Measuring the sunbeam: making room for quality in a complex world.
Sometimes coherence can take you by surprise.
I'm grateful to belong to a network of good souls with a curiosity about what it means to flourish as a human being and with an awareness that connecting with others for mutual support is part of what it means to flourish. In some ways I am unique amongst the group which has formed as a forum for healthcare professionals to explore flourishing in systems that seem actively designed to prohibit this human need. Unique because I come from a background in professional ecology, though I find myself amongst friends concerned as we all are with a connection to the natural world and an understanding of its regenerative powers. As Wendell Berry eloquently summarises in his poem The Peace of Wild Things:
When despair for the world grows in me…
…For a time
I rest in the grace of the world, and am free.
Geographically separated, our group relies on WhatsApp to meet and apply the salve of listening and sharing. Last week some posts caused a flurry of activity and responses which spilled over into the monthly meet up. The trigger was the posting of a couple of scientific research papers, one on ecotherapy and the other on “sacred moments” in medicine. “Research papers are not quite the stuff of flourishing!” I can hear you cry and when much of the posts come in the form of poetry and pictures of beautiful landscape, plants and other animal relations the dry stuff of scientific inquiry does seem the very antithesis.
My friend Jane responded to the paper on sacred movements with the following:
“….. I find myself sitting with a familiar discomfort as I read the paper I’m wondering why we feel the need to “prove” the value of what is intuitively precious - intimacy, continuity, the sacred - by showing its usefulness in reducing burnout or improving efficiency. Of course, that kind of evidence is vital in influencing policy or design. But part of me wonders what is lost when we only validate these aspects of care through the lens of impact. What if the real task is not to explain why sacred moments help the system - but to recognise that life itself is sacred, and therefore any system that doesn’t honour that will inevitably become dehumanising? I suppose I’m curious: how do we keep room for mystery, awe, and tenderness without needing to translate them into productivity gains? Can we name and protect what matters because it matters, even if it can’t always be measured”
From the comments that followed it felt like Jane had expressed something everyone was feeling, a gap that existed between an intuitive expression of care focussed on the emergence and sustenance of life, and the techniques of measuring and monitoring, particularly in terms of impact, that feels more suited to a reductionist vision of systems of machines that can be engineered into optimal functioning.
As if the universe was listening, immediately following this discussion, one of the groups working with a team of community health workers reported that the service she ran had been cancelled because of a lack of evidence for it reducing A&E waiting lists, and a lack of ‘belief’ that community interventions like social prescribing could really have an impact.
It reminded me of a time when I was working with a community rivers group as part of Surrey’s Catchment Partnerships monitoring the health of local rivers. It took some time to convince the EA and Water Companies to accept the data on levels of pollutants and aquatic insects collected by my “RiverSearch” volunteers as evidence on a par with employed EA/ Water Company staff as a trigger for action. In the end it was the “weight of evidence” – the sheer amount of data that volunteers collect, when they can be monitoring in more places and at more times than paid staff. Volunteers can add local knowledge including an intuited sense that a river is not in good health garnered by conversations with fishermen, canoeist, river users- a human sensor network based on deep relational connection.
I’m not sure I can directly answer Jane’s question about how to make room for mystery, awe and tenderness except to say these for me are different qualities of relationship to the world and to each other (I also want to gently soften those distinctions between self/ other humans and the world) and in this blog I want to explore more generally thinking about our relationships differently. I’m going to focus on my contribution to the conversation and let others talk about their own insights, partly because while the excitement felt like a coherence in our stories, we all will have slightly different perspectives. So, like the parable of the blind men and the elephant, context matters, and each of us has a story to tell about our experience of the complex picture.
What I think Jane was alluding to in her plea above was part of a growing intuition that the way we perceive the world through the lens of modernity is not just a problem but a metacrises. In Prefixing the World Jonathon Rowson writes:
“The metacrisis is the historically specific threat to truth, beauty, and goodness caused by our persistent misunderstanding, misvaluing, and misappropriating of reality. The metacrisis is the crisis within and between all the world’s major crises, a root cause that is at once singular and plural, a multi-faceted delusion arising from the spiritual and material exhaustion of modernity that permeates the world’s interrelated challenges and manifests institutionally and culturally to the detriment of life on earth.”
So, if there is a problem in how we perceive the world, where do we start to change our perceptions? I am going to talk about a different way of thinking about the world but first a couple of health warnings: “the map is not the territory” (Alfred Korzybski 1931); The menu is not the meal” (Alan Watts) “all models are wrong, but some are useful (George Box 1976). All our attempts to explain reality are doomed because abstraction is instantly not reality! So models and metaphors can help us understand by directing our attention to things instead of the relationships between things, or by insisting on truth as something that has to be empirically proved.
