palace coups within. The rhetoric today, especially from the USA's Strategic Policy, seems to be based in that model - the goal is to be top warlord and run the world, and everything else

Wadenoreply@blogger.com2tag:blogger.com,1999:blog-17525962.post-1162908179490519562006-11-07T08:29:00.000-05:002006-11-07T09:03:24.216-05:00

"Houston, we have a problem!" The first picture here, of an Amish Barn Raising by a team of people, suggests a solution to the problem illustrated in the second picture, namely that our problems are now larger than our brains.(some of this previously posted on my other weblog)Amish Barn raising by "heyburn3" at http://community.webshots.com/photo/204253285/1219517433039037642uyqVaXThis graph

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1162695516505298392006-11-04T21:45:00.000-05:002006-11-06T15:17:08.523-05:00

Time for a survey?If there's no problem in a work culture, ask employees and they'll say "no problem." But if there is a problem, they'll still say "no problem," at least if asked face-to-face or in non-anonymous surveys.If anonymous surveys produce a different answer, then there is a problem.Many safety culture questionnaires exist now, in various states of validation. Here's a sampling of some

Wadenoreply@blogger.com1tag:blogger.com,1999:blog-17525962.post-1162693613206098472006-11-04T21:06:00.000-05:002006-11-04T21:26:54.753-05:00

It seems that in many businesses and government, people are unaware of how much power they have as leaders or managers to suppress dissent. There is a fine but crucial distinction between questioning a mental model and questioning authority, not always recognized. When staff can't question the facts without it being taken as a challeng to command authority, there are very bad results coming.The

Wadenoreply@blogger.com1tag:blogger.com,1999:blog-17525962.post-1160476449354965152006-10-10T06:27:00.000-04:002006-10-10T06:45:24.376-04:00

Gary Trudeau's Doonesbury portrays how distant e-presence has brought both home and the battlefield into each-other's context, with surreal results. One wonders what the emergent result is of tens of thousands of such events over time.Slate brught this to my attention atthrough the email sandbox at http://gocomics.typepad.com/the_sandbox/and http://www.doonesbury.com/strip/ray3.html

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1159992222060385742006-10-04T16:01:00.000-04:002006-10-04T16:03:42.846-04:00

If each step carries you further away,you will never arrive at home.

Wadenoreply@blogger.com1tag:blogger.com,1999:blog-17525962.post-1159989527077028442006-10-04T15:16:00.000-04:002006-10-04T15:19:07.406-04:00

On the importance of relationships in the successful outcomes any kind of planning, but especially in health behaviors...this might be a fair additional summary. The author would love to hear some debate.1) For a human to sustain peak performance, it is not enough to engage the brain; we have to engage the heart.2) We're very social animals, always watching each other for clues; to sustain a

Wadenoreply@blogger.com2tag:blogger.com,1999:blog-17525962.post-1159528826405021142006-09-29T06:22:00.000-04:002006-09-29T07:27:41.870-04:00

They constantly try to escapeFrom the darkness outside and withinBy dreaming of systems so perfect that no one will need to be good.But the man that is shall shadowThe man that pretends to be. T.S. Eliot, Choruses from The Rock There is, in Western society in general and in the USA in specific, a culture that almost worships high-technology. Multiple people have graced the cover of Newsweek

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1158836270625568672006-09-21T06:57:00.000-04:002006-09-25T16:07:41.286-04:00

I want to thank Professor Laura Morlock at Johns Hopkins for focusing my attention on the area of "microsystems."The Institute of Medicine lately has recommended that we focus quality and safety efforts on "Microsystems in Health Care". "Microsystem" refers to the next coherent organizational level above humans, typically a small team of under two dozen interdisciplinary people who work together

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1158666962316133302006-09-19T07:42:00.000-04:002006-09-19T07:56:03.136-04:00

Raining down, against the windI'm reaching out 'til we reach the circle's endWhen you come back to me againAnd again I see my yesterday's in front of meUnfolding like a mysteryYou're changing all that is and used to be.Garth Brooks"When you come back to me"from the movie Frequency(Dennis Quaid, fighting fires across 3 generations)Comment: one of the properties of closed feedback loops is that

Wadenoreply@blogger.com2tag:blogger.com,1999:blog-17525962.post-1158145492182940122006-09-13T07:04:00.000-04:002006-09-13T07:16:08.946-04:00

Maybe there are ways to add more people to a group and get better decisions, unboundedly. If so, we may underestimate the insights in religious scriptures.Our tacit assumptions about that question dominate science's view of "religion", and what insights collections of goat-herders could possibly have that could ever compare with what brilliant, modern, university-educated experts could

Wadenoreply@blogger.com1tag:blogger.com,1999:blog-17525962.post-1158028562939389592006-09-11T22:21:00.000-04:002006-09-11T22:48:46.583-04:00

Ken Birman at Cornell's Comp Sci Department is a founding member of TRUST - Team for Research in Ubiquitous Secure Technology. In his words:We need computers that can be trusted....We're poised to put air-traffic control, banking, military command-and-control, electronic medical records, and other vital systems into the hands of a profoundly insecure, untrustworthy platform cobbled together from

