Four Problems with Master Plans: (1 & 2) Precision & Imprecision, part two, Verstand and Begriff

Calvin on Verstand and Begriff

Two different kinds of thinking lead to two different kinds of processes for creating order, which lead to two different forms of order: (1) Verstand-thinking leads to mechanistic processes (such as master planning and hierarchical decision-making), which leads to mechanistic order; (2) Begriff-thinking leads to living processes, which lead to organic order.

In part one we introduced Verstand-thinking; let's turn now to Begriff-thinking. Begriff-thinking is easiest to introduce by its differences from Verstand-thinking. To understand what a Begriff is, you have to understand what a Verstand is, and the clearest way to explain that is to explain what a Verstand is not.

A Verstand is not the most powerful, rigorous, logical form of an idea. It only seems that way to someone who does not understand a subject. Likewise, at first, Verstand-thinking seems like a powerful process of thinking. Because it is so abstract ("All things are mechanisms; all mechanisms are made of parts; ergo, all things are made of parts.") it covers a lot of ground in just a few statements, which makes it seem more efficient and expressive. Because it is so abstract, it lends itself to logical deduction, which also makes it seem more rational and rigorous.

Ironically, though, a Verstand is the kind of idea you have about things you do not understand. The kind of person who would think "All black people are lazy and stupid" is the kind of person who does not much about black people, who may not really know any of them. The same applies to any abstract statement ("All conservatives are . . ." or "All project managers are . . ."); these are the ingredients with which ignorant people "think" about things they know little or nothing about. Lacking experience or evidence, they try to compensate with abstract ideas that feel powerful to them - but that usually lead them to false conclusions because they are so irreal.

It is not the universality ("all" or "none" or "always" or "never") that makes such ideas Verstands. It is the vague certainty of them, the empty, one-dimensional force of them. There's not much to them because they were formed in an experience vacuum, pulled together out of fancies, prejudices, and wishful thinking, but structured in the form of logical assertions to make them easy to use to deduce more Verstand-ideas. The ease with which they lend themselves to rigorous, logical processes of thinking is used to obscure the lack of rigor in the ideas themselves, as though math and logic can compensate for false and largely empty premises.

Above all, Verstand reasoning cannot make bad ideas into good ones. To understand the world you need Begriffs, not Verstands, but there is no rigorous process of deduction or analysis that can produce a Begriff from a Verstand; you only get more Verstands and remain trapped in an empty, abstract, false world.

Thomas Henry Huxley, 1825-1895

However, there is a completely different, irrational process by which you can create Begriffs out of Verstands, by which bad ideas can lead to good ones. It's the process of gaining real-world experience. As any experienced person will tell you, the process of gaining experience does not follow a script or logical syllogism, and the conclusions you reach through experience often cannot be described to someone who has not gone through those same experiences. Until you've had a lot of your proud, beautiful Verstands beaten to pieces by reality, you simply cannot imagine how wrong you are.

"The great tragedy of Science—the slaying of a beautiful hypothesis by an ugly fact." -- T.H. Huxley, Presidential Address at the British Association, "Biogenesis and abiogenesis" (1870)

Consider the job you're best at of all the things you do, the thing you actually are an expert in, the thing you've spent decades learning to be great at. You weren't always an expert. Once upon a time, you were a newbie who wanted to do that job. The kinds of ideas you had about that job before you did it were mostly Verstand-ideas. The kinds of ideas you have about it now are mostly Begriff-ideas. The endless painful lessons taught by experience beat Verstand-ideas out of their smooth but false abstract shapes into more complex and difficult-to-describe but vastly more accurate shapes until they began to match reality, until they began to become Begriff-ideas.

Verstand-thinking in action.

That's why experienced people often grin at each other when they listen to the proud boasting claims of someone inexperienced. Journeymen and masters have been initiated into the world of Begriffs, so they know just how wrong the apprentice is. They also know just how immune he is to learning from more experienced people. They know, as a result, that the arrogant newbie has decades of painful disillusionment ahead of him on the road to mastery. He will not willingly give up the seductive power of Verstand-thinking. It's going to have to be beaten out of him by his own repeated failures, until he reluctantly gives in and begins letting reality shape his ideas into Begriffs.

