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Edgeware: Lessons from Complexity Science for Health Care Leaders

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As an innovation matures, it moves from one characteristic group of adopters to another. The topics of complexity and nonlinear dynamics were initially adopted by people who were considered "outliers" by their peer group, "freaks". Such innovators are comfortable spanning across disciplinary boundaries to learn how something works. The successful diffusion of the innovation does not occur however until the innovators hand over the ideas to the change agents in the system--those individuals who are creative enough to listen to the innovators, and yet respected and legitimized enough within the system to steer collective opinion. Today complexity and nonlinear dynamics have reached that level of diffusion, and in such instances "implementation" becomes of utmost important, and such discussion of implementation is necessarily domain-specific.

Such is the nature of "Edgeware", a new book by Zimmerman, Lindberg, and Plsek. "Edgeware" is aimed at health care leaders--nurses, doctors, and administrators--who want to learn specific techniques and intervention strategies based on the premises of complexity. The book is broken up into four sections: a user-friendly primer on complexity, a summary of basic managerial principles based on complexity (e.g. "grow complex systems by chunking"), tales from the field (e.g. "Learn-as-You-Go Strategic Management", a story from University of Louisville Hospital), and Aides (e.g. "wicked questions" that surface differences in people's mental models). Additionally there is an appendix written by Adelphi professor Jeff Goldstein that provides the most effective "non-mathematical" nominal definitions of complexity terms that exists anywhere.

The book is unique in several respects. First, the authors span an intriguing experiential set. Zimmerman is an associate professor of business at York University in Toronto, and has written extensively on the "fractal" nature of organizations, and on emergent strategic planning. Lindberg directs an educational and consultative activity within VHA (Voluntary Hospitals of America, a purchasing cooperative that also engages in leadership and organizational development, and encompasses over 1400 health care providers in the U.S.), transfering the concepts of complexity into health care practice. Plsek is a former corporate quality manager at AT&T who now consults extensively in health care quality issues. Second, the book is the result of an evolutionary design process where it was given extensive "field testing" before being finalized. "Edgeware" essentially serves as the handbook for VHA's efforts to spread the concepts of complexity into practice.

Third, the book is arranged in a hypertext fashion (in fact, it is available on-line to VHA members), in a fashion similar to Senge et al's "Fifth Discipline Fieldbook". For example, references to books or articles, or principles and aides, are made in the margin of each "tale"; the book does not need to be read sequentially. Fourth, the science of the book is solid. Unlike so many other business and complexity books being published, the principles of complexity are represented faithfully. Finally, the book's section on "Aides" gives practitioners very specific advice on how to move from theory to practice, another missing element in most current business and complexity books.

This book is an excellent read and reference for anyone interested in the application of complexity principles to business and social systems.

As a journalist and business author myself, I've read virtually every book seeking to apply complexity science to strategy, work, and economics. None, I assure you, comes close to EDGEWARE in terms of sheer clarity and utility. Though solid on the theory of complexity, this book's real breakthrough in its tremendous practicality for leaders. The pages are brimming with case after case--episodes of complexity in action that inspire as well as inform. For leaders (in hospitals and anywhere else) who ask, "What do I do on Monday morning?" EDGEWARE provides literally dozens of suggestions.

Don't get me wrong. Applying complexity is hard work. No book will ever make it easy to abandon command-and-control leadership or to let organizations "play" their way into the future. But with EDGEWARE as your guide, the work will be joyous.

Peter Drucker once described healthcare as the most complex of all business enterprises. So perhaps it's appropriate that the best book on the emerging science of COMPLEXITY should come out of healthcare. EDGEWARE will prove useful to managers in all industries. The book contains a primer on complexity, a set of unifying principles, practical applications, a rich bibliography, glossary and web site guide making it, page-for-page, the most valuable book to date on complexity and management.

The book is wrong and misleading on many levels.

First, the alleged Physics is wrong, even Classical Mechanics. For example, the authors tell that Newtonian systems are always linear and never chaotic; then they mention the Lorentz attractor as an example of Chaos, apparently unaware of the supreme irony that the Lorentz attractor describes a non-linear chaotic Newtonian model. They allege that Newtonian systems respond proportionally to input; one doesn't need any books to see that this is wrong: try placing a pencil vertically on a table top, sharp end down; regardless of how weak a subsequent input is (maybe just a fly flew by) the pencil with tumble and fall. Does this look like a "proportional response" to the input? Their tales about Chaos and virtually everything else are equally mispleading; I'd rather not dwell too much on that.

Second, I didn't like the condescending tone. For example, the authors warn that new terminology is coming, as if the readers were too scared to learn a few new words. The authors seem to suffer from science envy; they even discuss that at length in a dedicated section: apparently they used to envy Physicists and now they envy Biologists. Thus the book is focusing more on their injured ego than on the subject, leading to the condescending tone.

Third, there is very little useful information in the book. They tell the readers very little beyond the fact that the subject of complexity exists. As Bart Simpson would say: "I don't know Complexity Theory, I know OF Complexity Theory."