Health care systems are like any other business or corporation in terms of how they function as a whole. There are going to be moments of peace, moments of discord, and some moments of utter chaos. This all is dependent upon the environment in which the health care provider works in. A wonderful tool that can help find a solution suitable for many different environments is the Cynefin Framework, developed by Snowden.
The idea of Cynefin Framework peaked my interest when considering problems within a work environment in health care. Many situations are unique and develop protocols towards a solution, but when looking at the same problem/situation with the Cynefin Framework lens first, an administrator can come to a solution uniquely tailored for that event. The framework is described as a sense-making device, and is used to help managers/administrators identify perceived situations that help to make sense of their own and other people’s behaviors.
Cynefin Framework encompasses five “domains” — Obvious, Complicated, Complex, Chaotic, and Disorder. The Cynefin Framework Domains:
Obvious or Simple (the Known) — This domain can be seen as “standard operating procedures” or practices that have proven to work. It is easier to see this as if X happens then expect Y as the outcome. Obvious is centered in the realm of reason and in such situations one should “sense-categorize-respond,” (best practice).
Complicated (the knowable) — As the name says this is a bit more complicated and the domain is “known unknowns”. This requires analysis or expertise on the cause and effect to which there could be multiple right answers. Complicated situations should be approached with “sense-analyze-respond.” In this domain one can work rationally towards a decision but also have refined expertise and judgment along the way.
Complex (unknown of the unknowns) — The administrator can conduct experiments that are safe to fail. Hard cases that involve human underwriters or sensitive detailed work is also known as “probe-sense-respond.” Many times everything is spread out to give multiple perspective view points and the actions taken strictly change the situation in unpredictable ways.
Chaotic (incoherent) — The causes and effects of a situation in this domain are unclear and this is why action is the first instinct. Drawing action to bring the chaos into complex allows for an appropriate start to the situation. “Act-sense-respond” gives the ground work to focus order out of chaos, and then find the stability, and then respond in a way that can change the chaotic into the complex.
Disorder (not determined) — There is no clarity within this domain and is hard to see when it should be applied. Anything that falls into this order could be broken down into smaller segments and then categorized into the other four domains. This will allow the administrator to intervene at times that are appropriate.
As we can see from the diagram the obvious and chaotic sections seem to form a wall, or separation, that is not quite as smooth as the rest. This is do to the autopilot that “obvious” can generate, and when things seem to be always obvious or simple systems are used quite frequently they can all of the sudden become “not so simple” systems. Management may find themselves deep in a hole, which is falling off the cliff into chaos, and must realign things into order to find the problem and solution.
My interest was with the chaotic domain and how this domain can be seen within many health care practices. Behind the scenes there is an obvious system in place that flows very well for sometime, but more often than I would like to admit, I have seen this fall over the cliff into chaos. The health care provider is dealing with a situation they do not know how to go about solving and also trying to keep things running. If the administration of the health care provider would put action into place and then sense the stability; they could then find a response appropriate to the situation. Many times the leader sits on their hands and waits for something to come along instead of making the solution come about. This Harvard Business Review article has a great section in regards to chaotic domains and leaders.
“In the chaotic domain, a leader’s immediate job is not to discover patterns but to stanch the bleeding. A leader must first “act” to establish order, then sense where stability is present and from where it is absent, and then respond by working to transform the situation from chaos to complexity, where the identification of emerging patterns can both help prevent future crises and discern new opportunities. Communication of the most direct top-down or broadcast kind is imperative; there’s simply no time to ask for input.”
Within an interview I conducted with a floor manager of a hospital, it was evident that some form of the Cynefin Framework was in use before Kurtz and Snowden formed it. The gentleman, whose name is omitted, stated that there were problem/solution training courses he had referred to, but that was all. Protocols were used in situations of distress or confusion. Many events that took place needing his attention for problem solving seemed to fall with in an “obvious or complicated” domain, for which he had experience with and used previous encounters to solve those issues. Mind you, this was just one floor of a hospital that he managed and many times other floors or sections would have their own way of dealing with problems or issues. If the whole health care system within the hospital were to incorporate Cynefin Framework into the culture I believe many problems would vanish or become rare instances that could be easily handled.
I ask anyone to put this Framework into practice, with business, work, or even personal life. This system can help in many areas of life, but I believe it can make waves within the health care industry. The health care industry is always moving and adapting and the Cynefin Framework is able to account for those changes.