I do not like them, Sam-I-am. I do not like green eggs and ham. -- Dr. Seuss, Green Eggs and Ham (1960)

That's where Begriffs come from, which as you can see is very different from where Verstands come from. By now, you may be starting to see how their very different sources can lead to very different processes for creating order. Next post we'll put the spotlight squarely on Begriff-ideas and Begriff-thinking so you can better appreciate why they lead to organic order.

Four Problems with Master Plans: (1 & 2) Precision & Imprecision, part one: Verstand

On 19 August 2009, I began a series of posts on Christopher Alexander's writings about organic order from his groundbreaking and underappreciated book, The Oregon Experiment (http://vistaexpertise.blogspot.com/2009/08/book-recommendation-1-oregon-experiment.html). My series ran until 24 November 2009 (http://vistaexpertise.blogspot.com/2009/11/principle-of-organic-order-our-journey.html), when I summarized the series to date before turning to an exploration of fluxus quo.

Christopher Alexander (photo by Jerry Telfer)

In a typical rejection of the idea that old is bad and new is good, I'm turning back the clock to resume my series.

We left off in the middle of a discussion of four problems with master plans. We have discussed (1) precision and (2) imprecision. Before continuing on to (3) alienation, we need to take a closer look at why master plans are both too precise and also not precise enough.

The problem is a pressing one, because ever since the passage of the Clinger-Cohen Act (1996) the main federal VISTA adopters (VA and IHS) have done most of their VISTA development through contracts awarded and administered through the U.S. General Services Administration (GSA). This method of software development requires that the federal agency in question specifies at the outset the outcome for which they are contracting. Every federal VISTA-development contract begins, de facto, with a master plan.

So why do the plans that VA and IHS try to use to develop VISTA lead them to both too much precision and too little?

In The Oregon Experiment, Christopher Alexander answers thusly: because master plans reduce developers, users, planners, and project managers to prophets, to predicting the future, to trying to decide in advance how things will turn out. We suck at prophecy. Any system of organization that requires us to be prophets steers us toward our weaknesses, makes failures of us, because we rarely know at the outset how things will turn out in the end.

Alexander's right, and that's the easiest way to explain what's wrong with master plans, but there is another explanation, another way to look at the problem.

Hegel (steel engraving by Lazarus Sichling)

In Die Philosophie des Geistes [The Philosophy of the Mind/Spirit, 1816-1830], German philosopher Georg Wilhelm Friedrich Hegel makes a distinction between two different kinds of thinking that produce different results. In English we can't easily make this distinction, because we lack the words to express the difference, but in German Hegel was able to show just how different these two kinds of thinking are. One of these kinds - Verstand - is used in the production of abstract master plans; the other - Begriff - is used in concrete, user-driven development.

As Hegel defines the terms, Verstand is a left-brain process of analysis, in which the whole is analyzed into parts. Verstand sees the whole as merely the sum of its parts, attempts to comprehend it through identification of those parts, attempts to control it through the manipulation of those parts. This fragmenting perspective on wholistic, organic systems invites Verstand to try to deduce knowledge about the whole through a process of logical derivations from a priori assumptions (such as what the parts are that supposedly make up the whole). It's like trying to understand the world if your only tool for investigation is a knife, good only for chopping things into pieces and rearranging them on the table.

Toaster, made of parts (photo by Conavan Govan)

The problem is that neither life nor living systems are logical syllogisms, nor are they puzzles. Organic order cannot be understood through dissection. Living systems are not composed of components, of discrete parts; you cannot remove your arm and then put it back on without doing terrible violence to yourself. It only looks like a part, and only to the Verstand process of thinking, which sees all things as abstract, manipulable parts. A cat is not a toaster, but that's how the Verstand mode of thinking sees a cat, or a house, or a software system, or a human being.

