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What Collaborative Care Can Learn From Chaos

Posted By Peter Y. Fifield, Thursday, July 7, 2011
A client once told me, "Humans pray for outcomes and God laughs. Now that’s chaos”

Chaos Theory is paradoxical; sort of like when you see an object clearer in the dark when you don’t stare directly at it. Chaos theory for me reminds me of this concept. It comes more into focus the less and less I try to figure it out. The mathematics behind chaos theory are extremely abstract and difficult to conceptualize and I’ll be the first to admit quite frankly they are way over my head. That being said, in my interpretation the basic premise is simple: We need not waste time seeking control of a system, instead we seek order within the system.

Generally we humans think in a very linear fashion. Schools, are organized by the born on date of the student, factories by what products they make, hospitals by triage needs, organisms by phylum and genus, mental illness by diagnostic criteria etc. The list goes on. It seems that we find it very difficult to live in an environment that we do not control: A world that is not classified in a way that allows us to make sense of all its parts. Vexing as it is, we tend to have difficulty grasping nature’s reluctance towards linearity. In the name of ‘education’ and the need for classification we conversely limit our divergent thinking ability. As contradictory as it may seem, I am convinced that via our own "advanced” education, nourished by underlying Newtonian philosophies we are limiting our mental potential.

Although it may just take some good old fashion ‘out of the box’ thinking a different approach to seeing and working within our world may prove to be helpful. Chaos is not chaotic, it is actually a series of events made up of numerous reiterations that when seen as a whole, actually displays innate order. These ‘events’ are quite formulaic and result in a system of data that is fed back into that system over and over again. Graphically these reiterations result in fractals; a wonderful display of order.

This new science reminds us that ALL systems exist in chaos. Although superficially these systems appear ordered, they are actually in constant state of internal flux. Typically a few guiding formulas dictate the initial setup and organization. These formulas are designed to maintain structure within the system by a constant feedback process. Importantly, each variable has a high level of autonomy working within the well ordered system. Now this is collaboration!

Chaos transcends mere theory. However, actualizing the theory into collaborative practice is not easy. Sometimes the sticky wicket is around the collaborators needing to possess a level of curiosity and a view point that is never convinced that it knows anything. When creating a new collaborative network it is important to create a system of standards; a calculus that defines the roles and actions of each player. Once an algorithm of flow has been created, and the roles of key participants have been defined an integral next step has to be taken--the creation and maintenance of relationships. Collaboration is all about creating and fostering bidirectional relationships. These relationships create conduits of communication that facilitate how information (about the patient) gets back into the system (not only in the Electronic Medical Record but w/ personal interactions such as hallway consults as well). This is an example of a simple chaotic reiteration.

When primary care providers, medical assistants, behavioral health consultants, case coordinators, administrators, front desk staff etc., all collaborate and operate at the upper limit of their scope of practice, then patient centered care happens. When accurate feedback is provided into the system a greater sense of confidence arises. Providers are then allowed to stay informed AND stay curious. The providers, now playing the role of change agent, feel comfortable letting go of the wheel and allowing the patient to drive the bus. Patient autonomy is gained and they subsequently become responsible for their own health. This in turn, not only reduces the provider's anxiety but as important, frees the provider to offer what they do best--direct medical services.

So in the end, chaos is not chaotic. There is always some semblance of order hidden within. We as providers of whole person health care are best utilized when we realize that control is an illusion yet order is a certainty. We often will find that systems best work when in flux and when all members are operating at the height of their scope of practice. As we become more comfortable operating as such we realize that we can let go of the control. Not only control over patient outcomes (the age old myth of non-compliance) but as importantly control over the who, what and where of how we function within the care giving system. Furthermore we find that when we create, foster and maintain environments where learning and sharing are the constant and we the observers are colleagues co-creating new environments; then we are all are free to seek the innate order in the system. Chaos theory can provide a tenable environment, a nurturing place where mysticism meets hard science.

Peter Fifield is an integrated Behavioral Health Consultant at Families First Health and Support Center; an FQHC in Portsmouth NH. In his off time he is the Managing Editor of CFHA Blog and makes all attempts to keep up with his wife and two sons.

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