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1157974601538007582006-09-11T07:01:00.000-04:002006-09-11T07:36:42.186-04:00

What would driving be like if your speedometer showed your speed 45 seconds ago instead of your current speed? In many cases you might be "flooring it" to get up to the speed limit when you'd already passed the speed limit 30 seconds ago. In an car, you have other traffic to provide ground-truth and some reference. In a business dashboard, you don't have that ground-truth. Like the

Wadenoreply@blogger.com1tag:blogger.com,1999:blog-17525962.post-1157934564886278632006-09-10T19:14:00.000-04:002006-09-10T20:29:25.646-04:00

I just realized that rejuvenation is a universal attactor at every level of the loosely-coupled multi-level biosocial life form that humans are part of. Cells, organs, people, organizations, nations, cultures, and probably entire planets and beyond all have an interest in rejuvenation.This is interesting because it also suggests two other scale-invariant factors, or "points of constancy", in

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1157894521647079112006-09-10T09:15:00.000-04:002006-09-10T10:12:08.943-04:00

Review: In the introduction by Jeffrey A. Krames, Author of What the Best CEO's Know, he states The US Army Leadership Field Manual presents vital information that can help to shape leaders who inspire people, organize actions, develop strategy, and respond to uncertainty with speed and effectiveness."As a civilian and MBA, I was startled and pleasantly surprised by the new US Army Leadership

Wadenoreply@blogger.com2tag:blogger.com,1999:blog-17525962.post-1157623950969474352006-09-07T04:57:00.000-04:002006-09-07T06:12:31.493-04:00

How do we reconcile "survivor of the fittest" competitve models with needs for an end result that has a unified view of the patient chart? Issues include management of diversity versus homogeneity, and how to manage a "best of breed" herd of cats, that is, vendor systems that are close to incompatible, or silos of departmental expertise that are close to incompatible and spit when they get near

Wadenoreply@blogger.com4tag:blogger.com,1999:blog-17525962.post-1157592775651552902006-09-06T21:25:00.000-04:002006-09-06T21:32:55.853-04:00

Drug-Resistant TB in South Africa Draws Attention From U.N.By LAWRENCE K. ALTMAN, NY Times, Sept 6 2006WASHINGTON, Sept. 5 — The World Health Organization will hold an urgent meeting this week to seek ways to deal with deadly strains of tuberculosis that are virtually untreatable with standard drugs.The meeting, in Johannesburg on Thursday and Friday, comes in response to recent reports from a

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1157590920584635232006-09-06T21:01:00.000-04:002006-09-06T21:02:00.736-04:00

High reliabilty organizations don't get that way by having the subsystems compete - they get that way by getting rid of the "competition" piece, as being in the way of quality and innovation.Continuing looking at the Plsek article [1], if we really use a full multi-level model of the biosocial hierarchy, competetion is an illusion. Tuborg and Karlsberg beer, in Copenhagen, Denmark used to

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1157588789172378772006-09-06T20:26:00.000-04:002006-09-06T20:26:30.566-04:00

Paul Plsek asks "How do we make sure that we're working on things that are stategically important and that will help us in the competitive environment?" [ Plsek 2000 ] I think that the "competitive environment" term is misleading, because, like a helicopter's rotor blades, we are mostly flying in our own prop-wash. Plsek notes that the solutions of today tend to be become the problems of

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1157581395776156912006-09-06T18:22:00.000-04:002007-03-12T16:32:45.833-04:00

Is "six sigma" incompatible with systems thinking? At first glance, the idea of achieving almost perfection in standardizing a routine production process defines the opposite end of the spectrum from Complex Adaptive Systems, which are always adapting and never repeat the same state.In that sense "Six sigma is dead!" and all the engineering types should please retire so the new young Turks can

Wadenoreply@blogger.com4tag:blogger.com,1999:blog-17525962.post-1157558695682906012006-09-06T12:04:00.000-04:002006-09-06T12:05:58.830-04:00

One barrier to responsible managers in high-risk industries accepting systems thinking is the threat posed by a loss of control. Exactly how, they might ask, is "herding cats" going to work? Once you open the door to everyone doing their own thing, won't there be chaos?The key fact is that it is OK not to know everything, provided you know the key piece of information you need to make whatever

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1157509049338266742006-09-05T22:17:00.000-04:002006-09-05T22:17:29.486-04:00

Univ of Texas Threat and Error Management (TEM)-- Airlines now use TEM and there's some cross-over into hospital settings. BMJpaper, BMJ slideshow , aircraft pilot comments from KLEX discussion follow.From BMJError results from physiological and psychological limitations of humans.2 Causes of error include fatigue, workload, and fear as well as cognitive overload, poor interpersonal

Wadenoreply@blogger.com4tag:blogger.com,1999:blog-17525962.post-1157508970155348072006-09-05T22:06:00.000-04:002006-09-05T22:16:11.313-04:00

