The proposal to introduce competitive funding for Victorian hospitals is likely to have some unexpected and highly undesirable outcomes. The causal loop diagram below indicates the dynamics of this particular policy changeThe use of competitive funding will lead to funding Hospitals with the lowest bids who will only be able support these low bids by severe cost-cutting. This cost-cutting will put pressure on the services that are provided and ultimately will lead to the hospital being unable to meet the targets. This will increase the government’s use of competitive funding to restrain costs.
There are some other consequences of this policy.
The reduced levels of funding will lead to hospitals cherry picking the surgical procedures with the highest return. This will lead in turn to a differential growth in the waiting lists with the less “profitable” procedures being given a lower priority.
As these waiting lists grow, public hospitals will move increasingly to providing elective surgery places for privately-insured patients. This shift in resources to the privately funded sector will further reinforce the government’s ability to shift the funding emphasis in the public hospitals.
The result will be privately funded patients will have more places available to them, public patients who have ”profitable” procedures will get preference and those public patients with complicated and “low profit” procedures will find themselves faced with increasingly long waiting lists.
When we examine systems, we look at four aspects: events, patterns, structures and mental models. Events are single occurrences like a win at the races or an accident at a railway crossing. Events occur as a result of luck or human failure. Patterns are the regular occurrence of events: jockeys regularly winning money by betting on horse races or repeated accidents at the same railway across. These patterns are result of the third element of systems: structures. Structures come in many forms. In the case of the railway crossing could be the configuration of the road for the visibility of the crossing itself. In the case of the jockeys, it could be an informal group that colludes to ensure certain horses win. In a more general sense, structures can be physical elements such as the layout of an office, rules, regulations or policies in an organisation or an organisational culture, which is an informal set of rules that people act by often without actually acknowledging them. The final element of systems is the mental models of those who work in the systems. It is the way that people think and the values and attitudes they hold that ultimately keep the structures in place.
Archbishop Pell has stated that child abuse in the Catholic Church is not systemic. However, it does have many of the elements that define systems. In this case we can safely ignore events and move straight to patterns. There is now ample evidence of widespread pedophilia going back many decades in the Catholic Church. This constitutes a pattern which can only be produced by structures within the system. When the Archbishop says child abuse is not systemic he may be confusing systemic with “officially sanctioned”. But it would be hard to argue that there is not a culture, not only of child abuse, but of covering it up within the church. It is well understood that cultures are one of the most important determinants of behaviour in any organisation.
This causal loop diagram shows how this process works and perpetuates itself.
It is a sad fact that many organisations that care for the young and vulnerable are likely to attract pedophiles and the Catholic Church is no exception. The presence of pedophiles within the church has led to a culture of secrecy, evidenced by the refusal to report pedophile activities to the police. This culture of secrecy leads to the relocation of offenders. However the more this is done, the more there is a need for secrecy and the need for secrecy itself leads to more relocations and increases the culture of secrecy. The culture of secrecy itself and protection provides the paedophiles, means that the organisation is more likely to attract people with paedophile tendencies. This in turn increases the number of paedophiles in the church.
Each element of this particular causal diagram acts as a reinforcing element, namely it increases the incidence of the behaviour that causes. There is nothing in this particular causal diagram that dampens the effect of pedophiles within the church. The logic of the diagram suggests that the problem may be getting worse over time rather than better.
And finally we come to mental models, the values attitudes and beliefs that are held by the people work with him in the system. From his public utterances, many people would assume that the Archbishop does not accept that there is a significant problem with pedophilia in the Catholic Church. With the most senior church official in the country holding the servitude, there is unlikely to be little stomach for change within the church.
It is a truism of systems thinking that sustainable systems generate their own behaviour. In a technical sense this means that there are positive feedback systems they keep the system working. This is particularly true in the drug trade.
The first important dynamic is the way the supply of heroin maintains the stock of heroin in any given community. This dynamic is classic supply and demand. As the supply of heroin increases, the stock of Heroin in the hands of drug dealers increases. This in turn sends the price down and the supply slows down as result. But when the supply slows down the heroin stock declines and the price rises again. Generally speaking there will be an equilibrium in this dynamic. The other part of the dynamic is the seizure of large shipments of heroin by the authorities. These seizures decreased amount of heroin available in the market driving the price up and increasing the supply. Most of us do not realise how well organised the logistics of this industry are. Seizures of drugs have little effect other than to put the price up in the short-term
However, there is a consequence of the price going up which is shown in the next loop. The price rise leads to an increase in petty crime: house burglaries, car break-ins, shoplifting etc. These small crime waves are often met by a spate of arrests on the part of the authorities who generally bundle the addicts off into the local jail. The absence of the addicts from the street leads to slight decline in use and an oversupply of heroin in the market. The fact that convicted drug addicts tend to be able to get drugs in jail is not something that civil authorities spend much time thinking about.