Now a jargon warning! I’ve been an ecologist for over 20 years, but I’ve recently been exploring and working using a “complex systems” lens as a researcher and practitioner in social-ecological systems. Ecology is the science of how organisms relate to each other and the physical world and how patterns of abundance and distribution emerge across time and space. Through developments in ecology along with biology, behavioural science and physics over the last couple of centuries, the related sciences of systems thinking and complexity have emerged which have revolutionised the way we think about life. The biggest changes have been the shift to thinking about structures or systems (which are relationships or networks like social organisations, governments and businesses) from machines to organisms and from things to relationships between things. Other features of complexity include:
· interconnectedness
· self-organization (patterns arising without central control)
· emergence
· Non-linear dynamics (The relationship between cause and effect in complex systems is often not straightforward. Small changes can lead to disproportionately large consequences, and vice versa, making prediction challenging
· Feedback loops
· Surprise (sudden changes in state) and Unpredictability
Of courses this lens emerges from western scientific thinking, but an intriguing feature of complexity science is that there is some congruity with non-western knowledge systems in its focus on relationships rather than things or ‘nodes’. In Sand Talk, aboriginal complexity scholar Tyson Yunkaporta explains:
“People today will mostly focus on the points of connection the nodes of interest like stars in the sky but the real understanding comes in the spaces in between in the relational forces that connect and move the points contemporary science is beginning to understand this way of knowing through chaos theory complexity theory network theory and fractal geometry it's becoming clear that complex systems are adaptive self organizing and patterned with the logic that can be discerned and used for trend analysis and predictive technologies”
I’m not going to delve deeper into the complexity science in this blog but instead wanted to return to the conversation about evidence and intuition and the implications of seeing human networks through a complexity lens.
I’ve found the Cynefin (‘Kuh-nev-in’) Framework very useful to help me think about complexity. Developed by the Cynefin Co, it helps in thinking and planning action depending on the context of the problem. Cynefin distinguishes between clear, complicated, complex and chaotic contexts based on the relationship between cause and effect. This relationship is important in decision making because if we know what caused a problem we can fix it, or we can analyse the situation and through expertise decide upon a solution. For instance, making tea involves a series of clearly understood cause-and-effect relationships of boiling water, adding a teabag to a cup, adding milk etc (clear). Fixing a broken leg in accident and emergency is more complicated and requires expertise (complicated), but through a similarly linear relationship between cause-and-effect we can predict the leg will be healed. But there are other problems that involve multiple interacting relationships, and with parts constantly adapting through learning and behaviour change, cause and effect relationships become difficult to predict, but there are patterns. Where feedback loops dampen or lead to runway effects, small interventions have large impacts. This is the domain of complexity. Chaos is a space of disorder or randomness where cause and effect relationships are completely indiscernible.
Applying this lens means we also must think about what constitutes evidence and how much weight we give it depending on the context. Should A&E waiting lists be given more weight as a measure of change in the complex relationships people have with their own wellbeing, or might engaging with stories about relationships to health be at least as-possibly more- important? Critically, deciding on what works best in complex systems isn’t the domain of experts and good/ best practice, at least not in the traditional sense, until causal relationships are more fully understood. We might also ask where we can’t rely on experts in the traditional sense, we must trust the intuition of those most closely embedded in the context in question.
Scale also governs how we think about evidence in a complex system because it governs networks of trust and accountability. It is much harder to maintain these in large anonymous networks than in smaller face-to-face ones. Ivan Illich wrote” The size of a convivial tool must be limited to the number of people who can sit around a table and make a decision.”
Communication is essential in enabling self-organisation and adaptation in complex adaptive systems. Complex patterns emerge from simple rules such as in those that govern the position of each bird in a starling murmuration. Human beings are narrative animals, and I’m interested in understanding what role narrative plays in CAS and how this might help us develop better relationships. Narratives are often seen as frames we adopt to make sense of and act in our world, but in its meaning-making impulse and linear relationship to time narrative is also is both a state of mind (cognitive lens) that governs how we see the world and a relational process by which we develop frames for action. They therefore govern the way we assemble and play a part in what the sociologist Norbert Elias called The Civilizing Process.
Sage Practices is well positioned to explore the adjacent possible in the complex relationships and process of a new understanding of healthcare that we call Flourishing. We are starting out not with a brand-new idea, or a strategic plan and key goals, but small probes, experiments in complexity and trusting in a very natural process of self-organisation and adaptation to see what emerges and remains coherent under its own energy. This is the process of life itself, a process captured eloquently in this poem by Gary Snyder.
