Halfon – levels of change

When you begin to think about how you start to change the system, the change strategies that people routinely employ, and we just went through this in our health reform in the United States, the change strategies that come out of the management literature, are for, one is for a fix-it strategy which is go in and fix what is broken. So you go into the health care system or the early childhood system and you say “okay, we’re going to fix things” so you fix the child care centres and you fix what’s wrong in the paediatrics. And that’s very appealing to the pragmatism and the immediacy of most politicians and you know, and it’s usually framed by “if it ain’t broken don’t mess with it” you know, and so people go in and want to fix things and that’s the simplest thing. 

The second level is when you try to improve things. And you have a part of the system that you know isn’t functioning well, so delivery of preventive services to children, or doing developmental screening. And someone has done an evidence-based trial that says “well there’s a better way of doing it”. So that’s an incremental change that’s using an evidence- based approach to improve things. So that’s an incremental step that you’re taking. And again,  that’s what we mostly do in health care and in other areas because it’s easy to tell, convince a politician that, well, this is more cost-effective or more efficient than doing it the way we’re doing it so we’ll take the old one out and we’ll put the new one in. It’s usually a step up.  

The third way of doing things is actually making a transition, and where you’re transitioning to a new state so that you’re doing things in a completely different way. So going from paper health care records to electronic records, or going from using a typewriter to a word-processing computer, or state changes that happen where we completely transition from what we were doing in the past to a new way of doing things. Once people start using electronic medical records, once someone starts using a CAT scanner for looking at the body, when someone discovers a way of assessing children that’s more effective and holistic they’re probably not going to go back to that way. 

But usually to get to that new way of doing things, it really takes a nudge, to sort of nudge you and that’s where the behavioural economists talk about that you need nudges, especially since most humans are not rational individuals a la, you know, Spock [?] kind of a, in a more like I think analogy it’s more like Homer Simpson. So unless you change the structure, Homer Simpson will go back to doing what he normally does. So it takes nudge strategy to change the system to a new state. 

And the last is transformation in which transformation you’re really changing the logic model, the operating system, you’re trying to create something completely different and new. And getting the transformation is hard because it takes a big change and there’s more risk and more uncertainty where you’re going to end up. But oftentimes we we see, in complex systems, this comes out of the physical sciences, is that open complex systems start to take on more and more energy: more information, more people, more whatever it is and then they break it down and try to reformulate it at a higher level of complexity and functionality.