Univ of Texas Threat and Error Management (TEM)-- Airlines now use TEM and there's some cross-over into hospital settings. BMJpaper, BMJ slideshow , aircraft pilot comments from KLEX discussion follow.From BMJError results from physiological and psychological limitations of humans.2 Causes of error include fatigue, workload, and fear as well as cognitive overload, poor interpersonal

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1157459812943285072006-09-05T07:36:00.000-04:002006-09-05T08:36:53.703-04:00

Our bodies probably have no clue why we "go to work" some days: there's no food, no sex, no safe place to sleep or even comfortable place to stretch out, and no visible benefit. There's high stress so there must be predators nearby. There's no hunting or harvesting of food. It's just "body-boggling."Actually, having heard the sincere phrase more than once that "I'm staying home today so I can

Wadenoreply@blogger.com1tag:blogger.com,1999:blog-17525962.post-1157451429897029242006-09-05T05:56:00.000-04:002006-09-05T06:17:10.373-04:00

"At the very least it is hoped that this little book may serve as a warning to those who read it, thus helping to counter the headlong rush into Systemism that characterizes our age... SYSTEMISM n. 1. The state of mindless belief in Systems; the belief that Systems can be made to function to achieve desired goals. 2. The state of being immersed in Systems; the state of being a Systems-person."(

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1157328648778049782006-09-03T20:10:00.000-04:002006-09-03T20:10:48.876-04:00

This is a copy of my post to wikipedia's "talk page" regarding what should be posted on wikipedia regarding Comair Flight #5191.I'm a private pilot. I read many accident reports, and I'm also doing academic research on the nature of "human error" and system failures. There's a lot of solid literature on what can be done to prevent errors from happening again in complex systems (nuclear power

Wadenoreply@blogger.com1tag:blogger.com,1999:blog-17525962.post-1157328474917771472006-09-03T18:38:00.000-04:002006-09-03T20:07:55.333-04:00

This is a copy of my post to wikipedia's "talk page" regarding what should be posted on wikipedia regarding Comair Flight #5191.I'm a private pilot. I read many accident reports, and I'm also doing academic research on the nature of "human error" and system failures. There's a lot of solid literature on what can be done to prevent errors from happening again in complex systems (nuclear power

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1157280441335964822006-09-03T05:57:00.000-04:002006-09-03T07:01:30.410-04:00

Musing: The concepts "patient" and "problem" cut us off and blind us to important insights.First, the protoplasm blob with the medical record number sitting in our office is not "just one thing." That blob is, simultaneously, a patient, a caregiver, a father, a son, a husband, a team member, a voter, a community member, an employee of Ford, etc. While the health system may try to deal with,

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1157206021290817042006-09-02T10:00:00.000-04:002006-09-02T10:07:13.936-04:00

It is like we are all in this strange bus, trying to escape a valley that's flooding, but the bus has parts that stick out and keep getting stuck on trees so we can't move fast enough.But, don't worry, people are coming to cut off the wings, and then we'll be safe.

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1157138568691792472006-09-01T15:22:00.000-04:002006-09-01T15:22:54.690-04:00

Airline Pilot Warned Of Confusing Runway LayoutThis snippet from the FlightAware website:FlightAware has discovered that in 1993, the pilot of an air carrier filed a report with the NASA ASRS (aviation safety reporting system) after nearly departing from runway 26 when instructed to depart from runway 22 at Lexington.The report reads, "Aircraft was cleared for immediate takeoff (traffic was

Wadenoreply@blogger.com1tag:blogger.com,1999:blog-17525962.post-1157113694583155232006-09-01T08:27:00.000-04:002006-09-01T08:28:14.686-04:00

Federal funding should be provided for pilot programs in transforming Hospital IT departments from records-managers into complex adaptive system catalytic change agents.The inherent power in health systems is rate-limited by legacy conceptions, both within and outside system Information Technology departments, that the role of IT is handling accounting and bookkeeping, with some trend towards

Wadenoreply@blogger.com1tag:blogger.com,1999:blog-17525962.post-1157106026726241172006-09-01T04:56:00.000-04:002006-09-01T06:20:27.053-04:00

Why didn't Flight 5191 ask for help? In High-Reliability organizations people feel safe asking for help. Contrast that with "Guys never ask for directions, even if they're lost."So, these two extremes define an axis we can use, and we can try to place the crew of Comair Flight #5191, as they taxied out, on that axis. And, that may not be a "location" on the axis, it may be a "current

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1157058448002546952006-08-31T17:06:00.000-04:002006-08-31T17:08:10.656-04:00

The tragic crash of Comair Flight #5191 last sunday, with the loss of 49 lives and severe injury of the copilot, deserves at least the tribute of a deep study to learn how things can possibly go so wrong when even good, dedicated, highly-trained people are at the controls.Yesterday I listed some of the possible other, "system" type things that could have added to the mix. I read in the Kentucky

