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 \u201cokay, we\u2019re going to fix things\u201d so you fix the child care centres and you fix what\u2019s wrong in the paediatrics. And that\u2019s very appealing to the pragmatism and the immediacy of most politicians and you know, and it\u2019s usually framed by \u201cif it ain\u2019t broken don\u2019t mess with it\u201d you know, and so people go in and want to fix things and that\u2019s the simplest thing. <\/p>\n\n\n\n
The second level is when you try to improve things. And you have a part of the system that you know isn\u2019t functioning well, so delivery of preventive services to children, or doing developmental screening. And someone has done an evidence-based trial that says \u201cwell there\u2019s a better way of doing it\u201d. So that\u2019s an incremental change that\u2019s using an evidence- based approach to improve things. So that\u2019s an incremental step that you\u2019re taking. And again, that\u2019s what we mostly do in health care and in other areas because it\u2019s easy to tell, convince a politician that, well, this is more cost-effective or more efficient than doing it the way we\u2019re doing it so we\u2019ll take the old one out and we\u2019ll put the new one in. It\u2019s usually a step up. <\/p>\n\n\n\n
The third way of doing things is actually making a transition, and where you\u2019re transitioning to a new state so that you\u2019re 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\u2019s more effective and holistic they\u2019re probably not going to go back to that way. <\/p>\n\n\n\n
But usually to get to that new way of doing things, it really takes a nudge, to sort of nudge you and that\u2019s 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\u2019s 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. <\/p>\n\n\n\n
And the last is transformation in which transformation you\u2019re really changing the logic model, the operating system, you\u2019re trying to create something completely different and new. And getting the transformation is hard because it takes a big change and there\u2019s more risk and more uncertainty where you\u2019re 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. <\/p>\n","protected":false},"excerpt":{"rendered":"
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 […]<\/p>\n","protected":false},"author":39,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-text-only.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-1121","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/content.scienceofecd.com\/transcript\/wp-json\/wp\/v2\/pages\/1121","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/content.scienceofecd.com\/transcript\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/content.scienceofecd.com\/transcript\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/content.scienceofecd.com\/transcript\/wp-json\/wp\/v2\/users\/39"}],"replies":[{"embeddable":true,"href":"https:\/\/content.scienceofecd.com\/transcript\/wp-json\/wp\/v2\/comments?post=1121"}],"version-history":[{"count":1,"href":"https:\/\/content.scienceofecd.com\/transcript\/wp-json\/wp\/v2\/pages\/1121\/revisions"}],"predecessor-version":[{"id":1122,"href":"https:\/\/content.scienceofecd.com\/transcript\/wp-json\/wp\/v2\/pages\/1121\/revisions\/1122"}],"wp:attachment":[{"href":"https:\/\/content.scienceofecd.com\/transcript\/wp-json\/wp\/v2\/media?parent=1121"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}