With Verstand we cannot model living systems without doing such violence to them that we deeply miscomprehend them. The grotesque inadequacies and distortions of the clumsy, clanking mechanisms by which Verstand insists on trying to understand organic order creates false distinctions between what are only aspects of a vast, organic whole. Further, while attending to these false distinctions it also misses whole swaths of vital meaning that do not present themselves in the Verstand-friendly forms of parts or facts or axioms or deductions. From the resulting homunculus, Verstand then tries to draw logical inferences about the optimal future state, then builds plans to try to reach that false future through mechanistic means and logical deduction. Even before the plan is written, the battle has already been lost because the planners are not dealing with reality but with Verstand's blinkered, mechanistic conception of reality. It's as though the master-planning process begins by putting on one-dimensional glasses, and then drawing up plans based on the linear, cartoon  world that results.

"Keep that up and I'll bite one of your parts."

As a man is, so he sees. With Verstand, we see a logical puzzle, a mechanism, which no living system is. In other words, it isn't just that when we draw up master plans we are looking at the real world and unable to foresee its future. With the Verstand processes of thinking, we are not even looking at the real world. We are looking instead at the world of abstract ideas, which is awash with distortions and falsehood.

This is why master plans are paradoxically both too precise and not precise enough. The key to avoiding this paradox is to avoid using Verstand thought processes when dealing with complex, organic order.

Fortunately, human beings are also equipped from birth with an alternative mode of thinking, with Begriff. In part two we'll show how to distinguish the two and how to use them in their proper spheres.

Electronic Health Record VHA-Wide Medical Scheduling

Download our response to the Department of Veteran Affairs Request for Information VA118-12-I-0102 on tour new Documents page of our website.

Meaningful Use certification at Oroville Hospital

A local news piece on our friends at Oroville Hospital, with Dr. Narinder Singh.

Carol Monahan: Introducing Myself

As the new director of support at the VISTA Expertise Network, I have had the opportunity to spend the last few months learning about the VISTA community. I was delighted to meet so many dedicated people at the recent VISTA Expo & Symposium, and I want to thank everyone who participated in our session on open-source licensing.

I have a decidedly eclectic background, including a grounding in computer science, with extensive managerial experience in sales, logistics and ERP planning, while working at Wizards of the Coast. On a lighter note, my first job was as an assistant to a couple of large- and small-animal veterinarians in Ireland, and I have also worked as a Tiffany salesperson, and a "spokesmodel", meaning that I got to hand out ham samples at a trade-show. Generally speaking, I enjoy a challenge.

I'm looking forward to promoting community licensing solutions and codebase reunification, as well as getting to know more of the excellent VISTA Hardhats.

More About Us

Here is some additional information about VISTA, the VISTA Expertise Network, and our goals and approach. If you're visiting us for the first time, please also read the "About Us" tab.

Background:

The VISTA Expertise Network was set up to promote the use of open-source VISTA software. VISTA is more than just an electronic health record (EHR). It is an entire suite of fully-integrated clinical support programs, built on a powerful database engine designed from the ground up to support the practice of medicine. VISTA was created over the course of three and a half decades within the Department of Veterans Affairs (VA), and a close cousin is in use within the Indian Health Service (IHS). An adaptation of an earlier version is also being used by the Department of Defense (DOD). It has been successfully adapted for use outside of governmental systems, using an open-source approach to build on the public-domain codebase supplied by VA, under the Freedom of Information Act.

Until fairly recently, VISTA development was driven by the direct involvement of VA clinicians, using an agile, adaptive process. Unfortunately, a drive toward homogenization and centralization has led to a severe slowdown in innovation within VA. Facilities using VISTA outside VA have been hampered by having no communication back into the VA system, meaning that VA updates and upgrades—although welcome—are developed with no consideration for non-VA users. VA has also suffered from diminished direct user feedback in their development cycle.

During the last decade, the bureaucracy’s response to this “death of innovation” has been to pursue a wholesale replacement of VISTA, which has been branded as a “legacy” system, implying that it is outdated—even though it still supports a higher quality of care than any newer system has been able to demonstrate. This has lead to a series of very expensive, failed initiatives. Fortunately, this year, VA is experimenting with a new approach—setting up a custodial agent (OSEHRA) and working to create an open-source development ecosystem where outside contributions can make their way back into VA, IHS, and DOD systems, and variations within those systems can be shared to create an even richer pool of options for all VISTA systems. On the downside, some VA and DOD managers involved with the project still seem to hope that this will result in a wholesale replacement of their systems with “plug and play”, “modular” software.

