Irving Wladawsky-Berger

What Doesn't Kill Us Makes Us Stronger

Complex systems, whether natural or engineered, are composed of many parts.  But it’s not the mere number of components that makes them complex.  After all, stones are composed of huge numbers of molecules, yet we would not consider them complex.  A truly complex system consists of many different kinds of parts, intricate organizations and highly different structures at different levels of scale.  Humans, bacteria, advanced microprocessors, modern airplanes, global enterprises, healthcare organizations and  urban environments are all examples of complex systems exhibiting these massive, heterogeneous, intricate characteristics. 

What makes these systems so complex?  Whether they were designed by humans or evolved in nature, why aren’t they simpler?  What purpose does this complexity serve? 

A few years ago I heard a very interesting talk addressing these questions by Cal Tech professor John Doyle.  The talk was based on a paper, Complexity and Robustness, which he co-authored with professor Jean Carlson from UC Santa Barbara. 

According to Carlson and Doyle, you can find very simple biological organisms in nature, and you can design very simple objects.  The key ingredient you give up is not their basic functionality, but their robustness - that is, the ability to survive, for biological organisms, or to perform well, for engineered objects - under lots of different conditions, including the failures of individual components.  Robustness implies the ability to adapt and keep going in spite of a rapidly changing environment.

Complex Sociotechnical Systems: the Case for a New Field of Study

Digital technologies are enabling us to develop systems with huge numbers of interconnected components and sophisticated software that infuses them with seemingly unlimited capabilities.  They are penetrating just about every nook and cranny of the economy and of society in general.  And, they are profoundly changing the way all organizations operate, as well as our working and personal lives. 

We are increasingly able to pull all these capabilities together and develop sociotechnical systems, which combine the powerful, inexpensive and ubiquitous digital technologies with the people and organizations they are transforming.  But, we have much to learn on how to best design and operate these systems.  They generally exhibit a level of complexity that is often beyond our ability to understand and control.  Not only do they have to deal with the complexities associated with large scale hardware and software infrastructures, but with the even more complex issues involved in human and organizational behaviors. 

A few weeks ago, MIT professor Joseph Sussman addressed these issues in a lecture - Complex Sociotechnical Systems: The Case for a New Field of Study.  Sussman is Professor of Civil and Environmental Engineering and Engineering Systems and interim director of the MIT Engineering Systems Division. 

Complex sociotechnical systems are high-impact, difficult-to-understand, technology-intensive systems that have major societal, political and economic implications.  While this definition can rightfully apply to many of the systems we have been developing in the last few decades, their importance is on the rise now for two major reasons. 

We are increasingly using systems thinking to address some of our most critical contemporary problems including climate change, energy and the environment, cities and metropolitan areas, jobs and productivity, the global economy, financial systems and national security.  At the same time, we now have the technologies, tools, engineering methodologies and scientific principles to be able to better design and manage such systems.

The Emergence of Cognitive Computing

On October 21 I participate in a Colloquium on the Frontiers of IT at IBM’s Thomas J Watson Research Center.  The colloquium, - which was part of IBM’s Centennial celebration, - brought together experts across industry and academia to discuss and debate the direction of four key Grand Challenges at the very leading edge of IT:  nano systems, exascale, big data, and cognitive computing.

John Kelly, senior VP and director of IBM Research, gave an overview of these four areas.  Here is a similar version of his talk given a week earlier at the University of Melbourne.  John explained that these four areas have the potential to transform the IT industry because of their exponential growth, a result of both continual improvements and disruptive innovations.  “Exponential curves,” he said, “will either put you ahead of the competition of kill you.  It’s one of the other.”

Over the next decade, nano-devices are expected to advance by three orders of magnitude, from a billion to a trillion transistors in a chip.  We will be able to design sophisticated, powerful nano systems-on-a-chip that will be totally contained within such a trillion transistor nano device.  To do so, we will have to shift from silicon to other carbon-based materials.  This requires disruptive technologies and innovations at all levels, including new materials, fabrication processes and design tools.  The work is underway.

The MIT Systems Thinking Conference

I recently participated in MIT’s 2010 Systems Thinking Conference for Contemporary Challenges.  This annual conference is sponsored by Systems Design and Management (SDM) - an interdisciplinary program between MIT’s School of Engineering and Sloan School of Management.  The SDM program aims to provide mid-career professionals with a systems perspective that will help them address and solve large-scale, global, complex challenges.  Most of the students in the classes I have taught at MIT are enrolled in SDM.

