Democratization 2.0

I heard a great talk last week by Andrew McAfee, a professor at Harvard Business School, about Web 2.0 and, as he terms it, Enterprise 2.0. This expanded into a discussion of the inherent democratization that occurs in the 2.0 environment, from which Andy rhetorically raised the question of how reliable and accurate this kind of approach is. Of course, my immediate response was, "Compared to what?" He then reminded us about the "contest" in 2005 that was held comparing Wikipedia to the Encyclopedia Britannica. The two sources were found to be equally accurate, until several hours later, when the mistakes on Wikipedia had been corrected!

This reminded me of a post I wrote several weeks ago about my hope to create the organizational equivalent of a wiki. And, of course, it relates to all the stuff I have been boring you with about BIDMC SPIRIT. The underlying premise is that a democratic approach to problem identification and problem solving is what makes it possible for a complex organization to discover ways to improve. As Steven Spear notes, the alternative method -- trying to design the perfect complex system in advance using the traditional business hierarchical approach -- is unlikely to produce a sustainable and efficacious solution, especially in an environment characterized by structural change.

Can health care institutions learn this approach to adaptation and improvement? The jury is still out.