Our Goal:

The VISTA Expertise Network believes that VISTA can continue to evolve and adapt, building on its track record of proven success. To that end, we have dedicated ourselves to both promoting adoption of the software and training a new generation of programmers and users.

Our Approach:

There is a pressing need for EHR software among underfunded rural hospitals. New legislation dictates that hospitals that cannot show Meaningful Use of their EHR will begin seeing reductions in Medicare and Medicaid (CMS) reimbursements beginning in 2015. These hospitals could receive ARRA funding toward purchase of EHR software during the next few years, but many do not have sufficient capital on hand to get the process going, leaving them unable to qualify for assistance, and facing penalties all too soon.

VISTA, as open-source software, can save these hospitals the large licensing fees associated with most commercial hospital software. It does, though, still require configuration, customization, and training of both IT staff and end users. VISTA Expertise Network recruits and manages the experts necessary for both installation and training.

One criticism that is leveled at VISTA is that it is “old fashioned,” since many functions within the system still rely on text-only user interfaces. The VISTA Expertise Network has collaborated with Dr. Rob Tweed of M/Gateway in launching the development of a new generation of user interface for VISTA, using Enterprise Web Developer (EWD) software. The new interfaces are device-independent, allowing them to run on anything from a PC to an iPad to an Android phone. The underlying system is unaffected, but the user experience is brought right up to date. The VISTA Expertise Network is promoting training of programmers and adoption of the new interfaces.

The VISTA Expertise Network is committed to creating the best training materials and courses to prepare programmers and users to gain the full benefits of VISTA. With our emphasis on promoting projects at hospitals and clinics in underdeveloped rural areas, we have the opportunity to create skilled jobs (and the skilled workers to fill them) right where they are needed the most.

2012 VISTA Expo & Symposium, 11-14 September, Where?

Now that the 2011 VISTA Expo and Symposium has concluded, we are hard at work on planning the next conference. We have tentatively selected September 11-14, 2012 for the next VISTA Expo and Symposium. Our next task is to choose a location.

The Marriott in Redmond was wonderful, and we are in conversations with them about using them again. However, we are strongly considering making the VISTA Expo and Symposium a moving conference, holding it in a different place every year. To that end, we have identified two other possible cities for 2012.

One possibility is Reno/Sparks, Nevada. It has the advantage of being close to Oroville Hospital, one of VISTA’s early Meaningful Use success stories. It also provides an opportunity for a couple of days’ vacation, if people would like to come a little early or stay a little late.

Another possibility is Albuquerque, New Mexico. Its principal advantage is that it would make things easier for our friends in Indian Health Services, so that more of them might be able to attend. And Albuquerque is also a lovely place for a few extra days.

We are getting opinions and feedback from a variety of sources, and we are interested to know what the hardhats think. Redmond, Reno, or Albuquerque? Which would you prefer for the 2012 expo?

24th VISTA Community Meeting

WorldVistA is holding its twenty-fourth VISTA Community Meeting Friday through Sunday, 13-15 January 2012 at the University of California, Davis, in Sacramento. Owen Hermsen, Chris Richardson, Larry Landis, David Wicksell, George Lilly, and I (and possibly another Network staff member to be named later) will all be attending. We look forward to seeing you there. We all have a lot to talk about and plans to make together.

Since the conference is just a month out, this is a good time to make your travel plans while flights are still cheap. Head on over to the WorldVistA website for details and registration.

VISTA Planning and Management Part 3: Do the Right Thing

When you aim for the wrong target, success = failure.

Most of the challenge in VISTA management and planning lies not in hitting the target but in choosing the right target.

Usually, it doesn’t matter how hard it might be to achieve our VISTA project goals, because their success or failure is irrelevant. Most failed VISTA projects were pointed at the wrong targets. Hitting the target does you no good when it’s your own foot you’re aiming at.

We try too hard to accomplish our goals, and we don’t try hard enough to choose the right goals. When we aim our organizations in the wrong direction, even vast budgets and resources cannot help us; on the contrary, the greater our progress, the worse off we are.