There is a final dynamic in this loop. It’s called marketing in this diagram and represents what drug dealers do when they have small amounts of drug that they cannot sell. They simply give it away to a non-addict in the hope that it will become habit-forming. if this strategy is successful, it replaces the jail addict with a new addict. Remember, the old addict is probably still using heroin in jail, so the total consumption of heroin is probably gone up as a result of this.
The logic of this diagram indicates that the war on drugs does nothing more than to put fluctuations into the price of heroin. But these fluctuations, and, as a result the increases in price, increase the crime rate.
The policy levers that have been used until now have been punitive ones: the seizure of drugs and the arrest of people in the drug trade. These policies seem to have done little to solve the problem of drug-taking in our community.
There are actually two other leverage points and this system that can be used. The first is to reduce the number of addicts. There are two ways of doing this as the stock flow diagram shows. The first, and most conventional one is to turn addicts into ex-addicts normally through programs such as the methadone programme.
The other, and much more difficult approach is to stop the flow of new addicts. This means addressing a wide range of social problems. It is a general truism that solving a problem normally takes as long as it took for the problem to develop. So this will be a long and necessarily costly process.
Which brings us to the other leverage point: The price of heroin. If heroin were to be legalised, the government could control the price. It would also be able to collect tax revenue from the sale of heroin and use that to fund rehabilitation projects. It would also be possible for the government to set a price well below that of the current illegal price.
These solutions are not perfect but they provide a better alternative than the “war on drugs”
There has been much commentary in the paper recently about Australia’s falling standards in science and mathematics. Like most long-term problems this one has a built-in structure that is self-perpetuating. This causal loop diagram shows the simple but entrench structure that is creating this problem.
The low quality of science teaching in schools produces students who are not well trained in science. This in turn means that the students entering teacher education programs are not well schooled in science. This leads to a dearth of good science teachers and the decline in the standards of science teaching. This cycle continues year after year and it is likely that the standards are continuing to decline.
The causal loop diagram demonstrates that there are two leverage points. The first is to improve the quality of the existing science teachers through extensive and intensive in-service training. The second is to pay a premium to school leavers go into teaching with strong qualifications in science.
If the goal of the second policy were to place two outstanding science teachers in every school in Victoria, there would need to be 5600 science-specific graduates. The Victorian teacher education system produces 4200 graduates each year. So, if approximately half the intake per year were 1000 graduates devoted to science teaching, it would take approximately 6 years to produce the necessary number of excellent science teachers. Unfortunately, if current trends continue, it can be expected that 30% of these will leave in the first five years, so the net long-term gain per year is likely to be closer than 600 per year. This means the realistic lead-time for improving science teaching is around 10 years. Sadly, this is probably beyond the concentration span of most state governments.
This sobering statistic highlights the increasing importance of retaining teachers in the profession, particularly those who are well trained and talented. However, it also highlights the huge potential of improvements in retention rates for improving the quality of science teaching.
Two aspects of Australian sport have dominated the media in recent times. The first is the extent to which betting is coming to dominate Australian sport and the second is the extent to which drug taking has become endemic. No one seems to be joining the dots.
There is sufficient evidence to suggest widespread corruption associated with betting on sport. At its worst, this involves match fixing where whole teams are suborned by unscrupulous bookmakers. In its more minor form, it takes the form of betting on single events in a game over which an individual player has complete control, namely bowling a no ball on the fourth ball of the second over. In both cases, people in the know have an opportunity to make money at the expense of those who do not. Is important to remember that the amount of money available to those who do know is equal to the amount of money available from those people who do not know.
More invidious form of corruption is the use of performance enhancing drugs. In many cases, this is done, somewhat naïvely one thinks, simply to improve Individual or team performance and bringing glory on all those involved. However, even endeavouring to see such activity in the best possible light ignores the fact that the taking of illicit drugs is often associated with contact with criminal elements in the sport. These criminal elements often have large amounts of money to launder through bookmakers. Thus the supply of drugs in many cases is closely linked to illegal money-laundering activities.
This causal diagram shows how these links work. If drug taking is providing a team (or horse) with a marked advantage then the chances of winning a greatly increased for those who have inside knowledge. As this degree of certainty (based on inside information) increases, the amount of money invested also increases and as the pool of money increases, the money invested by “mug punters”, who simply back their own team out of loyalty, also increases. It’s a win-win for the money launderers and the bookies.
One technical aspect of this diagram is important. It is made up entirely of what are known as reinforcing loops, which means the system keeps heading in the same direction all the time. In this case, things will only get worse. At present, there is no balancing loop (in the form of some policy control) to bring the situation under control.