The Systems Thinking Conference is intended to showcase innovative ways of addressing complex challenges, in particular, how to integrate technology, management and social sciences to successfully solve very tough problems.  The agenda included sessions on sustainability and urban systems, health care and services.  The talks covered a wide range of subjects, from the global development of Boeing’s 787 to the home of the future.  I was co-organizer of the session on service systems, gave a talk on Technology and Innovation in the Service Economy and moderated a panel with the other speakers in the session.

John Sterman - professor in MIT’s Sloan School of Management and director of the Systems Dynamics Group - gave a very interesting talk: A Banquet of Consequences: Systems Thinking and Modeling for Climate Policy.  The title of his talk is based on a quote by Scottish writer Robert Louis Stevenson: Everybody, soon or late, sits down to a banquet of consequences.

Lessons from the Rescue of the Chilean Miners

I first visited Chile about 25 years ago, and have continued to do so from time to time, most recently in September of 2009 when I went to Santiago to join in the celebration of the 80th anniversary of IBM Chile.  I will return in a few weeks to participate in the Smarter Cities meeting that IBM is holding in Santiago on November 23.  Over the years, I have met, worked closely with, and established personal connections with a fair number of people in the country.

This personal connection added an extra dimension to my interest in the rescue of the 33 Chilean miners, although the rescue story has been so compelling that I am not sure anything extra was needed to capture my attention.  Along with a large portion of the world, I was transfixed by the rescue of the miners. Would everything work as planned?  What if something went horribly wrong as we were all watching on live television?  Disaster movies have taught us that just as you become confident and relaxed, things start going haywire.  Would that happen here?

Thankfully, everything went smoothly.  There was indeed a lot of drama, but it was all provided by the emotional reunion of the miners with their families as each reached the surface, as well as by the warm welcome they each received from everyone present, including Chilean president Sebastian Piñera and mining minister Laurence Golborne.  We held our breaths from the time the first miner, Florencio Ávalos started his ascent right before midnight (Chile time) on October 12, to the time the last one reached the surface less that 24 hours later, Luis Alberto Urzúa, their shift supervisor and overall leader.

A lot of the attention is now likely to focus on how the miners and their families deal with their new celebrity status and potential financial rewards.  Everyone agrees that while their fame may be lucrative, it will also be stressful.  There will be lots of opportunities for public appearances, press and TV interviews, and possible book and film deals.  Some will undoubtedly find their new fame too stressful and will yearn for their simpler lives as miners.

Values, Trust and Reputation in an Increasingly Complex World

Both present and future leaders expect the business environment to grow significantly more complex over time.  This is one of the main conclusions of two recent studies conducted by IBM, the 2010 Global CEO Study, and the companion student study, Inheriting a Complex World.  CEOs and senior government leaders - who I presume are mostly in their 50s and members of the Baby Boom Generation, - said that their primary challenge is figuring out how to operate in a world that is substantially more volatile, uncertain and complex.  The students, on the other hand - mostly Millennials in their 20s, - understand implicitly and intuitively that economies, societies and organizations are interconnected and interdependent.  They don’t even need a definition of complexity, since that is the only world they have ever known.

These two generations of leaders, - one at the top of their careers and the other about to start out on theirs, - are reacting to the changes all around them in distinctly different ways.  The Boomers keep replaying the ideological and cultural battles with which they grew up.  “What degree of government regulation is needed to help curtail the kinds of abuses that led to the ongoing global financial crisis?  Are self-regulated free markets always the best answer?  What does it mean to live in an increasingly multicultural society?  Should society accommodate to the different kinds of nuclear families all around us?

The Millennials are in a very different space.  They don’t need to keep defending market economies against communism, as this issue was settled with the fall of the Berlin Wall and the subsequent collapse of the Soviet Union, which happened when they were little or even before they were born.  They have generally grown up and are comfortable living in a much more diverse environment.  They have had openly gay and lesbian friends since high school.  Get a life is what I imagine they are thinking when they hear the tired ideological and cultural debates of the older generations.