Successfully leading the organization in the wrong direc­tion has been the paramount problem with VISTA development efforts since about 1998. The further VISTA managers have led our community toward badly chosen technological targets, the less productive VISTA development has become. It cost billions of dollars more to inch VISTA marginally ahead during the past fifteen years than it did to achieve the miles of progress we made before that.

We are failing because we pursue the wrong goals, but we are not learning from our failures.

A recent study of human rationality discovered that when people who subscribe to mistaken ideas are confronted with irrefutable evidence that they are mistaken, instead of acknowledging their mistakes and changing their minds they tend to cling more fiercely to their now discredited ideas. This same thing happens to those of us who lead our organizations in the wrong directions. Rather than stop to reconsider our goals, we recommit ourselves and our resources further, at most revising our tactics so we can head in the wrong direction more effectively.

There is a lack of introspection about our choices of goals. We treat requests for reconsideration as indecisive, impractical, and irrelevant, as though the main danger we face were a lack of effectiveness rather than an excess of effectiveness in the wrong direction. We believe it is our job to be go-getters, proving our worth as managers by the amount of movement we can create rather than by the rightness of that movement.

We behave as though agreement about our goals corresponded in any way to whether those were the right goals. In the real world outside the Beltway of Washington D.C., neither majority agreement nor even consensus matters. The real world is not impressed by our opinions, our votes, our public relations, or our change-management strategies. Even if everyone agrees the Sun revolves around the Earth, the converse remains true.

The laws of information science are just as relentless and implacable as those of rocket science. We defy them at our peril. Nothing can save from failure a project aimed in the wrong direction unless we reconsider and correct its goals.

The search for the right targets is the first duty of a VISTA manager or planner, and learning from failure the second.

VISTA Planning and Management Part 2: The Paradox of Success

The Paradox of Success: Not Every Problem is a Nail

Past success with other projects can lead directly to failure with VISTA projects. The greater the past management success elsewhere, the greater the chance of failing to manage VISTA successfully. It is not an absolute correlation but a strong one and a major risk.

The problem is not unique to managing VISTA. It is an under-recognized problem in life generally, most famously described as Maslow's Hammer:

"I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail." -- Abraham Maslow, The Psychology of Science: A Renaissance, 1966

and earlier described and explained as Kaplan's Law of the Instrument:

"The price of training is always a certain 'trained incapacity': the more we know how to do something, the harder it is to learn to do it differently . . ." -- Abraham Kaplan, The Conduct of Inquiry: Methodology for Behavioral Science, 1964

As with any other faculty, human beings only use part of the possible range of management strategies. The ideal manager would be expert at the complete suite of possible approaches - and no doubt in moments of pride we tell ourselves we have mastered them all, that we fluently use all the tools at our disposal, the right tool for every job - but in our more sober moments we know it is not true.

We are creatures of habit. We tend to lean on our strengths and avoid our weaknesses. Whichever strategies we use on the projects that go well, we tend to use again in future projects, and because we keep using them we tend to get better at them and lean on them further. Conversely, the strategies we did not use in the past tend to atrophy, so we avoid them in the future.

The result is that we try to hammer every problem into submission. We overuse our previously successful strategies even when they do not apply. The more successful we have been, the more likely we are to try to force new problems to fit our past strategies. The most successful managers tend to be the greatest offenders.

Where managing VISTA is concerned, this has been a big problem in the past and can only continue to be so in the future - unless the problem itself can be put on the radar, can be made a part of the strategy of managing VISTA. If VISTA managers can recognize the impact of the problem and force themselves to approach each project with an open mind, and if we can force ourselves to better develop the strategies that have not worked in the past, to create a more well-rounded suite of strategies, then we will be better able to do justice to the problems VISTA presents, better able to plan and manage VISTA projects successfully.

For example, we will be better able to accept VISTA's true complexity and shift strategies to something capable of dealing with something so vast and intricate.

VISTA Planning & Management Part 1: Complexity

Complexity: Michelangelo's Sistine Chapel ceiling fresco.

When VISTA projects fail, it is almost always for one reason - a gross underestimation of the complexity involved. VISTA is one of humanity's most complex creations. It pushes far beyond our capacity to fully comprehend it, and therefore to successfully make plans about it as a whole.