Wadenoreply@blogger.com1tag:blogger.com,1999:blog-17525962.post-1157038967700854572006-08-31T11:42:00.000-04:002006-08-31T11:42:55.803-04:00

T. S. Eliot describes mankind as vainly "dreaming of systems so perfect that no one will need to be good." (Choruses from'The Rock', 1934). Perhaps it's time to reverse that, and "dream of mankind so good that no one needs systems."Regardless, it seems increasingly clear to people that computer systems are sociotechnic in nature, the stuff of hybrid organizational beings. Trying to plan for

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1156938251881149022006-08-30T07:30:00.000-04:002006-08-30T10:58:59.036-04:00

Today's theme is how invisible global, distal culture can totally shape and dominate local, proximal "individual" behavior, in hospitals and aircraft cockpits.Like viruses, "systems" act like obligate parasites, and have to survive and operate through other organisms' actions and DNA. Individuals are actually embedded in a whole Russian-doll set of nested contexts, each one of which is

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1156851178375556822006-08-29T07:04:00.000-04:002006-08-29T07:32:58.913-04:00

Wow. I just found an astonishingly delightful, insightful, and immediately helpful paper on the roots of the conflicts between control-cultures and learning-cultures in the high-risk workplace: "Organizational Learning From Experience in High-Hazard Industries: Problem Investigation as Off-Line Reflective Practice", on the MIS Sloan School of Management Working paper site (Working paper #4359-

Wadenoreply@blogger.com2tag:blogger.com,1999:blog-17525962.post-1156674519451637762006-08-27T05:32:00.000-04:002006-08-27T06:28:39.923-04:00

There are military precedents for strategies where maximum local flexibility yields maximum global determination of the outcome. Let's call these "open-control systems" or OCS for short.The lesson is that there is, indeed, such a thing as "too much control". It's not obvious until you take into account how the system adapts to the expectations and what it behaves like, overall, when that

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1156611070484377702006-08-26T12:46:00.000-04:002006-11-06T15:14:29.866-05:00

It's a year since Katrina made it obvious that people watching CNN knew more about what was going on top government officials. We have to ask how that is even possible. It defies our intuition, although not our experience, which is interesting.While the "blame-game" remains in high-gear, Systems Thinking leads us to discount the obvious "bad people" and look for deeper root-causes in the social

Wadenoreply@blogger.com5tag:blogger.com,1999:blog-17525962.post-1156423198738159312006-08-24T08:37:00.000-04:002006-08-24T09:17:17.523-04:00

Houston - We have a problem! Complexity and Collaboration.I have a post I really like on this subject on my other blog.Wade

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1156416647162053042006-08-24T06:50:00.000-04:002006-08-24T06:50:47.223-04:00

Why are the Big Three auto companies going broke, and if their high-tech Detroit area assembly-line operation is our model for health care, is that our destiny as well?Consider this recent news.New York TimesAugust 19, 2006Ford Is Slashing Production 20% for 4th QuarterBy MICHELINE MAYNARDDEARBORN, Mich., Aug. 18 — The Ford Motor Company, which is struggling to keep its grip on second place in

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1156416501311411712006-08-24T06:38:00.000-04:002006-08-24T06:48:21.696-04:00

Why are the Big Three auto companies going broke, and if their high-tech Detroit area assembly-line operation is our model for health care, is that our destiny as well? Consider this recent news.New York TimesAugust 19, 2006Ford Is Slashing Production 20% for 4th QuarterBy MICHELINE MAYNARDDEARBORN, Mich., Aug. 18 — The Ford Motor Company, which is struggling to keep its grip on second place in

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1156254783499257422006-08-22T09:45:00.000-04:002006-08-22T09:53:05.506-04:00

According to Cornell University, "The Bill & Melinda Gates Foundation has awarded $25 million to Cornell to support the construction of the signature building for a planned information campus that will bring together the several units of the university's Faculty of Computing and Information Science (CIS). "Jan. 25, 2006 , Cornell Chronicle online.Cornell gets $25 million grant to build William H

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1156252212703285362006-08-22T09:09:00.000-04:002006-08-22T09:10:20.340-04:00

Just testing. Tuesday 9 AM.

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1156161701328955362006-08-21T07:50:00.000-04:002006-08-21T08:01:42.030-04:00

Some stray thoughts on patient hand-offs at the end of a shift, from one clinician to another,and what documentation "works" best.=====================Hypothesis:There may be a different solution for open-ended signouts and a closed-loop signout process, at least for humans.It's one thing, behaviorally, psychologically, for me to figure out how to pass on the rental car I'm driving to the next

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1155638346809656122006-08-15T06:22:00.000-04:002006-08-15T06:46:46.126-04:00

Review:Selling Systems Dynamics to (Other) Social ScientistsNelson P. RepenningSystem Dynamics Review, Volume 19, Issue 4 (winter 2003) p 303-327 Published on-line by Wiley InterScienceAccessed August 15, 2006 (subscription required) athttp://www3.interscience.wiley.com/cgi-bin/fulltext/107060997/PDFSTARTemail: Nelson P.

