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Lessons from a Rubik’s Cube in solving health IT challenges

We have all become used to simple problems. Like a jigsaw puzzle, they all follow the same rules and we can solve them using the logic that we learnt previously. Complex problems are less comfortable. They require a new set of skills. It’s like moving to a 3D puzzle from a traditional flat one. But if we adapt what we know and try some new skills, we will be able to solve the problem.

I was 14 when I was given a Rubik’s Cube. In 1980 the cube didn’t come with a solution. Google didn’t exist. I would invest hundreds of hours trying to solve the cube. The first thing you learn is that you wished you hadn’t muddled the cube up. In its initial state, any sequence of movements has a consequence that can be understood. In a muddled state the same is not possible.

I shared the cube with my friends. We began to work together. There were tasks that emerged. The most crucial was unexpected. We needed a method of writing down what we did so it could be repeated. We invented a language of cube experimentation. Moving in set patterns would allow us to move a piece from one place to another. Ultimately, we would solve the cube, but more importantly we had a way of writing it down so that others could copy.

The Rubik’s Cube represents a wicked problem, and one that needed a new type of solution. It reminds me of the ultimate wicked problem: healthcare.

Medicine is getting more complex. Patients are on more medications. They are cared for by more people. Evidence grows at exponential rates. The information that one clinician needs to be able to provide best care is enormous. Worse than the quantity, however, is the rate at which it changes.

At an organisational level we have paper notes with paper prescribing. We now have two warehouses that store our paper notes. That costs money. Providing notes to care for patients becomes a logistical nightmare. Co-ordinating care across organisations is increasingly difficult.

This wicked problem will not be solved using the solutions we know. Better logistics, bigger warehouses or better training are the solutions we have tried. It’s time for IT systems to be allowed to manage data, implement care pathways, remove clinical variation and stop logistic problems. Doing so however will require lots of people with lots of skills. We will need a new language and a new set of skills – just as my friends and I did with our Rubik’s Cube.

The story of the Rubik’s Cube and the Wicked Healthcare Problem struck a chord at Wrightington, Wigan and Leigh NHS Foundation Trust (WWL). The Cube became something of a symbol of what we were looking to achieve with a new Health Information System (HIS), which is Allscripts Sunrise™ platform.

Later, when we were looking for a logo, the HIS cube evolved:

It’s there to remind us why we started this work in the first place, and the role that we will all have in solving the problem.

Because while complex problems are less comfortable, we can adapt, work together and develop new skills to unravel any challenge. With this approach, no problem is too wicked to solve.

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