The Heart of Complexity

Stories and Applications of Complexity: Building Health Care Systems

with Helen Harte and Paul Plsek.

• In retrospect, what are some questions you wish you would've asked prior to a merger? Answers included:
  • "What are the values of the 'other guys?'"
  • "Why are we doing this?" "What are we really trying to accomplish?" (e.g., Is it just so-called "economies of scale?")
  • "What, really, is the financial situation of the other guy?"(Amazing, how often statements lie or mislead! This shows up as an issue about 25% of the time in Wall Street Journal case studies.)
  • "How are we going to manage the new system we are creating?"
  • "Who's going to be the boss?"
  • "How does information flow in the organization?"
  • "Does size matter?"
  • "How much geographic area is being covered?" "How dispersed will we be?"
  • "What business are we in? (Is it improving shareholder value? Or serving community health?)"
  • "Will the new organization be one great big bird, or will it be a flock?"
  • "What will the patients say? Will they like this?"
  • "What does the customer need? And who is our customer?

• "In mergers, sometimes it's a question of margin: How much can you lose, and how long until you run out? It's just a matter of time until those deep pockets run dry."
  
  
• Seem to be a lot of issues of size. To exceed optimal size in a system is pathological. In biology, there's a ratio of nutrients to flow in body. (A mouse and elephant both have 5 branches in capillaries, for example. Could this be analogous to information flow in an org.?) Is there an optimal size in a health care system?
  
  
• " Why doesn't size seem to be a problem for General Electric? Of course, GE's CEO, Jack Welch, has allowed separate divisions to self-organize..."
  
  
• "Operating a health care system is not the same as operating a hospital. You can't say 'well, we ran one hospital. Why can't we run 15 hospitals?' It's a different skills set."
  
  
• "How do you know if you've made the wrong decision... or if this is just the natural outcome of change, which is always difficult? (Is it intuitive to know when a risk is too great? Should we trust our intuition more?)"
  
  
• "In our merger, we have convinced our board not to evaluate anything we do for three years. If everyone agrees its right for the community, then we let it ride and suspend judgment."

Copyright © 1999, VHA Inc. Permission
to copy for educational purposes only.