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1155555723982367382006-08-14T07:41:00.000-04:002006-08-14T07:42:04.250-04:00

I'm starting a list of the novel, basic pedagogical concepts that an educational program in Systems Dynamics would hope to convey, along withinformation on how to assess that operationally, what simulation examples embody or employ this,who has had what success or failures teaching that, andcites to prior work. A spreadsheet format would be best and I'm setting up an FTP site so we can store

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1155508166912039742006-08-13T18:25:00.000-04:002006-08-13T18:29:27.010-04:00

The Cornell System Dynamics "vision and barriers" document lists this seminar:System Dynamics Modeling as a Basis for Understanding Fishery Management ComplexitiesDr. Richard DudleyDept. of Natural Resources, Cornell University1:30 PM - 2:30 PM Friday, April 18, 2003401 Warren HallHere's his homepage:http://www.people.cornell.edu/pages/rgd6/

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1155507882333358572006-08-13T18:21:00.000-04:002006-08-13T18:24:42.403-04:00

Cornell's SD site, in "Other Resources", at the bottom line, lists this:The main concept behind system dynamics is feedback thinking. To explore the history of feedback thinking, see: Richardson, George P. (1991, 1999) Feedback Thought in Social Science and Systems Theory. Now available from Pegasus Communications (Click on the System Dynamics link in the “Browse Products by Subject box on the

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1155506254757673142006-08-13T17:55:00.000-04:002006-08-13T17:57:35.103-04:00

Cornell University's status report on a new initiative (2002-3)to start a campuswide Systems Dynamics course, in conjunction with WPI.Describes actions taken to get this rolling.

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1155423209700004792006-08-12T18:49:00.000-04:002006-08-12T19:00:24.873-04:00

Title: NHS Leading edge paper on system dynamics [ NHS is National Health Service Confederation, in London, UK ]Eric Wolstenholme posted this to the Systems Dynamics listserverand suggested sharing it with others, so here is what he posted:I thought colleagues on the SD list would be interested in a development that might help to raise the profile of system dynamics work in health and social

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1155421430447573782006-08-12T18:13:00.000-04:002006-08-12T18:23:51.023-04:00

The Systems Dynamics Society web-pages on "Other Resources" have a link to the K-12 education SD community, and to the newsletter "The Creative Learning Exchange".Volume 15 number 2 (Spring, 2006) issue of that has an article by Gary B. Hirsch, Consultant and Creator of Learning Environments, Wayland MA, USA, titled "Packaged Simulators and Simulation-Based Learning Environments: An

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1155402708507477722006-08-12T12:41:00.000-04:002006-08-12T14:59:55.610-04:00

ASPH Education Committee Master's Degree in Public HealthCore Competency Development ProjectVersion 2.1 (June 2006) Systems Thinking List -pdf page #25 (shown below)Systems Thinking membership: pdf page # 40http://www.asph.org/UserFiles/FinalVersion2.1.pdf Systems Thinking The ability to recognize system level properties that result from dynamic interactions among human and social systems and

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1155400819197672472006-08-12T12:13:00.000-04:002006-08-12T12:40:19.950-04:00

The first major lesson that Peter Senge teaches in his classic The Fifth Discipline is that, in complex systems, failures can occur due to the overall system structure, even if every component is "working properly." Senge uses an example of a supply chain for "Lover's Beer" to illustrate this.In the human role-playing simulation of this at MIT, each person does a sincere job of managing their

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1155399183395133152006-08-12T11:59:00.000-04:002006-08-12T12:13:03.643-04:00

One of Gall's Law - paraphrased:When a complex system fails, it is probably due to the piece someone just added to make the system safer.In the 30 years since that book came out, I've found that law to be true at least once a month in my own IT systems-maintenance work. I think I've bought 30 copies and passed them out to friends over the years.Many other laws are quoted or linked on wikipedia's

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1155397814773622362006-08-12T11:44:00.000-04:002006-08-12T11:56:51.100-04:00

Sterman quotes Lewis Thomas in Lives of a Cell, 1974 (p90):When you are confronted by any complex social system, such as an urban center or a hamster, with things about it that you're dissatisfied with and anxious to fix, you cannot just step in and set about fixing with much hope of helping. This realization is one of the sore discouragements of our century. You cannot meddle with one part of a

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1155391109726137852006-08-12T09:53:00.000-04:002006-08-12T09:58:29.786-04:00

I'm changing the direction of this blog to focus on Systems Thinking in Public Health.In particular, the focus will be on how systems thinking is used, or not used, in public health, and how to educate, train, cross-link, and support those who want to use it in the most efficient fashion.This is an "overflow" site for discussions or postings that don't really fit into the Systems Dynamics Society

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1139225803528514622006-02-06T06:36:00.000-05:002006-02-06T06:36:44.326-05:00

