|Complexity: Michelangelo's Sistine Chapel ceiling fresco.|
VISTA projects that might succeed are easily distinguishable from those that will fail. Right at the beginning, during the initial planning is when most VISTA disasters are wound up like a clockwork mechanism, after which they run down to their inescapable conclusion regardless of the intelligence, experience, power, funding, or passion of the project's participants. Prudent and experienced VISTA strategists can look at the initial sketches and tell promising from doomed within minutes at a better than 90% rate of accuracy. This skill can be learned by those new to VISTA planning and management, if they can come to grips with VISTA's complexity.
Part of why it is so easy for us to distinguish them is that VISTA projects doomed to fail are rarely close; they rarely almost succeed, barely fail. They almost always fail spectacularly because the plans underestimate the project's complexity not by a little, not double, not ten times, but usually over a hundred times, and sometimes by a thousand times or more.
If you feel disbelief at this claim, we understand, but we are right about this. It is measurably true. Most of the known VISTA-project failures of the last fifteen years were off by two to three scales of magnitude in their estimation of the problems they planned to solve, and their eventual failures were usually predicted at the outset by experienced VISTA engineers. If you can accept the truth of this situation, you must be asking yourself the question all of us have asked - and to become a great VISTA planner and manager, you need to understand the answer - Why is VISTA so complex?
There are two answers.
First, for forty years the software industry has suffered from The Software Crisis. At the same time hardware has grown more powerful, faster, smaller, and less expensive, software has been growing slower, larger, and more expensive. The cause of this crisis is an inevitable paradox: with software, success leads to failure. The more programs you write for your system, the more you have to take into account to write the next program. The more you write, the harder it gets. In the world of software, that is the price of success. Given time, we can create systems so complex that we cannot manage them.
Second, healthcare is staggeringly complex, and VISTA's purpose is to help support healthcare, so it too must be complex. There is no way around it. To make VISTA less complex, you must make it less useful, that is, you must sacrifice patient care or hospital-support services.
We refuse to do that, so we must accept and plan for VISTA's complexity. That means changing the planning and management strategies with which we succeeded in our careers until now. We must switch to less well-known strategies that can deal with VISTA's complexity successfully. If we do, our VISTA plans too must change so they can succeed.