Making sense of healthcare systems using sensemaking and the Price Is Right

Do you recall the “Cliff Hanger” game on the Price Is Right? An overly bedazzled and frantic contestant with the “I spayed Muffin for Betty White” T-shirt has the chance for a hot tub that he never knew he needed. First of all, do we really need a hot tub? With the energy of a roaring audience, the contestant may resign himself and become giddy over the chance for a big algae pool. Each guess that is incorrect causes a flat, one-dimensional yodeler in front of cardboard Alps to move precariously towards the cliff and his impending doom. However, the error in the guess is not revealed until after the cardboard yodeler has moved up the mountain illustrating the deviation of the guess from the correct answer.

Bhermer (1999) spoke of something called “dynamic decision making”. In order for a decision to be labeled dynamic, the cliff hanger decisions are made in “real time” and are dependent on previous actions (guesses). Some factors into the gaming decisions include the initial mechanism used by the contestant to come to the guess, any dynamic alterations made to subsequent guesses, the distance away from the actual price (which is shown in the steps taken by the figure) as well as the distance left from the top of the mountain.

Hodl-oh-ooh-dee
Hodl-ay-ee-dee-
Hodl———–ay–ee-dee -yi—ho.

The show is based on the fascination of the possibility of success, not its realization of success. But what is unique to The Price is Right is that the contestant often calls upon the help of the screaming audience for help in making future guesses, particularly if he failed miserably on an attempt. In the end, there is a system to work through which may in this case be futile for both the contestant and the flat guy in Lederhosen.
The health care delivery system has many stakeholders, with many screaming for attention, not unlike a game show crowd. Each studio audience member works their uvulas in at a frenzy to be picked. But there is an undisclosed system of who can “come on down”. Likewise, Americans across the country have a profound investment with the state of the present health care system, but those voices are not created equal. You must have an acknowledged voice to be an influential citizen. Burke (1966) contends that it is through consensus building that we get meaning. Who is expected to be a part of the deciding consensus? When a reality is deemed in need of repair, communities of like-minded individuals might organize, seeking power through numbers. What cannot be lost in the rendering of “health in America” is the structural reality in which it exists.

In this process of agenda setting, participants may participate in “sensemaking” (Weick, 2005). Sensemaking is based on prior experience that affects our framing of current events. Making sense of a concern within its healthcare context is the crux of sensemaking (Weick, 2005). But too often we divorce decisions from “health” altogether, opting exclusively for emotion and social pressure. Health policymaking, in particular, involves several people each with differing prestige. The powers often listen to the wealthiest and loudest interests. We need to explore sensemaking to separate the chaff from the wheat.
Generally speaking, health policy influences patient services through legislation pertaining to areas such as reimbursement, licensure, and malpractice. Haddow et al. (2007) warns that the fast pace of decision making during such medical crises impedes a true understanding of procedural concerns of such actions. I argue that we often ignore procedure however the procedure comes from collective agreement that is housed within personal and shared values and influences. Society unfortunately fails to grapple with complexity before investing our efforts into a leverage point that give us the most return. The state of gapping disparities in healthcare access has placed a time-based premium on access to patient care, often tying reimbursement to a pre-existing cost-saving market environment. Society unfortunately fail grapple with complexity in favor of a tantalizing newsbyte rather than wisely investing our efforts into a leverage point that give us the most return for limited resources and effort (Resnicow and Page, 2008; Meadows, 1999).
Rockwell (2005) wisely wrote that “if we do not know in detail what the system is doing, we can’t even ask how the system does it.” According to Meadows (2008), “a system is more than the sum of its parts.” I could not state that better than Meadows. Fixing a healthcare “system” requires more than a falsely disjointed approach to its separate elements (which ,in reality, are interconnected). A key to making meaning of health policy is adaptation to the “self- evolving system” as the context of that system dictates and investing where policy will be most salient. Meadows (2008) warned that changing a “mindset” around a system is the hardest change to realize. But the mindset around the healthcare system must first acknowledge the “system” in the truest sense. Policies must be continuously reimagined and we must let go of the resistance in admitting change is even there (Meadows, 2008). We cannot afford to fall miserably off the cliff. We have more than a hot tub at stake.

References

Brehmer, B. (1992). Dynamic decision making: Human control of complex systems. Acta
Psychologica, 81(3), 211–241.

Burke, K. (1966). Language as symbolic action. Berkeley, CA: University of California
Press.

Haddow, G., O’Donnell, C., & Heaney, D. (2007). Stakeholder perspectives on new ways
of delivering unscheduled health care: The role of ownership and organizational
identity. Journal of Evaluation in Clinical Practice, 13(2), 179-185.

Meadows, D. (2008). The Basics. In Thinking in systems: a primer. White River Junction, VT:
Chelsea Green Publishing Company.

Meadows, D. (1999). Leverage Points- Places to intervene in a system. Hartland, VT: The
Sustainability Institute.

Resincow, K., & Page, S. (2008). Embracing Chaos and complexity: a quantum change for public
health. American Journal of Public Health, 98, 1382-1389.

Rockwell, W. (2005). Neither Brain nor Ghost- a nondualist alternative to the mind
-brain identity theory. Boston, MA: MIT Press.

Weick, K. (2005). Sensemaking in organizations. Thousand Oaks, CA: Sage
Publications.

NOTE:

The suggestion has been made to consult the ReThink Health tools and materials (Fannie E. Rippel Foundation) and what Simudyne is doing with health care simulations (http://www.simudyne.com/case_studies/health/)…Thank you Kim Warren

Check this out- “The Secret of Price is Right” -http://tv.yahoo.com/blogs/tv-news/what-makes–the-price-is-right–tv-s-most-successful-show-ever–215848146.html

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About Michele Battle-Fisher

This is an archive of the Orgcomplexity Blog. Please follow me at the following sites: mbattlefisher.wix.com/orgcomplexity Michele Battle-Fisher (Facebook author page) www.linkedin.com/in/mbattlefisher mbattlefisher (Twitter) michele.battle.fisher (Skype) Author Website http://amazon.com/author/michelebattlefisher

2 thoughts on “Making sense of healthcare systems using sensemaking and the Price Is Right

  1. The CDC and others have put quite some effort into grappling with the dynamic complexity of the US healthcare challenge. In addition to the many publications on the topic from leading SD folk like Jack Homer and Bobby Milstein, a model they developed has been turned into a large-scale game, designed for stakeholder groups in cities and states to understand the interdependencies between the community, healthcare providers, payers, Govt and help them move towards better policies on the issue – see http://www.simudyne.com/case_studies/health/. As Justin Lyon at Simudyne says – we now have the science and the tools to back up all serious decision-making with sound simulation testing, so it is irresponsible not to do so!

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