REPLY SD Impact on National Government policies (SD6199)

[System Dynamics Mailing List]

Posted by  "Schuette, Wade" <wschuett at jhsph.edu>

Even one stock may be sufficient to make a point,  and we know many bright
people can't figure out if the bathtub is going to fill or empty with competing inflow
and outflow.
 
But, if we apply that level thinking to the SD field itself, it draws attention not just
to the enthusiasm that starting students and clients have (as Erling Moxnes points out),
but to the dampening and outflow effects that often follow shortly thereafter, with a 
larger time-frame boundary.
 
In some evangelical organizations I've looked at,  the growth rate is actually 
almost completely dominated by the rate of people falling away from the faith, 
which makes that look like an interesting candidate intervention point.   What is it, 
in particular,  that changes loose individuals with enthusiasm for a new love or
realization into a knit-fabric that can bear up under the soon-to-arrive wet-blanket
effects?   How does one sustain the energy that many-coals-interacting have and
that scientific edge (as in "cavity radiation") and prevent the coals, once separated,
from going out?  This is a problem that many of us have insight regarding.
 
The key factor that is emphasized in Public Health, particularly "Health Education", which
is to say, "lifestyle change",  is that the appropriate unit of change cannot be "one person" 
but really needs to be "one small group of people."   This is supported by many studies.
The Institute of Medicine's "Crossing the Quality Chasm" focuses attention for those who
would change healthcare systems on "the microsystem", that is, the small-team of 5-20 
people who deliver care together - because trying to change individuals doesn't actually
seem to work very well, and larger systems are too big to change. 
 
Small groups are startlingly effective for many psychosocial reasons. For example, it's
more effective to pay a woman's children $10 for every kilogram she loses than to pay
her.   
 
The Institute for Health Care Improvement has developed an entire "Collaborative" model
where the trend-leaders get together, catch the fire together, then go back to their home
institutions, where the fire tends to go out, but the leaders have already formed interactive
bonding, and have several more repeat meetings together to deal with all their home
wet blankets together. That seems to be fairly effective.
 
So, I'd pose the question to this list:  does that sort of effect happen with regards to 
system dynamics too?    And, assuming it does,  has that been taken into account in 
designing fire-passing interventions?
 
The key thing here is that, if we want the number of individuals to grow, and the usage of 
the tools to grow,  then it is important (by this model) that the interactive FIELD grow at the
same time.   This argues that, due to far less post-excitement declcine,  training a group of 10
people may be far more effective than training 10 individuals, in the long run.
 
Jim Porto at UNC will be having a training session for faculty of schools of public health in the new 
"core competency" for MPH students of "systems thinking"  in early February.  That should help get a whole
new cadre of policy advocates started.  But, from looking around this summer at Johns Hopkins, they
will tend to go home to legacy-trained biomedical epidemiologists, etc., who will heatedly attack what will
be perceived as "soft headed" squisy thinking because, obviously,  bleeding kills people,  not bullets or 
people with guns or "angry people with guns" or "poverty that leads to angry people with guns",  or "US social 
policy that leads to poverty that leads to anger that leads to terrorism that leads to guns that leads to 
bleeding." At Hopkins the ratio of biomedical epidemiologists to distal-causality epidemiologists is 
approximately 70 to 2 the wrong direction.   And even if you want to publish, who is going to review the work 
who is sympathetic?  It's a long haul problem, and opposed with almost religious zeal to stomp out "sloppy 
thinking",  which is how it is perceived, way too close for comfort to "God made it happen" which they've 
almost finally stomped out.  As Norm Anderson at NIH  OBSSR found out, the audience is not "disinterested", 
the audience is actively hostile and perceives system dynamics as "enemy action."
 
Obviously, your field's mileage may vary.  My point is not to dwell on public health, although that's an 
important field for policy and governmental action in many key areas, but to suggest that a stronger strategy 
is to increase the size of the working unit to be taught as one and to remain together after teaching above one 
person.  The continuing connectivity and social warmth is a crucial factor to fight off the wet blankets and 
increase our stock of people who think globally.
 
At least, it seems like a great avenue to explore to me.
 
Wade
 
Wade Schuette, MBA
MPH student at Johns Hopkins
and otherwise Senior Systems Analyst
University of Michigan Health System
Ann Arbor, MI 48105
Posted by  "Schuette, Wade" <wschuett at jhsph.edu>
posting date  Fri, 19 Jan 2007 16:12:55 -0500