Chaordic Healthweb

“Understanding events and influencing the future requires mastering four ways of looking at things; as they were, as they are, as they might become and as they ought to be.”
Dee Hock – from book One from Many1

In One to Many, Mr Hock outlines the concept of Chaordic Organization and really a call for a now perhaps over used term”Paradigm Shift.” A synopsis of his concepts is further outlined in his essay - The Chaordic Organization: Out of Control and Into Order. Chaord is reaching a balance between chaos and order that is achieved in complex adaptive systems which is the “zone” of balance and sustainability (health). The human body, communities (both human and natural/animals) and the ecosystem are all dependent upon this fragile balance between chaos and order. In the “business world”, examples of Chaordic are witnessed in examples such as VISA (which Dee Hock was instrumental in creating) and the internet.

It is amazing how the internet has taken on a persona, a “virtual” life of its own. We speak of the internet in various humanistic terms and even suggest that attachment, obsession and even addiction are possible. When looking at Chaordic processes, it is understandable why the internet or “Web” has taken on a life of its own. The web can easy translate to a dynamic “living” system. The infrastructure of wire and fiber optics provides the “neural pathway” to the synapses which one would consider the computer but in actuality the transmission of knowledge to actually “touch” the individual.

Again looking to Dee Hock and his definition 2 of the Information Age

“The so–called Information Age could best be understood as the Age of Mindcrafting, since information is nothing but the raw material of that incredible chaord we call mind and the pseudo mind we call computer. Software, the tool with which we shape and manage that information, is purely a product of the mind.

As we further transition into the Information Age, the current business organizational framework continues to lag behind the explosion and access to information. Information and technology is coming to us faster than business systems and organizations can assimilate. Additionally, we are witnessing increasing failure of Business, Wall Street and ultimately economic turmoil all in respond to organizations continuing to operate based on Newtonian (cause and effect) concepts and Industrial Age (mass produce, uniform and hierarchal ) systems.

Perhaps nowhere else is the limitation and failures of antiquated practices more apparent than in healthcare all this in the face of a great explosion of information and opportunities. What is the future of healthcare and how will the internet play a role in shaping the direction?

The key to the future of healthcare can come from incorporation a Chaordic approach, one which supports a symbiotic and truly collaborative effort. Central to the healthcare shift is system is to fully develop the “Mindcrafting” and leverage the benefits of information to fully expand our knowledge to empower a true dynamic and holistic approach of patient care. The internet represents a model or perhaps the actual connection, the “white matter.”

At least in the immediate future, the internet will continue to serve pathway for connection but I believe that in the future there will eventually be a standalone network by which the healthcare system operates. This network will come through the drive for a National Heath Information Infrastructure NHII. With the NHII comes the opportunity to further the movement for the shift from traditional systems. NHII consist of three components or “dimension” of personal health, healthcare provider and public health. This triad address healthcare as dynamic and interconnected/interrelated system3.

Advantages of a standalone network will provide for elements of connectivity and needs within healthcare that the current systems are lacking. Specifically the issues of proprietary systems, lack of interoperability, privacy and security along with credibility of information leads to challenges with developing a healthcare network under the current system.

Certainly having involvement and endorsement by the Federal Government has been viewed as important and actually requested need within the original objective of the NHII initiative. But for a true Chaordic approach the need for more autonomous collaborative and open exchange must occur. Self interest and proprietary control over processes are creating the friction and resistance to reform. Direct governmental driven programs do not remove and can actually perpetuate the struggles for implementation especially if focus and priorities change due to outside influences (e.g. unemployment, war, pork-belly projects…).

Developing a patient-centric approach is felt to be the most important driver to healthcare reform and the ultimate creating of the NHII and within the patient-centric needs, the Personal Health Records PHR is absolute necessary/required to meet the vision.

Pressure for reform is rapidly approaching a “boiling point.” In California, the issue of rising healthcare cost and increase insurance premiums, 5 have pitted insurance companies against healthcare providers, against patients – everyone is point fingers and blame. The environment is ripe for a “disruptive solution” but will not expect the changes to come from current cast of characters. My sense is that the tipping point will come from a consumer driving demand for change.

PHR hold the greatest promise to healthcare reform and the development of a NHII in that a consumer driven program will “commoditize the data” and “decommoditize” the applications. This will allow for an open market and optimizing competition for service, letting the consumer decide which application makes the most sense based on needs and ability4. The caveat is that a minimum set of feature need to be available in a “basic” program and one that readily accessible to assure universal access to information is possible.

Reason and argument for a separate “internet” for healthcare can be summaries in the need for the following:

1. Access
2. Education
3. Health focus
4. Individualized

With access, it is not simply a matter to have internet connection, the patient need to have a safe and secure means of exchange and protection from unauthorized access. Confidence in a PHR system will require full protection and security for the user. Additionally access and strength of PHR is participation. Bridging the digital divides is an absolute so all “dimension” of a NHII can be realized. Private secured connections with media such as built-in “Healthweb” enable/connected television or handheld (Smartphone) to include video teleconference or store and forward video capabilities will prove valuable for acceptance and compliance.

Education is a challenge! With current internet assurance of high quality and effective education tools prove a struggle given the amount of miss/disinformation that is present. Having a health network has advantage of screening and certifying through “peer-review.” Important to this process is that the material be audience specific and appropriate – which may require a prescriptionThis again will be an effective means of providing consumer confidence.

Personal Health Records allow the individual to become an active participant in the healthcare team. The ability to interact and have access to valuable resources to include secure support groups make PHR and Health network powerful tools.

Individualize care is the ultimate goal of PHR which, in turn provides the integration necessary for the other two dimensions of the NHII Triad. PHR will lead to greater Health provider collaboration and address the overall health of the community, region, nation and perhaps world. We are all linked and the “Healthweb” will provide the conduit for connectivity, collaboration and a Chaordic system .



1Hock, D. (2005) One From Many – VISA and the Rise of Chaordic Organization. San Francisco, CA: Berrett-Koehler Publishers (page 91)

2Hock, D. (1995) The Chaordic Organization: Out of Control and Into Order. World Business Academy Perspectives. Vol. 9, No. 1

3 National Committee on Vital and Health Statistics – United States Department of Health and Human Services (2001) Information for Health: A Strategy for Building the National Health Information Infrastructure Retrieved from http://aspe.hhs.gov/sp/NHII/Documents/NHIIReport2001/report5.htm

4Christensen, C. M., Grossman J. H., & Hwang J. (2009) The Innovator’s Prescription. New York, NY: Mc Graw-Hill (pp 141-143)

5 CaliforniaHealthline (2010, March 8). Anthem Premium Hikes Bolster Democratic Push for Health Care Reform Retrieved from http://www.californiahealthline.org/articles/2010/3/8/anthems-premium-hikes-helping-obama-reignite-push-for-health-reform.aspx