Cybernetic Applications and
Health-Care
Julien Libbrecht
Motivations
-Increasing needs and costs of health-care and health care
systems in the future
-Increasing difficulties on behalf of health-care workers in
their relation with patients: complexification and differentiation
of relations, stress, burn-out, early exit,…
-Increasing demands in performance of the workers, the institutions
and the system on macro-scale
Why cybernetics?
-Art and science of regulation and control
-Health-care is regulation of health-condition of patients
and regulation of systems
-Applicability of cybernetics in a broad range of domains:
economy, sociology, biology: many activities in almost
every branch of science and life.
-Cybernetics: art of managing relationships (also by
quantification)
Tree different elements
Common terms
-Two players: patient and care provider (in the most
simple form)
-Tree elements as basic system:
Patient (D), care provider (R) and outcome (E)
-One desired outcome: patient’s health or healthstabilisation (idealised expectation)
Tree elements
Cybernetic terms (Ashby)
Patient: disturbance or variety inducer
Amount of different problems
Care provider: regulator
Amount of different responses
Outcome: amount of different results
Conceiving variety
-Each element has variety of a certain amount
-The amount of variety depends of both the element and the
observer of the element (we must be aware of the trap of the
detached observer: he does not exist)
-One’s variety is determined, it can be measured
-Measuring variety is the beginning of knowing it
-Knowing it is the beginning of handling it
Conceiving variety
-Variety reflects a state of a element at a certain moment
-The element will always be composed of parts or components
that can change in function of time
-This element will be called a vector
-The components of the vector can have different values
-Change of the vector always means change of values
Variety and constraint
-Variety and constraint are intimately interlinked
-Variety without constraint is not conceivable
- Constraint sets a limit on variety and enables us to handle
the world
- Constraint makes things predictable
- Constraints are the rules for every transformation
Transformation
-Transformation is always the action of an operator on
an operand with transform as result
-Transformation can be closed or open
In theory, every transformation on an unlimited number
of operands can result in an unlimited number of
transforms
In practice, a transformation operates under certain rules
or constraints, e.g. the transformation of the embryo into
a foetus will occur under certain constraints
Transformation
-A transformation can be single valued or multiple valued:
Single: when each operand will be transformed in one
transform
Multiple: when each operand will be transformed in many
transforms
-A transformation can be single valued and one-one, when each
operand corresponds with a different transform
-In all other cases they will be of the many-one type
-Another type of transformation (the most frequent one) is the
identical transformation
Formalisations
Open, single-valued, one-one
A
B
C
T
B
C
D
T1
C
D
E
T2
D
E
F
Formalisations
Closed, single-valued, one-one
A
B
C
T1
D
A
B
T2
D
D
A
T3
D
D
D
Formalisations
Ph
(T1)
Ps
(T2)
Ps
(T3)
Ph
Ps
Em
1
0
0
1
1
0
1
1
1
Variety and health-care
-Every patient is a vector with different possible values
-Every patient can have an infinite number of values
-Every care provider is a vector which can take a limited number
of values
-The variety of the outcome is the different possible values
the outcome can take.
-The table T is the system (unit, hospital,…) which provides the
outcome.
Confronting variety
Vo
Vd/Vr
R
Int
Ph
D
Ps
H
Psy
H
Soc
Em
Soc
T
H
C
Re
C
Agr
C
E
The Law of Requisite Variety
-Only increasing variety of R can force down the variety of
outcomes
-To force down the variety of outcomes, the variety in
R must increase
Vo >or = Vd / Vr
-Only variety can destroy variety
-If we want the outcomes to take one value, the variety of R must
be at last equal to that of D.
Variety of patients and care
providers
-How to control the patient’s variety?
-The variety of patient needs is in most cases larger than
the variety of care providers.
