Matt Morgan: Covid-19 and the need for bold decisionsBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2320 (Published 16 June 2020) Cite this as: BMJ 2020;369:m2320
All rapid responses
Matt Morgan calls for better systems of thought and bold decisions and thoughts for Covid-19, mentioning complicated decision making (1).
Covid-19 produces issues that are simple, complex, complicated and chaotic, often overlapping, intertwined and changing, requiring decision making in that context. A system of thought to understand and use this to make bold and better decisions is available in chaos, complexity and complex systems thinking and science, and are being used for bold decisions for Covid-19, with examples/references below.
The Cynefin diagram, proposed as a framework for decision making (2) best describes the differences, relationship, overlap and change re simple, complex, complicated and chaos (3). Simple is straightforward and anyone can handle, complicated requires detailed knowledge, expertise and experts, complex means many changing interacting interdependent parts with unpredictability and uncertain outcome requiring feedback, adaptation and change in decision making, chaos means most things novel with the need for creativity and making some of it up, while trying to move to the other more comfortable phases.
Medicine is complex, especially in the ICU during Covid, but it can be changed by training to simple, complicated, easy and even dull, as described by Morgan, an ICU physician. Similarly for a practitioner in a busy office or the ER – who generally feel at home when others would not be, or for air traffic controllers and restaurant managers mentioned, at home, when we would not be.
This is a novel system of thought that can be used for Covid-19, and is being used for the simple, complex, complicated and chaos of covid-19. A short BMJ letter does not allow me to elaborate, but you can search, with a few random/selected examples given, including specific real world “coal face” practical uses and bold decisions, not just theoretical and conceptual:
Santa Fe Institute, home of complexity, the science for a complex world: research, teaching and transmission of ideas on all aspects of the pandemic to policymakers, governments, decision makers, etc.
New England Complex Systems Institute: stopping the corona virus and endcoronavirus.org - complexity used for research, policy, decision making and practical advice for individuals, groups, governments, etc.,
Stephen Hawking: says he thinks complexity will be the science for the 21st century.
Complexity Institutes, societies, etc at universities, other agencies in UK and globally, addressing Covid-19.
“Complexity Explained” webpage with downloadable PDF, as an intro, Complexity Digest, and posts on complexity Covid including on decision making in medicine, health, health systems, business, etc.
Can Google chaos complexity Covid-19 for many more examples, with a few BMJ eletters submitted by this writer, and pre-Covid-19 – a book on medicine from a complexity perspective, and “Tsunami Chaos Global Heart” book made available free online, subtitled “using complexity science to rethink and make a better world” (3).
Chaos and complexity thinking is proposed as a different and possibly better system of thought for bold decisions and thoughts for Covid-19.
1 Morgan M. Covid-19 and the need for bold decisions BMJ 2020; 369:m2320 doi: https://doi.org/10.1136/bmj.m2320 (Published 16 June 2020).
2 Snowden D, Boone M. A Leader’s Framework for Decision Making. Harvard Business Review Nov 2007. https://hbr.org/2007/11/a-leaders-framework-for-decision-making Accessed April 20, 2020.
3 Rambihar VS, Rambihar SP, Rambihar VS Jr. Tsunami Chaos and Global Heart: using complexity science to rethink and make a better world. 2005. Vashna Publications. Toronto, Canada. http://femmefractal.com/FinalwebTsunamiBK12207.pdf (accessed June 20, 2020).
Competing interests: No competing interests