Operations Logic And Health Care

Written by Roger Erickson

Thirty-seven years ago Wendell Perry wrote a chapter* in his book of that year titled “Solving for Pattern“. It was (and is) a very timely confirmation of what we’ve been working on for years. Everything this author said – back in 1981 – mirrors our current application of basic Operations Logic to other national and cultural policies.

Perry quickly defines the known challenge, “accounting for all effects of local changes on a given system” and known answer: No progress “until health is set down as the aim.”

{Not surprisingly, that’s nearly the same wording as many others, myself included, have independently arrived at, both previously (Walter Shewhart, W.E. Deming) and since. Our current example at the Interbiome Foundation asks whether we want HEALTH, or HEALTH-REPAIR.}

All the things he says after that are specific examples of local vs global optimizations.

To solve a whole problem, the entirety of the problem must be recognized. In Shewhart’s jargon from 1926, process tuning is not definable without perceiving full context.

That’s known as the challenge of experimental “control” in the scientific method, which requires adequate description of the difference between before/after “states” of a system. An experiment cannot be controlled without adequate instrumentation. Similarly, without adequate social-instrumentation, cultural experiments aren’t useful to an aggregate.

process tuning is not definable without perceiving full context

And without full system feedback & accounting – i.e., adequate instrumentation – operators of growing systems can’t distinguish changes that tune vs de-tune (degrade) a system.

Every statistician will verify that winging it without getting full system feedback is a losing strategy. The 2nd Law of Thermodynamics acknowledges the inevitability of disorder without a way to select improbable states (more order) vs probable states (more disorder). The deck is always stacked against us, so we have to be more, not less, selective every year. Further growth – in any way, shape or form – of a system requires increasingly selective tuning. Without full feedback about all effects of a given change, the likelihood of a net increase in disorder is always well above 50%.

So why is it that all human cultures aren’t even more selective? The most probable answer is that no species has been a threat to us …. except ourselves. We’re only as adaptive as we’ve had to be, but we’re going to have to do a lot better going forward, or most of existing human cultures aren’t going to stay with us for very long.

We’re only as adaptive as we’ve had to be

It’s extremely curious that human cultures manage to evolve at all, since we don’t explicitly teach the differences between:

• making changes,
• driving concentrated revenue from changes, and
• managing aggregate outcomes (tuning/de-tuning or benefits/costs) from changes.

It seems that human cultural tuning occurs so gradually that adaptive changes are established only by chance, as the aggregate that accidentally chooses those new cultural practices happens to out-do competing cultures. Surviving aggregates never know what features they “selected” – through random recombination – until after the fact. Humans run so many uncontrolled experiments on themselves that the survivors are the best definition of results.

Over 50,000 years of human culture, and the conscious behavior of individuals is still largely “self” first and “team” second, despite explicit acknowledgement of the higher adaptive power of “social” species? When it comes to selecting for more order vs disorder in our national culture, it looks like we rely primarily upon brute force trial & error.

conscious behavior of individuals is still largely “self” first and “team” second

At present, we still allow an overwhelming number of random changes in a complex system, and check, only long after the fact, which ones helped vs hurt? Any one who’s worked on tuning any model system whatsoever, from sports/dance/music teams to car engines to nuclear power plants, must acknowledge that we could do so much better at aggregate cultural tuning.

A second conclusion is that humans are finally forced to face this timeless challenge largely because we’ve run out of physical frontiers where we can avoid one another. For the time being, there’s no new physical niche to invade, so humans must now put more effort into improved process tuning. Physical Nomads are extinct. Only Context Nomads remain. We’re now stuck wandering around our own living room, constantly remodeling and changing practices, but never leaving. We change our context, but not our location. That’s undoubtedly going to represent an inflection point in the course of human history.

Physical Nomads are extinct. Only Context Nomads remain.

Is there a limit to evolving systems? Perry is talking about farms, but that’s just part of the bigger question of National Health.

Is our nation over-producing, or are we under-consuming, and in which evolving patterns? Tuning our evolving national culture always involves comparing changing contexts and constantly expanding options – which we explore through endless recombination – both genetic and cultural.

Asking serious questions about process? That occurs only in people working close to the process, which isn’t likely among increasingly isolated specialists. To manage National Health, we need the equivalent of farmers in all professions. Everyone has to be as close to the aggregate mission as farmers are to the land.

Can we generalize from the cattle production solutions he discusses? The general concept is HIGHER THROUGHPUT in any process – but only upon demand. That means:

1. tuning every process to full context needs, never to local “progress” definitions alone;
2. adjusting averaged cost-accounting to deal with distributed costs, not just concentrated revenues
3. selecting/educating for better process-teams, not components that are “better” by purely local definitions

Everyone has to be as close to the aggregate mission as farmers are to the land.

Interestingly, Perry totally skips the concept of savings, or at least replaces financial savings with increased process resiliency. That could be an endless discussion in itself. Which is better, savings that are locally/transiently defined, or net aggregate “savings” defined as increased aggregate capabilities?

There’s a totally non-surprising reminder in all this. Sustained surplus (profit) = (concentrated) revenues – (distributed/delayed) costs. Well Duh! Who hasn’t implicitly known that, for a million years running, even though we don’t act on it in daily practice?

I can’t find fault with Perry’s general conclusions, about process scale & the definition of aggregate vs local progress. In fact, there’s little in this author’s process-specific jargon that isn’t contained in Shewhart’s 1920’s general postulates about process optimization. The rate of adopting “Operations Logic” across all disciplines seems to be slowed largely by the competing demand for discipline-specific semantics (jargon and slang). That’s a huge challenge for K-12 education in general. How can our language and users be even more focused and efficient when necessary, and yet also agile enough to discuss the accelerating changes in perspective required to manage FutureShock?

The more our populations and perspectives expand, the more demand we place on language and speakers, to interleave efficiency and resiliency upon demand. That’s an escalating challenge that parents, kids and teachers – from Kindergarten on – will have to solve. There’s already pent up demand to teach more citizens to think more critically about any and all local as well as global processes. Only the culturally and linguistically flexible will survive. Who says homo sapiens aren’t evolving? Are we up to the adaptive demands? Only if we start making even more selective product development decisions, fast enough to navigate the context changes we force on ourselves. The Age of the Context Nomad is upon us. Good luck, kids. You’ll need it.

I’ll end with a reminder that the difficulty of process growth – including cultural evolution – is a function of scale. Increased process throughput tracks increasingly arduous selection of only those process extensions which survive review by all system feedback loops. The result is the slow addition of highly conserved sub-processes. As Wendell Berry implies, that requires the ability to collectively, not just individually, discriminate global from local optimizations.

Thanks to Jerrit Erickson for sending a copy of this book chapter.

* Chapter 9 in The Gift of Good Land: Further Essays Cultural & Agricultural (North Point Press, 1981)