Confronting Complexity

The book you are seeing on your screen may look like a normal book; it is not. It is a conversation in which you are a participant. The book does not offer pat answers to hard questions. In fact, it barely even gives definition to hard questions. Rather, this book presents that stage in which science is most challenging and, arguably, most interesting—the period of identifying just what the problems and issues are. That is why we solicit your help in writing this story—the story of extreme events in social systems.

The participants in this book-writing enterprise are independent thinkers who wish to understand the forces impinging on social systems and the systems’ often dramatic and extreme responses to those forces. Extreme events, the sudden and discontinuous response of social systems to these forces, are what we for shorthand term X-Events. X-events We imagine the reader to be a person who wants to intelligently manage his or her actions and behaviors in the midst of an X-event—in short, to manage an organization in chaos. And not only manage, but be a beneficiary of that event. Explicitly, we understand that there are no simple answers to social questions. But but there is at least a gestalt that can help an individual anticipate and manage X-events. The program outlined here is to build the gestalt by total immersion in the topic—by examining the issues from many perspectives.

Drivers of social change

At a random moment in time, the generic behavior of any social system is to be in a trending pattern. In other words, if you ask how will “things” (e.g., the GDP of an economy, the financial market averages, the political climate) look tomorrow, the answer is that they will be just a bit better or a bit worse than today, depend- ing on whether the trend at the moment is moving up or down. This is a large part of what makes trend-following so appealing: it’s easy and it’s almost always right—except when it isn’t! Those moments when it isn’t are rare (infinitesimally small in the set of all time points, actually) and the event is usually surprising within the context of the situation in which the question about the future arises. These special moments when the current trend is rolling over from one trend to another are the critical points of the process. And if that rolling over involves great social damage in terms of lives lost, dollars spent, and/or existential angst, we call the transition from the current trend to the new one an X-event. In the natural sciences, especially physics, such a transition is often associated with a “flip” from one qualitatively different type of structure or form of behavior to another, as with the phase transition from water to ice or to steam.

US Healthcare as a Complex System

Healthcare in the U.S. is complicated. There are dozens of components: hospitals, hospices, assisted living facilities, nursing homes, home care, pharmacies, pharmaceutical companies, the Food and Drug Administration, the Patent Office, specialized physicians, general physicians, physicians assistants, nurses, medical device manufacturers, Medicare, Medicaid, private insurers, self insurers, employers, self-employed, wellness centers, chronic conditions, acute conditions, end-of-life conditions, rare diseases, personalized medicine, cosmetic surgery, concierge medicine, and many more. The complication is impossible for any single person to penetrate or understand.