PHILADELPHIA--Researchers from the Organizational Dynamics Program at the University of Pennsylvania hosted a meeting on April 29 designed to encourage participants to view survival from sudden cardiac arrest (SCA) occurring outside hospitals from a perspective that challenges current thinking. Co-Chairs, Larry Starr, PhD, and Allan Braslow, PhD, described three ways to think about the world:
- Narrative (stories, personal experiences)
- Research/Analytic (controlled studies, evidence-based criteria)
- Design/Systemic (creation of something new based on what is desired).
The organizational dynamics team at Penn then proposed that SCA survival is not a complicated problem that can be deconstructed to analyze and optimize components using the Research/Analytic method, but rather a complex problem—or in management science terms—“a wicked problem" or a "mess.”
According to Starr and Braslow, “A wicked problem is characterized by strongly interacting events that produce confusion, conflicts, and failures within large organizations, communities, and environments that prevent the main goal—in this case, survival—from being adequately accomplished.”
Consequently, they said, the linear method of deconstructing, analyzing, and optimizing the components of what is now considered the ideal response system, the "Chain of Survival" (early EMS access, early CPR, early defibrillation, and early advanced care), must be paired with systems thinking to improve SCA survival rates, which have languished at about 7% for decades.
Specifically, SCA survival must be considered with a different mindset that takes multiple environments and influences into account, including:
- Stress reactions
- Family, social, and organizational cultures
- Economic forces
- Regulatory factors
- Multiple stakeholder groups
- Personal interests.
The systems method considers the environmental influences on components, rather than the components themselves. It uses a process of "synthetic expansion," which encourages openness and creativity and is designed to eliminate the fear of loss--an obstacle to linear thinking.
Meeting participants were asked to consider these influences and use the Design/Systemic Method to create an ideal system from scratch, assuming nothing is in place, nothing needs to be changed, and there are no financial limitations.
The results of the brainstorming session will be reported soon on the Penn Organizational Dynamics website, as a starting point for community review and input. Following this, interested parties will be invited to participate in creation of an ideal system, using crowdsourcing.
Who Was There?
Faculty included representatives from:
- University of Pennsylvania Organizational Dynamics
- University of Pennsylvania Center for Resuscitation Science.
Invited participants included representatives of:
- American Heart Association
- American Red Cross
- Children’s Hospital of Philadelphia
- Emergency Training Xcellence
- Greenwich, CT, EMS
- National Safety Council
- Penn State University
- Philadelphia University
- Philips Healthcare
- Sudden Cardiac Arrest Foundation
- University of Pittsburgh
- University of Texas
- Zoll Medical.
Also participating was Guy Knickerbocker, MD, one of the inventors of CPR.
Related article: http://www.sca-aware.org/sca-news/sca-survival-a-wicked-problem