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.

Reunification

Mumpster has consumed my VISTA-blogging energies lately, but I'll be returning over the next few weeks to discuss a long-overdue topic: reunification of the VISTA dialects. I understand the factors that have prevented it until now and I have solutions for all of them. I believe that by March 1st, we will have a commitment from most of the major VISTA adopters and developers to reunify around a shared, common code base and a common license.

Watch this space for regular updates on progress toward that goal.

Mumpster

We've launched a new MUMPS Users' Group on the web. Our first project is Mumpster, an online discussion site dedicated to the MUMPS programming system.

Values Conflict

[1777 painting by Jean-Baptiste Greuze of Benjamin Franklin, who exemplified both the need to choose among values and the ability to do so (Wikipedia)]

The first thing to understand about the tension between class-three and class-one software, that is, the tension between local and national development - that is, between innovation and standardization - is that there is that tension and it's neither subtle nor something you can safely ignore.

The important thing about values like innovation and standardization is not that we want them, but (a) which we are willing to sacrifice to get the other—how we prioritize them—and (b) how exactly our systems for achieving one are related to our systems for achieving the other—how we relate them.

The choices we make between values define us as individuals, organizations, cultures, because we can't have everything we want. When Benjamin Franklin wrote They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety, he was making a choice that helped define a nation. Our choices have consequences.

So do our failures to choose. They who give up essential liberty for safety almost never realize they are making a choice. They think they can strengthen one value without weakening another, if they even realize the two are related at all.

In modern, scientific culture, we like facts and theories and plans but we're pretty stupid about values, because generally we ignore their conflicts; we think we can have our cake and eat it too. Our mission statements read like Christmas wish lists, as though all our problems would be solved if we could just have all the great things on our list. We don't think we have to choose, but we do.

All good things come to those who wait, we are told, but no one tells us those good things arrive in a knock-down, drag-out fight. Values conflict. Every single value conflicts with every other value.

Heraclitus wrote "War is the father of all things." This is the war he meant: the invisible war among principles that creates reality, and the all-too-often unconscious war among values that creates us.

In this all-consuming war, no man is an island; no one stands apart, a neutral power. We all take sides, willy-nilly. Since we naively believe our values don't conflict, we take sides nilly, unconsciously, by default.

As a result, within each organization, through random, ignorant selection, for each pair of values one will tend to be exalted because its merits are better recognized, but then out of balance it will crush the other value and the organization will suffer for its loss, baffled by how the pursuit of good could have led to such an evil.

The only way to have both values in a competing pair is consciously, through a deep understanding of the nature of the conflict between them, so you can realize how to bend back the conflict into a self-reinforcing flux, a homeostasis. That rarely happens by accident in the conflicts among human values, and it never, never happens when a bold leader pushes some values at the expense of others.

With that understood, let's examine innovation and standardization and the conflict between them, so we can begin to understand how the VISTA community once achieved homeostasis between them and will again soon.

VISTA & Homeostasis: An Introduction

[1638 engraving by Peter Paul Rubens of Hippocrates of Kos, whose precept "First, do no harm" is one of the foundational principles of medicine (Wikipedia)]

Dear Reader,

Would you want to be treated by a doctor who doesn't understand the importance of the circulation of your blood? What if he knows it's important but not that the heart has anything to do with it? Would it be okay with you if he knows the heart's involved but not the brain?

In general, how much would you trust your health to someone who doesn't understand what keeps you healthy?

People were successfully treated for millennia by care providers who didn't understand these or other systems but who did know to be cautious with the things they didn't understand. They knew that if it ain't broke, don't fix it. They abided by the fundamental medical principle, First, do no harm.

What happens when people subvert this principle, when they decide a better fundamental principle would be First, get control?

Replacing the Hippocratic principle with a totalitarian one leads to scenarios like this: your doctor removes your brain when he becomes your primary care provider because it's too complicated, difficult to manage, an irritating distraction, always making your body do things without first consulting him, probably not important anyway because he can tell your heart when it needs to pump.