States and Cities Lag in Bird Flu Readiness February 6, 2006New York TimesBy DONALD G. McNEIL Jr.High-points:WASHINGTON, Feb. 2 — The nation's 5,000 state and local health departments are rushing to plan for an epidemic of avian flu, but they say they are hobbled by a lack of money and guidance from the federal government. "It's a depressing situation," said Jeffrey Levi, a flu expert at

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1138702771684044732006-01-31T05:19:00.000-05:002006-01-31T05:19:31.703-05:00

A New Kind of Care in a New Era of Casualties - New York TimesBy ERIK ECKHOLM ...The doctors sort through a calculus of competing interests. Should they prescribe a blood thinner to dissolve the dangerous clots, even though that could cause more bleeding in the brain? Or should they just wait? ... Thousands of miles from the battlefield, intricate medical choices have become routine here,

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1138625265766525182006-01-30T07:47:00.000-05:002006-01-30T07:47:49.740-05:00

When It Comes to Blogs, There Aren't Enough WordsWhen It Comes to Blogs, There Aren't Enough WordsBy Leslie WalkerSunday, January 29, 2006; F07Okay, Web fans, it's time for new lingo to help us get a grip on the vast self-publishing landscape known as the blogosphere. Blogs vary so much that they cry out for pithy names to describe each of their many genres.Stop by the Web site of the 2006

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1138622189626077292006-01-30T06:56:00.000-05:002006-01-30T07:08:27.616-05:00

Microsoft Would Put Poor Online by Cellphone - New York TimesJanuary 30, 2006 By JOHN MARKOFF DAVOS, Switzerland, Jan. 29 — It sounds like a project that just about any technology-minded executive could get behind: distributing durable, cheap laptop computers in the developing world to help education. But in the year since Nicholas Negroponte, the founder of the Massachusetts Institute of

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1137581098027006252006-01-18T05:44:00.000-05:002006-01-18T05:44:58.103-05:00

HHS Works to Fix Drug Plan WoesEven as federal leaders touted the enrollment figures, state officials and health care experts continued to report widespread difficulties, especially for the poorest and sickest seniors who were forced to switch from state Medicaid programs to the new Medicare plans on Jan. 1. Nearly two dozen states have intervened, saying they will pay for medications for any

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1137580144158661842006-01-18T05:29:00.000-05:002006-01-18T05:29:04.163-05:00

Rolls Growing for Drug Plan as Problems Continue - New York TimesBy ROBERT PEAR WASHINGTON, Jan. 17 - The Bush administration said Tuesday that more than 2.6 million people had voluntarily signed up for Medicare's prescription drug benefit in the last 30 days, pushing the total voluntary enrollment to 3.6 million. Michael O. Leavitt, the secretary of health and human services, cautioned

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1137509484861987172006-01-17T09:39:00.000-05:002006-01-17T09:51:24.916-05:00

Teen's Bold Blogs Alarm Area SchoolsUninhibited Online Remarks Full of Risks, Officials Warn"after she gave a talk recently at the Lab School in the District, students raced to their computers to delete information." By Tara Bahrampour and Lori ArataniWashington Post Staff WritersTuesday, January 17, 2006; A01 No one under 18 would be surprised to hear that teenagers like to post their

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1137406024152766352006-01-16T05:07:00.000-05:002006-01-16T05:07:04.273-05:00

President Tells Insurers to Aid Ailing Medicare Drug Plan - New York TimesNew York Times (nytimes.com)January 16, 2006By Robert Pear With tens of thousands of people unable to get medicines promised by Medicare, the Bush administration has told insurers that they must provide a 30-day supply of any drug that a beneficiary was previously taking, and it said that poor people must not be charged

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1137319413897794542006-01-15T05:03:00.000-05:002006-01-15T05:17:27.153-05:00

Season's flu resistant to 2 standard drugsLawrence AltmanNew York Times (Jan 15,2006)WASHINGTON, Jan. 14 - Doctors should stop prescribing two standard antiviral drugs to treat or prevent this season's influenza because the predominant strain has quickly become resistant to them, federal health officials said Saturday. The standard drugs are amantadine and rimantadine.Instead, the Centers

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1137231641349431222006-01-14T04:40:00.000-05:002006-01-14T04:40:41.473-05:00

The States Step In As Medicare FaltersBy Ceci ConnollyWashington Post Staff WriterSaturday, January 14, 2006; A01Two weeks into the new Medicare prescription drug program, many of the nation's sickest and poorest elderly and disabled people are being turned away or overcharged at pharmacies, prompting more than a dozen states to declare health emergencies and pay for their life-saving

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1136638079827867382006-01-07T07:06:00.000-05:002006-01-07T08:04:58.806-05:00

In my earlier post "Black, White, and Dead" I discuss potential changes in the way news organizations report the news, and news-reader software.The question came up as to how this relates to public health, and the answer is important, so I'm making a whole new post on that.Recently my wife Cheryll and I attended the Knight-Wallace Fellows Ninth Annual Conference on Journalism, focusing on

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1135985339799914902005-12-30T18:28:00.000-05:002006-01-10T06:06:59.840-05:00