-The classic way of confronting variety of patient needs is to
enlarge the variety of the care providers so that
Vd = Vr or
Vo = 0
The art of Regulation
-Care providers are in se regulators who transform patient
needs in one outcome: stabilisation, health,…
-The aim of cybernetic approaches consists in investigating
the ways in which this regulation can be reached in the most
effective way
-The most effective way to do this begins with accepting
the law of requisite variety and to investigate the ways of
organising care taking into account the law.
Requisite variety
The Art of Regulation
16st
Ph
Ph
1
Ps
0
Psy
0
1
Em
0
0
Env
0
0
What’s regulation?
-Regulation is the way the regulator follows to transform
the input of D into a certain range of desired outcomes.
-The only way for the regulator to do this is to fully take into
account the variety of D.
-Without respect of the law, the regulator fails in his mission:
suffering and decline of the whole system are the result.
Regulating health-problems
Three questions – three answers :
-Confronting patient’s problems = defining the set of problems
- When the patient’s problems are known, define the target: result
- How can we transform the problems in the target: desired
Outcome?
Defining the problems (D)
R
D
Ph
Psy
Em
Re
So
Agr
?
?
Vd = 64 (possible states) = log2 = 5.17
Defining problems (D)
-Different aspects as components of one problem or vector
-Each component can have two possible values (0-1)
-Variety of the D-vector = 64 different states
-Describing patient’s problems = result of an interaction process
-Defining patient’s problems = first important step in delimiting
variety on the input of the system T (blocking).
Defining outcome
1 = pos. Outcome (target)
R
D
Ph
Psy
Em
Soc
Rel
Agr
Int-chir
Psy
1
1
Vo = or > D / R
Defining Outcome (E)
-Limiting outcome = enlarging R
-If outcome is limited to 1 value (1), Vr must be = Vd.
-Health-care is idealistic because it claims a limited set of
outcomes
-Health care providers must be precise in formulating outcome
and results.
Possible solutions
Increase Vr
-Vr = Vd
-Certain components of R becomes multi-functional: increasing
the competence of certain components of R.
-Increase the competence of R .
-R ‘s possibilities aren’t illimited
- Paradoxical with spcialisation
Decreasing D
-Division of D in different components
-Block Vd = selection in variety of components of D
Patient information: what can the patient expect?
-Sequentialisation of the transformation: stochastic problem
transformation of components
-Transform certain components of D in components of R
Implication of patients in the treatment.
-Clustering of different components
Increasing Vo
-Non-limiting the possible outcomes: compound target
-Non-defining the target
-Defining the possibile outcomes in function of Vr
The Anatomy of Health-Care
Five Functions
or Systems
5
4
3
1
2
Beer S. Brain of the firm, Whiley, 1981
5 systems or functions
System 1: operational level-activity-regulation-registration
System 2: metasystem subsuming all system one – coordination
by information
System 3: information transmitter – coordination by regulation
algodonometer – stabilisator/inhibitor
System 4: big switch – modeling
System 5: decision-making.
Division of work
From opposition to collaboration
Preliminary condition: patient and care-provider must be considered
as one unity. Switch from applicatif to process-care (2th cybernetics).
Autonomic activities
System 1: patient – CP
System 2: CP
System 3: CP
Management activities
System 4: patient
System 5: patient - CP
Managing variety
-System 1: patient too assumes a regulation function.
Enhance patients capabilities:
Increase Vr
-System 5: Define the target and objectives, evaluate and plan.
Increase Vo
Decrease Vd
Cross-matching LRV and
Managing HC-model
Objective: manage care trought the interaction between
Patient and CP in one system
Increase Vr:
-patient becomes a regulator too in collaboration with CP
-regulation becomes auto-regulation
-transformation becomes auto-transformation
Cross-matching LRV and
Managing HC-model
Decrease Vd:
•
•
Defining variety of D through negociation (interaction)
Defining limits on variety
Increase Vo:
•
•
Defining objectives as possible outcomes
Defining targets in a step by step method