Growing Up in a Complex World

Several weeks ago IBM released its 2010 Global CEO Study.  This is IBM’s fourth and largest CEO study since 2004, based on more than 1,500 face-to-face interviews with CEOs and senior public leaders from more than 60 countries.

I wrote about the CEO study in this recent blog.  The primary challenge emerging out of the CEO conversations was complexity - the fact that CEOs now operate in a world that is substantially more volatile, uncertain and complex.  They feel that incremental changes are no longer sufficient because the world is operating in fundamentally different ways.  The study concluded that Standout organizations - those that have been able to deliver good business results despite the recent economic downturn - feel much more prepared to capitalize on complexity by focusing on three key areas:  embodying creative leadership, reinventing customer relationships and operational dexterity.

On June 14, IBM released a companion to the CEO study, this time focusing on the views of young people, members of what is often referred to as the Millennial Generation or Generation Y.  Inheriting a Complex World: Future Leaders Envision Sharing the Planet invited graduate and undergraduate students to participate in a Web-based survey between October 2009 and January 2010.  More than 3,600 responses were received from students in more than 40 countries.  They were pretty evenly split between undergraduates and graduate students, as well as between emerging and mature markets.  More than two thirds were between 20 and 25 years old.

Smarter Public Health

The increased importance and fast rising costs of healthcare in the US and many other countries are causing a much greater interest in the subject of public health - “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.”  

We are all very familiar with the fierce political debates surrounding US healthcare reform, which culminated with the historical Health Care Act of 2010 signed into law by President Obama on March 30.  But healthcare is not only a major political challenge, but one of the grandest overall challenges facing the world in the 21st century.  

The problems are enormous at multiple levels.  Healthcare involves lots of people and institutions - patients, insurers, device manufactures, pharmaceuticals, advocacy groups, biotech, research institutions, IT companies, governments of all sorts, state licensing, state insurance commissioners, and on and on and on.  And this is before you get to the provider side, which involves doctors, nurses, hospitals, pharmacies, non-traditional providers, medical schools, and others.

History in the Making

I have been transfixed by the long health care reform debates in the US, which finally culminated with the House of Representatives passage of the health care reform bill on March 21, and which President Obama signed into law two days later.  The House also passed the reconciliation bill which the Senate subsequently approved on March 25.  The health care reform bill is now the law of the land.

This bill joins other landmark social legislation, like President Roosevelt’s 1935 Social Security Act, and President Johnson’s 1964 Civil Rights Act and 1965 Medicare and Medicaid Acts.  And, like those previous bills, you cannot analyze their pros and cons in purely tactical terms.  You have to focus on the impact of such landmark legislation on the long term evolution of the country.  You have to look at the 2010 health care legislation as history in the making.

There is no question that this legislation is imperfect, perhaps considerably so.  But there is also no question that health care in the US has been frozen in decades-old models that no longer work.  As many have pointed out, despite expenditures that are significantly higher than those of other industrialized countries, US healthcare performance has been declining relative to these countries on just about all key indicators of health, including quality, access, efficiency and equity.  Unique among industrialized countries, over 15% of the US population lacks health insurance, which according to several studies, is responsible for tens of thousands of unnecessary deaths every year.

The status quo was unacceptable.  Something had to be done.  Most of us would agree that, the US is better off for having passed social security in 1935, and Medicare and the civil rights act in the mid 1960s.  The key question we must now ask is whether years from now, our country will be better off as a result of our having just passed these health care bills.

The Healthcare Reform Debates

The ongoing US healthcare debates - or is civil war a better description? - remind me how incredibly hard it is to bring about disruptive transformations of any kind. 

In my experience, organizing disruptive transformational efforts is very difficult.  I learned this first-hand at IBM with efforts like the Internet initiative in 1996 and the Linux initiative in 2000.  Given that the organizational complexities go way, way up with the size and scope of the initiative, I am not surprised how incredibly difficult it has been to try to bring about the badly needed transformation of healthcare across the whole country.

A transformational initiative is subject to very different organizational dynamics from more incremental ones.  With incremental initiatives, you are looking to improve something that already exists in the marketplace - e.g., better products and services, higher customer satisfaction, increased overall efficiency.  Because you are improving something with a history, there is lots of information that can be analyzed to estimate the impact of the improvements on the business.  You can make a case for the improvements based on quantitative, fact-based, rational arguments.