The state government of Victoria has announced a plan to link east link freeway with the Tullamarine freeway. Both of these freeways are currently at gridlock during peak hours. Linking them will only move to congestion from one to another and neither has the capacity to the string peak hours. The dynamics of this are very simple, the situation will simply keep getting worse and worse and the new freeway will be as congested as existing freeways with a very short period of time.
The causal diagram shows these interrelationships.
The dynamics of building new freeways has been well known for some time. as traffic congestion rises, governments build more freeways. These new freeways provide, in the short term at least, increased access to residential areas on the city fringes. This in turn stimulates housing growth in these areas which places increasing pressure on the freeways which increases congestion.
The fatal attack on a British soldier in London that the would appear to be a retaliation for the activities of British troops in Afghanistan or in Mali, was not only shocking in its brutality but in its potential implications for British society. Such attacks can easily begin a downward spiral into sectarian violence. Within hours of the attack they were arrests as right-wing extremists targeted mosques. The pattern is shown in this causal loop diagram.
The extremists target the wider population of the group that they regard as representative of the crimes committed against them. This in turn sparks retaliation. The profound tragedy of this is that the violence in Afghanistan is transported to the streets of London where it can easily become endemic.
One solution is to round up the potential perpetrators of this violence: the extremists within the Muslim community and the right-wing fascists in the British community.
The causal loop diagram shows that policy objective in arresting extremists is to reduce the number of terrorist attacks.
Certainly this would be an effective and popular politically move in the short term. Unfortunately such a punitive approach would only have the long-term effect of further exacerbating the sense of grievance amongst the extremists.
Long-term solutions involve building a resilient and tolerant community. This is like an extremely difficult when countries have multicultural populations where the wounds of sectarian violence are still fresh.
State and federal governments are moving to ban the sale of synthetic drugs, currently being sold illegally through tobacconists and adult shops. The consequence of such bans demonstrates the difficulty of making current legislation work. While all evidence suggests that the “war on drugs” has been lost, governments do little to rectify the situation.
Sales of synthetic drugs, if properly controlled, provide an opportunity for some level of regulation of their use. Sales through legal outlets allow the government the opportunity to monitor the users and encourage them into rehabilitation programs. If there is a switch between the synthetic and the organic then this may lead to an overall decline in the use of illegal drugs.
The other advantage of the legal sale of synthetic drugs is that these sales will generate tax revenue through tax on company profits, GST and the taxes paid by individuals who sell them. This revenue can be used to fund the rehabilitation programs.
However, bans on synthetic drugs have a number of consequences. The first is that they will cut down the sales of synthetic drugs. The second is that they will increase the cost of monitoring and policing these bans. This in turn will reduce revenue available for rehabilitation programs but will also shift buyers back to illegal drugs and the crime associated with their sale.
While it might appear counterintuitive and certainly run contrary to the public sentiment following the death of the Sydney teenager, the availability and legal control of synthetic may present governments with an opportunity to address the problems of drug use in Australian society.Posted in Thinking Systemically| Tagged legalizing drugs, Synthetic Drugs| Leave a reply
The decision by the Americans to provide arms to the Syrian rebelsIs is as misplaced as the decision of the British government not to. Unilateral decisions by governments to withhold the supply of arms to either side will prove disastrous as decisions to supply arms to both sides. Each decision will lead to an unequal struggle and a significant loss of civilian life. This situation is described in the systems archetype “Escalation”, shown below. When arms are supplied to the rebels, the relative superiority of the government forces goes down. When this happens the threat to the Syrian government goes up, this leads to an increase in arms to the Syrian government and the re-establishment of their superiority and consequently an increase in the threat to the rebels. This in turn leads to a greater supply of arms to the rebels and the decline in the relative superiority of the government forces.
The supply of arms to each side is meant to bring the situation into balance, and indeed both of the loops are balancing loops. Unfortunately, the combination of two balancing actions is a reinforcing or escalating action and this situation escalates as larger and larger amounts of arms are supplied to each side.
The graph below shows how the supply of arms for the rebels decreases the threat to the rebels and also decreases the relative security of the government forces.
The next graph demonstrates the consequences of this:
As the relative superiority of the government forces declines (shown in the top graph), the supply of arms increases, the relative superiority of the government forces increases and as a consequence the threat to government declines.
And so the situation continues to escalate and the damage to the civilian population increases with it.
Paradoxically, the same situation exists if the supply of arms to only one side is reduced unilaterally by a single government. When the British cut isback the arms supplies, the Americans step in to fill the gap.
The answer is for a bilateral reduction in the supply of arms to both sides to a point where both are equally balanced and equally impotent. Arming the soldiers with feather dusters is a good example of this balanced impotence.