We make physicians swear an oath to uphold Hippocratic principles before we let them treat patients, in part to help prevent things like that from happening. Too bad we don't make medical-software programmers and managers swear the same oaths.

Over the last fifteen years, VA central management has been conducting dangerous and unnecessary surgery on VISTA's lifecycle, removing all of its living systems one by one and replacing them with simple mechanical controls that put central office in charge of everything. They call this getting VISTA under control.

As a result, VA's VISTA program is in a state of accelerating collapse that's passed the tipping point, yet VA keeps trying even harder to control and centralize VISTA. Doing the same thing but expecting different results . . . there's a word for that.

To help you understand why the way VA used to manage VISTA was healthy and why the last decade and a half have made it sick, I need to teach you about VISTA's vital signs and systems, the processes that make VISTA development healthy. All of these systems are based on homeostasis, so they're self-correcting when we let them do what comes naturally to them. To break those systems you'd have to dismantle their built-in self-correction and try to take control of them yourself. Sound familiar?

Let's start with one of two VISTA homeostatic systems that balances innovation against standardization—the tension between class-three and class-one software, that is, the tension between local and national development.

Yours truly,
Rick

The Hidden Harmony & Homeostasis

[Diagram of blood-insulin and blood-sugar levels over the course of a day, from the Wikipedia article on Blood Sugar]

Dear Reader,

The hidden harmony is present but often easy to overlook in the realms of math, physics, and chemistry, but biology demands an intuitive understanding of it because living systems exhibit all kinds of behavior that at first seems to contradict the rules and principles of these foundational sciences.

For example, consider the second law of thermodynamics (In a system, a process that occurs will tend to increase the total entropy of the universe, or, things tend to run from order to chaos, tend to run down, always increasing the unverse's entropy). It nicely explains aging, disease, and death but seems contradicted by conception, embryogenesis, evolution, and development (not to mention the Big Bang itself). Someone steeped for decades in the "hard sciences," when confronted inescapably by large-scale biology's many seeming contradictions of the hard-science principles, can either (1) turn away from biology and back to their more comfortable fields, (2) resort to miracles for explanation, or (3) search for additional cosmic principles that contradict principles like entropy, that wind things up instead of winding them down.

The second form of fluxus quo, the hidden harmony, intuitively explains what the second law of thermodynamics, entropy, does not—the capacity of living things to run from chaos to order, to wind up, to decrease an organism's entropy by unfolding layers of increasing order. The self-assembly of living systems is a miracle from the perspective of entropy but inevitable from the perspective of the hidden harmony.

In its simplest, easiest-to-explain form, the hidden harmony manifests in the ways living organisms work to maintain steady temperatures, or blood pressures, or access to glucose, or so on. This quality of living things, called homeostasis, produces what at first seem to be comparatively steady states through the harnessing and control of opposing forces.

One example of this is the way insulin and glucagon set in motion opposing tendencies with regard to the regulation of blood-sugar levels. When they rise too high, a healthy pancreas releases insulin to instruct cells to absorb more glucose from the blood, thus lowering the blood glucose levels. When they fall too low, the pancreas releases glucagon to instruct the liver to convert more glycogen into glucose and release it into the blood, thus raising blood glucose levels. Over the course of a day, blood-glucose levels are almost never at a steady state, never a status quo; rather they are always rising and falling in response to digestion and the cells' consumption of blood glucose, and when those cycles spike erratically from the consumption of sugar or from excessive energy demands the body intervenes with insulin or glucagon to channel them back into the narrow band of blood-sugar levels that supports human health.

Living systems are densely woven with such homeostatic systems for preserving an organism's health, as is the cosmos itself, since we evolved to be healthy within the normal conditions of our environmental niches.

[Photo of James Heilman juggling from Wikipedia article on Juggling]

In all these cases, the appearance of stasis is an illusion; both forms of dynamism are always in operation. First, there will be a cosmic river—an overt flow of materials and energies upon which life depends. Second, there will be a hidden harmony—two or more primary systems set in opposition to channel, set in motion, and modulate that cosmic river, and many secondary systems that stabilize and reinforce the primaries.

With all this flux going on, it shouldn't be called homeostasis. It should be called homeoflux.