Not so for initiatives based on disruptive technologies or ideas.  Disruptive transformations are, indeed, disruptive.  They are a break from the past, either because past approaches no longer work and are getting us into deep trouble; because a new technology or idea now offers us much better opportunities; or both.  But, while the changes might be absolutely essential, it is important to keep in mind that you are asking people to move from something that, while imperfect and flawed, they are familiar with, into unknown, most likely uncharted territory.

Reflections on Smarter Healthcare Systems: Practical, Concrete, Expert Advice

On October 1 and 2 IBM held its second global Smarter Cities conference in New York City.  I subsequently wrote about the excellent talk, Great Expectations for US Healthcare, given by Dr. Denis Cortese, CEO and President of the Mayo Clinic on the first day of the conference.

The next day, there were break-out discussions in six key areas relevant to building a smarter city: transportation, education, public safety, energy and utilities, government services and healthcare.  I was co-moderator of the healthcare session, along with Dan Pelino, IBM’s General Manager of Healthcare and Life Sciences.  Our panel of experts included Dr. Cortese; Chris Coburn - Executive Director of Innovations at the Cleveland Clinic; Dr. Ronald Paulus - Chief Technology and Innovation Officer at the Geisinger Health System;  and Dr. Armando Ahued Ortega - Health Secretary of Mexico City.  Let me summarize their practical and concrete remarks.

Designing a Smart Healthcare System

On October 1 and 2 IBM held its second global Smarter Cities conference in New York City.  The first such conference was held in Berlin this past June, and the third will be held in Shanghai next year.

As was the case with Berlin, the New York Smarter Cities event had a very impressive agenda.  It included talks by IBM Chairman and CEO Sam Palmisano, New York City mayor Michael Bloomberg, and Melody Barnes, Director of the White House Domestic Policy Council.  The agenda also included panels with governors, mayors, and leaders of cultural institutions. 

In addition, there were break-out discussions to enable participants to share their experiences on what it takes to build a smarter city in six key areas: transportation, education, public safety, energy and utilities, government services and healthcare.  I helped organize and moderated the healthcare session.  Our panel included Denis Cortese - CEO and President of the Mayo Clinic; Ronald Paulus - Chief Technology and Innovation Officer at the Geisinger Health System; Chris Coburn - Executive Director of Innovations at the Cleveland Clinic; and Armando Ahued Ortega - Health Secretary of Mexico City.

The Health Care Debates, Tribalism and The Golden Rule

Earlier this summer, I was in Berlin to participate in a Smarter Cities conference hosted by IBM.  I had not been to Berlin in a while, and was looking forward to seeing it, especially since it is one of my daughter’s favorite cities in the world.  I was not disappointed.  Berlin is a very nice city indeed, with lots to see and do, full of young people and positive energy.

But, you cannot visit Berlin and not be struck by its history, especially if you are Jewish.  Its Memorial for the Murdered Jews of Europe is haunting in its simplicity.  Newsreel images of Berlin Nazi rallies sweep through your mind.  And a question keeps coming up.  What happened?

Richard von Weiszacker, - who was mayor of the then West Berlin from 1981 to1984, and President of Germany from 1984 to1994, which included the fall of the Berlin Wall and the reunification of  East and West Germany, - spoke at the conference on the history of Berlin. He reminded us that before the Nazis came to power in the 1930s, the city was the intellectual center of the world.  People everywhere learned German to be able to read the best textbooks and academic journals in their fields, much as they do now with English.  How could such an advanced civilization engage in such monstrous acts?

Numerous books have analyzed this question.  The answer that makes the most sense to me is rather simple.  Civilization is a relatively recent and thin veneer on human behavior.  People are capable of terrible actions against their fellow men, especially when they are under severe stress and are incited to blame others for their fears by skillful demagogues.

The Innovator's Prescription: A Disruptive Solution to Health Care

Clayton Christensen is Professor of Business Administration at the Harvard Business School.  He is one of the world's foremost thinkers in strategy and innovation. In particular, Clay – since I know him personally, I feel I can call him by his first name - is an expert in dealing with disruptive innovations, developing organizational capabilities and finding new markets for new technologies.  In addition, he has a major quality that distinguishes him from most experts.  Not only does he repeatedly come up with great ideas, but he also comes up with innovative ways of communicating his ideas so that they are accessible to lots of people in the business world and the general population. 