Anders Wijkman International Herald Tribune FRIDAY, DECEMBER 30, 2005 STOCKHOLM On the first anniversary of the tsunami in South Asia, the news media propounded the conventional wisdom that we are powerless in the face of natural disasters, especially in the developing world. But seeing Nature or God as the culprit masks the reality that there is much we can do to minimize

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1135969416563006472005-12-30T13:41:00.000-05:002005-12-30T14:03:36.593-05:00

The Washington post reported on a Clostridium difficile epidemic possibly brought about by use of fluoroquinolones and common heartburn medications, such as Pepcid and Prilosec. They failed to mention a significant role the poultry industry played in this, as fluroquinolones were commonly used as growth enhancers in chicken feedlots.Heres a brief quote from Science Daily, followed by some

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1135851468066409562005-12-29T05:05:00.000-05:002005-12-29T05:29:32.260-05:00

The Pew Internet in America Project just released yesterday (12/27) areport on Gender and Internet Use.http://www.pewinternet.org/Click here for the full Pew report PDFWashington Post coverage excerpts:By Yuki NoguchiWashington Post Staff WriterThursday, December 29, 2005; Page D01Traditionally, women have lagged behind men in adoption of Internet technologies, but a study released yesterday by

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1135720377816146752005-12-27T16:48:00.000-05:002005-12-27T16:52:57.843-05:00

Week 50 (week ending Dec 17, 2005)."California" strain of influenza starts heading eastward, with the Gadsen Purchase route (the southern way around the Rocky Mountains) appearing to be the preferred driving route.(This strain is in the current flu vaccine, but many children didn't get that, or didn't get a necessary 2 doses).(From www.CDC.gov)

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1135596835093296392005-12-26T06:33:00.000-05:002005-12-26T06:41:46.586-05:00

December 26, 2005New York Times onlineHuge Rise Looms for Health Care in City's BudgetBy MARY WILLIAMS WALSHand MILT FREUDENHEIM..the cost of pensions may look paltry next to that of another benefit soon to hit New York and most other states and cities: the health care promised to retired teachers, judges, firefighters, bus drivers and other former employees, which must be figured under a new

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1135254655160584812005-12-22T07:30:00.000-05:002006-01-10T11:55:27.700-05:00

December 22, 2005Diabetes Study Verifies Lifesaving TacticBy GINA KOLATAA 17-year federal study has finally answered one of the most pressing questions about diabetes: Can tight control of blood sugar prevent heart attacks and strokes?The answer, reported today in The New England Journal of Medicine, is yes. Intense control can reduce the risk by nearly half.And, the study found, the effect

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1134702050989452922005-12-15T22:00:00.000-05:002005-12-15T22:02:36.973-05:00

According to this site, here's something that might help withmy project to use web 2.0 tools to facilitate chronic patientcoordiation with friends, family, and clinicians:"Structured Blogging - untangling the webStructured Blogging is a way to get more information on the web in a way that's more usable. You can enter information in this form and it'll get published on your blog like a normal

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1134391613467760702005-12-12T07:46:00.000-05:002006-01-10T12:02:08.780-05:00

Can We Stop the Next Killer Flu?By Joel AchenbachSunday, December 11, 2005; Page W10Scientists like Jeffery Taubenberger aren't just going to sit there waiting for a pandemic. They're gearing up for the war between bugs and humansJEFFERY TAUBENBERGER, VIRUS HUNTER, goes to work in a bland building overlooking I-270 in Rockville. It's the Armed Forces Institute of Pathology, and it is scheduled to

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1134309507825794272005-12-11T08:58:00.000-05:002005-12-15T14:20:18.723-05:00

False Positives From H.I.V. Test - New York Timeshttp://www.nytimes.com/2005/12/10/health/10aids.htmlFalse Positives From H.I.V. TestBy DENISE GRADYPublished: December 10, 2005Health officials in New York and San Francisco said yesterday that a widely used rapid test for the virus that causes AIDS had been producing too many false-positive results, frightening healthy people into thinking they

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1134259323919848542005-12-10T19:02:00.000-05:002005-12-10T19:02:04.016-05:00

A Record Amazon Drought, and Fear of Wider Ills By LARRY ROHTER Published: December 11, 2005 MANAQUIRI, Brazil - The Amazon River basin, the world's largest rain forest, is grappling with a devastating drought that in some areas is the worst since record keeping began a century ago. It has evaporated whole lagoons and kindled forest fires, killed off fish and crops, stranded boats and the

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1134213264101391862005-12-10T06:14:00.000-05:002005-12-10T06:22:22.473-05:00

Crisis Communications Remain Flawed(excerpts follow):Crisis Communications Remain FlawedDespite Promises to Fix Systems, First Responders Were Still Isolated After KatrinaBy Joby WarrickWashington Post Staff WriterSaturday, December 10, 2005; Page A06The chaos that followed Hurricane Katrina, vividly recounted in thousands of pages of documents recently released by Louisiana officials, had an

