In a popular report on health care system reform, Sholom Glouberman and Brenda Zimmerman describe the difference between simple, complicated, and complex systems by highlighting the following distinctions:
In simple problems like cooking by following a recipe, the recipe is essential. It is often tested to assure easy replication without the need for any particular expertise. Recipes produce standardized products and the best recipes give good results every time. Complicated problems, like sending a rocket to the moon, are different. Formulae or recipes are critical and necessary to resolve them but are often not sufficient. High levels of expertise in a variety of fields are necessary for success. Sending one rocket increases assurance that the next mission will be a success. In some critical ways, rockets are similar to each other and because of this there can be a relatively high degree of certainty of outcome. Raising a child, on the other hand, is a complex problem. Here, formulae have a much more limited application. Raising one child provides experience but no assurance of success with the next. Although expertise can contribute to the process in valuable ways, it provides neither necessary nor sufficient conditions to assure success. To some extent this is because every child is unique and must be understood as an individual. As a result there is always some uncertainty of the outcome. The complexity of the process and the lack of certainty do not lead us to the conclusion that it is impossible to raise a child.1
On one end of the continuum, following a recipe is a linear process: add the right ingredients, in exactly the right amounts, cooked in precise conditions, and you can be confident that the baked goods will turn out as intended. On the other end of the continuum, raising a child is an entirely nonlinear process: there is no parenting ‘style’ or practice that guarantees any results, and there is no way to predict for the events, opportunities, and tragedies that will come along. Formulae have limited applicability and expertise alone is not a sufficient ingredient for success. Children are complex because every relationship is unique, which means the dynamic of every relationship defies stringent rules and specification.
Glouberman and Zimmerman go on to argue that health care systems are complex. They are composed of human beings and they interact with human beings. Providing effective health care is therefore more like raising a child it is like baking cookies or sending a rocket into orbit.
The problem is that we want to intervene in health care systems as they are complicated systems, like rockets, not complex things, like parenting. If only we could align the right budgets, hire the right executives, develop the perfect strategy, then we would have the most ‘successful’ healthcare, or so we think.
Glouberman, Sholom & Zimmerman, Brenda. (2002). Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like? (Discussion Paper No. 8) Commission on the Future of Health Care in Canada. July 2002. p. vi ↩