Clay is also an accomplished writer.  His first book, The Innovator's Dilemma is a classic.  His second book, The Innovator's Solution - co-written with Michael Raynor – is a comprehensive guide to innovation in all aspects of a business.  I use it extensively in my MIT graduate seminar.

His new book, The Innovator's Prescription: A Disruptive Solution to Health Care - co-authored with Jerome Grossman and Jason Hwang, - is scheduled to come out on September 19 of this year.  When I learned that he is co-author of a new book on health care, I quickly invited him to MIT to give a public lecture on the subject.  Clay came to MIT last month, and not only was his seminar - which can be seen here - excellent because of its fascinating content, but it could also serve as a master class on how to discuss a very complex subject in an accessible, interesting and elegant way.

A Grand Challenge Crying Out for Leadership

The November 25 Sunday New York Times included yet another editorial bemoaning "The High Cost of Health Care."  It is a good editorial, and I generally agree with both its list of Causes as well as its recommended Solutions.  But I wonder if anything will come of it.

The editorial points out that "health care costs are far higher in the United States than in any other advanced nation, whether measured in total dollars spent, as a percentage of the economy, or on a per capita basis."  This would be fine, or at least tolerable, if the U.S. enjoyed a quality of health care commensurate with its higher costs.  But as we well know, this is not the case. 

The Commonwealth Fund, a private foundation, reported in a recent article, "Despite health expenditures that are twice those of the median industrialized country, a new national scorecard of U.S. health care system performance finds the nation falls short on key indicators of health outcomes, quality, access, efficiency, and equity."  It goes on to say that "Among 19 industrialized countries, the U.S. ranked 15th on mortality from conditions amenable to health care, or deaths before age 75 that are potentially preventable with timely, effective care. The U.S. rate was more than 30 percent worse than the benchmark—the top three countries. The U.S. also ranks at the bottom for healthy life expectancy and last on infant mortality."

There is nothing new here.  We have all been reading editorials and reports like these for a while now.  Calls for action abound.  Among the top recommendations of the 2004 U.S. National Innovation Initiative was a call to build a health care test bed, including electronic health reporting, standards for an integrated health data system, pilot programs for international exchanges on health care research and delivery, and the use of performance-based purchasing agreements.

Finally, the 2005 report, A Healthy System issued by the Technology CEO Council, concluded, "If there's one thing that everyone agrees on about the U.S. health care system, it's that it isn't, in fact, a system," and that "the sad truth is that in health care today the whole is much less than the sum of its parts."  The report went on to say, "We will never fix this problem simply by tinkering with its parts. As a practical matter, and as a moral imperative, we have to address the systemic problems of health care.  And the most glaring - and promising - is health care's shocking lack of modern, networked information technology (IT), and the lost quality and efficiency that result."

Applying "Lean" Thinking to Healthcare Solutions

The second Innovation Lecture Series: Engineering Systems Solutions to Real World Challenges took place on December 14 at MIT.  The series is co-sponsored by MIT's Engineering Systems Division and IBM's University Relations as part of its Skills for the 21st Century initiative.  The first lecture in the series was held in October and featured IBM's Senior Vice President Linda Sanford, discussing the IBM transformation initiatives that she leads.    

The Innovation Lecture Series are delivered by business and technical leaders, who discuss their concrete experiences in leveraging technology and engineering capabilities to address complex problems in their organizations.  This past lecture focused on healthcare and featured three top executives of the Vassar Brothers Medical Center, a regional medical center and hospital in New York State's mid-Hudson Valley: Dr. Daniel Aronzon, President and CEO; Nicholas Christiano, Vice-President and CIO; and Dr. Stephen Katz, Chief Medical Officer and Senior Vice-President of Medical Affairs.  A webcast of the lecture as well as additional materials are posted in the Innovation Lecture Series web site.

Building Open, Collaborative Health Care and Education Platforms

I wrote in a recent blog that "the Internet showed everybody how much more valuable IT is when you can connect and access everything regardless of vendor, and started the IT industry on a whole new strategy based on embracing open standards."  The Internet enabled IT to become an open, global platform for innovation, in particular a platform for open, global, collaborative innovation.