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1134162004136894412005-12-09T16:00:00.000-05:002005-12-09T16:03:50.543-05:00

eConnect - August 2005eConnect Code: PILOT 0805 Medical groups launch home healthcare IT projectWASHINGTON — The Centers for Medicare and Medicaid Services plans to demonstrate how doctors can use home health monitoring technology to help Medicare patients with chronic illness. The three-year CMS project, slated to begin in January 2006, will employ Health Hero Network’s Health Buddy system to

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1134127998930247222005-12-09T06:33:00.000-05:002005-12-09T06:33:18.930-05:00

Center for Innovation in Health Information Systems: Staff Our Approach >>>The Center for Innovation in Health Information Systems is committed to improving the health and well-being of individuals and communities, especially children, through strategic application and management of health information and its underlying systems and technologies. Established in 2000, The Center for Innovation

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1134127776069340952005-12-09T06:12:00.000-05:002005-12-09T06:29:36.093-05:00

Initiative to increase global health researchBy Kevin BergquistThe University launched a new project Nov. 29 aimed at preparing the next generation of health scientists and professionals to address critical research needs in global health. Funded by the Fogarty International Center of the National Institutes of Health, the Michigan Global Health Research and Training Initiative will engage

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1133951611939045652005-12-07T05:33:00.000-05:002005-12-09T16:11:13.803-05:00

Ecological implications (see full article):* disease and epigentic transmission both will be at a much higher rate, new crowding and mixing bowls.* village habits and constraints evolved over 100 years to control disease are lost, urban ones not yet learned.* people in transition are more vulnerable / susceptible (?)* "I've got mine Jack, screw you!" versus village common ties changes the

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1133865913926826912005-12-06T05:45:00.000-05:002005-12-10T05:49:29.390-05:00

U.S. Is Given Failing Grades By 9/11 PanelU.S. Is Given Failing Grades By 9/11 PanelBipartisan Group Faults Counterterrorism ProgressBy Dan EggenWashington Post Staff WriterTuesday, December 6, 2005; A01The federal government received failing and mediocre grades yesterday from the former Sept. 11 commission, whose members said in a final report that the Bush administration and Congress have

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1133864714882469502005-12-06T05:25:00.000-05:002005-12-06T05:28:54.773-05:00

The New York Times continues its coverage of India with a great in-depth look at the growing problem of AIDS, and how the new, improved economy and road system is also spreading AIDS, abetted by a culture of ignorance, the desperation of poverty, class distinctions, denial, and the corresponding rise in tuberculosis.December 6, 2005India AcceleratingOn India's Roads, Cargo and a Deadly

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1133596629477449012005-12-03T02:57:00.000-05:002005-12-03T03:22:10.783-05:00

Deadly Hospital Germ Is Spreading in U.S.Deadly Hospital Germ Is Spreading in U.S.By Rob SteinWashington Post Staff WriterFriday, December 2, 2005; Page A08A new, more dangerous strain of a germ that has long caused diarrhea in hospital patients is now widespread in the United States, causing severe, sometimes deadly outbreaks around the country, researchers reported yesterday.Strains of the germ

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1133562960176072252005-12-02T17:36:00.000-05:002005-12-02T17:42:16.473-05:00

Note- see my previous post from Nov 6th on the variouscountries that people are going to for medical treatmentfrom the US:http://cscwteam.blogspot.com/2005/11/outsourcing-health-care-work-and.html===========================================================This from today's IHT: (http://www.iht.com)Controversy in India over medical tourism - Print Version - International Herald TribuneInternational

Wadenoreply@blogger.com2tag:blogger.com,1999:blog-17525962.post-1133176209564985312005-11-28T06:10:00.000-05:002005-11-28T06:54:30.750-05:00

A WHO description of the Strategic Health Operations Center is here.The SHOC was a key communication centre during the emergency response to the recent Tsunami disaster. Thanks to the excellent collaboration of our Public Health Mapping & GIS focal points at SEARO, we were able to provide up-to-date and dynamic mapping of the health situation in affected areas. A full story on this collaboration

Wadenoreply@blogger.com1tag:blogger.com,1999:blog-17525962.post-1133125049755510022005-11-27T15:57:00.000-05:002005-11-27T16:02:38.690-05:00

The eHealth Initiative: (from http://www.ehealthinitiative.org/ )Welcome to the eHealth Initiative's home page. Below are links to details on important announcements. The eHealth Initiative and Foundation has expanded upon a growing set of resources and tools designed to support states, regions and communities across the nation who are engaged in health information exchange. New tools available

Wadenoreply@blogger.com0tag:blogger.com,1999:blog-17525962.post-1133105776192695182005-11-27T10:36:00.000-05:002005-11-27T10:42:42.123-05:00

Robert Wood Johnson Foundation's Health Information ExchangeResource Organization list:This is a list compiled by the Public Health Information Institute.Health Information Exchange - Resource Organizations AHRQ National Resource Center for Health Information TechnologyProvides technical assistance to AHRQ health IT projects and shares new knowledge and findings that have the potential to

Wadenoreply@blogger.com0