With or Without You? An Organizational Dilemma

We often get to know of cases in which the interaction between individual and organization is ineffective. A typical example that often finds the front pages of newspapers is that of people who, for instance due to an accident, are in difficulty when interacting with care service organizations. A few examples may help understanding the matter:

1. Newborn child dies in the ambulance before reaching a hospital.

   After a normal delivery, the newborn accused difficulty in breathing. The doctors tried in vain to locate a hospital where she could be transferred. The emergency service initiated a monitoring in the three hospitals in Catania in which pediatric intensive therapy is available: the Garibaldi, the Holy Child and Cannizzaro. None of the three centers had a free bed. The only hospital in eastern Sicily that responded to the call was Ragusa, more than a hundred miles away, a good hour travel. But the little girl died during transport in a private ambulance.

2. Girl dies of common cold while looking for a hospital.

   [...] A hospital in Milazzo (IT) does not have an Intensive Care Unit, and none was available in any of the other hospitals in the Milazzo province. Eventually, a place is found 200 miles away, in Caltagirone, on the other side of Etna. Two hours driving. A young girl dies.

3. 52 years old man died yesterday aboard an ambulance, while looking for a hospital in which to be operated for a double aneurysm.

   The sick was transported to the hospital Umberto I. There, unfortunately, cardiac surgery was 'locked' for technical issues since March 24. Rossella Moscatelli, deputy director of health at the Umberto I hospitals explains: "For two weeks we have been communicating to all hospitals, including Colleferro, and the emergency service, that the temperature controllers were out of order." These devices are essential to run the machinery for extracorporeal blood circulation during open heart surgery. Yesterday the new temperature controllers, just tested, "were in operation for two planned by-pass surgeries - she adds - and Colleferro was informed only five minutes before of the arrival of an ambulance: as they tried to locate in the city another hospital available, we attempted to stabilize the patient. After about two hours we manage to find one hospital available, the San Camillo. For the patient, however, it was too late. Simona Pasca of “Cittadinanza Attiva -- Tribunal for Patients' Rights” remarks: "If hospitals were better connected to each other, that patient might be still alive. The problems of the [classic] organization of emergency repeat themselves cyclically, and patients continue to die."

Other cases may be found here and here. As can be clearly understood from the above cases and the wise words by Simona Pasca, the challenge here is to tackle this problem and reformulate the care system into a “smarter”, more resilient organization such that the above dreadful cases, and similar ones, do not occur anymore.

I believe a starting point towards a solution may be found through the following reasoning:

If I analyze all the above cases I can see three recurring elements:

1. An event takes place and creates a new “need”
2. The need requires a response from a care institution
3. The interaction event-institution is almost completely managed by the individual or by individual parts of the overall care system. The system does not work as a Whole, but rather as a collection of fragmented units.

The disadvantages of the above scheme are clearly demonstrated by the reported cases. In particular, the limited knowledge that the individual and individual parts of the system have about the available resources and their state often traslates in time-consuming and error-prone queries (“pollings”). An answer to this problem cold be given by the engineering of a novel form of organization: the Fractal Social Organization (FSO) (cf. previous post here.)

Such new organization is based on the following “axioms”:

• Member. An individual or a cyberphysical thing can subscribe to a FSO and become member. Members of a FSO belong to a level of the FSO (a “community”) and refer to a representative of that level (“community representative”). The community representative is the “personification” of that level/community and has a dual nature: it is a member of the community it represents and it is also a member of the next higher level/community.
• Role. A member can take a role, namely accomplish actions belonging to a certain class of actions (surgeon-, driver-, nurse-, patient-specific actions...)
• Notification. A member can send notifications to its community representative. These notifications can be status notifications, requests for service, availability of service, etc.
• Check Up. For each new notification the community representative performs a semantic check: it verifies whether the new notification "enables" actions. By “Action” I mean a function of roles that become active when all the necessary “ingredients” (i.e., roles) are available (cf. Dataflow processing; Tomasulo algorithm, etc.)
• Exception. If an action is semantically labeled as “critical”, the lack of a role triggers an exception: the community representative propagates the notification to the next “higher up”.

(It is important to consider that an FSO can also be a member of a community; this translates into the “fractal” structure of FSOs.)

A new “general scheme of operation” enabled by a FSO is then as follows:

1. An event takes place and creates a new “need”
2. The need requires a response from a care institution
3. The institution acts as community representative and manages the response locally. If an optimal response can be found within the community (or, in other words, all roles can be allocated in the current “region”), the response in enacted and the state is adjusted. If no optimal response can be found, an exception propagates the need and the current response state to the community higher-up. Both need and response “travel” through the levels of the FSO hierarchy until the response is finally enabled.
4. While being executed, new knowledge is accrued both locally and globally. The response is thus refined, re-verified, and if (safer, cheaper, higher performing) alternatives are found, they are considered.

Organizational evolution is clearly a very ambitious and risk-taking endeavor. Among the many challenges that needs to be tackled are the following ones:

• Enable existing organizations to become members of an FSO. This will make it possible for existing organizations, e.g. one dealing with emergency care and one managing civil defense, to join forces and share resources and knowledge.
• Enable fast localization of resources (Example: e-Procurement, as in SHINE: Secured Health Information Network Exchange)
• Enable a “natural” (institutional) use of informal carers, and the social “network” centered around the user (its family, friends, etc...)
• Enable non-discrimination of members (an FSO casts no predefined classes of users, as “classic” organizations have: for instance, primary users, secondary users, patients)
• Enable “best use” of social resources (hospitals, equipment and skilled personnel, ...)
• Avoidance of resources being either underutilized or overutilized (cf. Service queues...)
• Enabling optimal responses to crisis management, in particular with the spontaneous integration of informal responders: cf. COMMUNITY RESILIENCE.

Traditional organizations are becoming more and more inadequate and chaos-prone by the minute. In the light of the new scenarios in which resources are getting scarcer and populations bigger, the “old ways” in the organization of human activities reveal all their limitation. We can't live with them; but we can't live without them either. What then?

The time is Now for experimenting with new and more intelligent ways of organization and management of resources. Turning around the current paradigm and having the organization tailoring an optimal response to the user's requests may provide mankind with one such way.

Evolving human organizations -- and learning how to do so without compromising the identity of the intended services -- is verily one of the greatest challenges humanity shall soon be confronted with.

With or Without You? An Organizational Dilemma by Vincenzo De Florio is licensed under a Creative Commons Attribution 4.0 International License.
Permissions beyond the scope of this license may be available at mailto:vincenzo.deflorio@gmail.com.