Like juggling, any apparent steady state is actually a state of continual change (the moving balls) that is itself driven by a more fundamental underlying pattern of change (gravity, mass, and the juggler). If, for fear of dropping the balls or making a mistake the juggler tried to just hold them still, the act of juggling would be at an end, the episode of juggling would die, because in a truly living system it is the fluxus quo that produces what we think of as the life within the system.

So it is with the human body. The flow of blood, lymph, cerebrospinal fluid, air, food, water, hormones, nerve impulses, chemical reactions triggered by photons striking the skin, the flowing transformation of biochemicals along metabolic pathways, and many many other things beside, the flow of all these things must continue for our life to continue. Stop even one of these flows, and sooner or later we sicken and die. The body is not flesh at all but is instead a flow, a nexus, a crossroad of many rivers, and we die when the rivers stop flowing through us, when they go their own ways and leave us in an apparent status quo (although the truth is that we go on flowing in different ways after we die, as we dissolve into the tributaries of other rivers).

So it is with managing VISTA. The effort to control VISTA, to hold it tightly, to decide what will and will not get worked on, these efforts kill a VISTA adoption. All of the elements of the VISTA model have to actually flow channeled but unimpeded to create a homeostatic VISTA system capable of supporting a hospital. A VISTA lifecycle is a living system, a form of nonorganismic life, in which the flow must go on; thirty years of experiments with the alternatives have proven the truth of this to anyone who has bothered to learn from its history.

At this point, if you don't feel comfortable with the fundamentals of fluxus quo, I'm gong to say the burden is on you now to ask about it. Fluxus quo is one of the essential principles that makes VISTA work, but as for what must flow and how—the fundamentals of its health, to succeeding with VISTA adoption—well, the devil's in the details, and it's time to talk about them.

Let's move now from the principle to its manifestations. Let's explore some of the homeostatic systems that must function correctly for the production, development, and maintenance of VISTA.

Yours truly,
Rick

Fluxus Quo: The Cosmic River & the Hidden Harmony

Dear Reader,

Recap of this entire blog using our new terminology: The VISTA community achieved a harmonic fluxus quo from 1977 to 1995 by harnessing homeostasis, modeled on the way biology harnesses flux to achieve stability. We will preserve and extend today's VISTA renaissance the same way, because it is the only sustainable path available to human beings, the only way to transform very complex interactions and dependencies into a self-reinforcing system.

Now, to explain homeostasis: Wikipedia and other traditional references are going to be of limited help here, since they explain it at only the most shallow, Platonic level, like a mechanism, without any appreciation for its cosmic significance. We need to define it in terms of fluxus quo.

For the discussion that follows, we need more concise terminology to describe the two main expressions of fluxus quo, because homeostasis uses the second to channel the first, which will be hard to explain without more descriptive terms.

I considered borrowing the contrast between kinetic energy and potential energy from physics and applying it to flux, but that dichotomy is too Platonic, built upon the assumption of stasis as the normal condition in which energies can be wound up (potential) and discharged (kinetic) according to the principle of entropy. Instead, let's use rich metaphorical terms borrowed directly from Heraclitus, the original philosopher of flux.

For the first kind of flux, the nonstop change in all things that goes on around us all the time, whether we see it or not, let's call it the cosmic river, the one you can't step in twice because it is always changing and so are you and everything else.

For the second kind of flux, the invisible flow of principles whose conflict produces the cosmic river, both the things in it and their flow and transformation, let's use the term hidden harmony, to capture the idea of the harmony in the bending back of forces against one another to produce apparent stability.

Now for homeostasis itself.

Yours truly,
Rick

What Does Fluxus Quo Do?

Perito Moreno Glacier Patagonia Argentina. Photo taken by Luca Galuzzi (http://www.galuzzi.it).

Dear Reader,

Fluxus quo acts upon our world through two kinds of dynamism: flow that results in motion, and flow that results in stillness.

First, everything is actually moving and changing even when it appears not to be. The appearance of the world is stability interrupted by intervals of change—punctuated equilibrium, as Steven Jay Gould called it—but the deeper truth of the world is flow. Look up from your computer screen and look about your room. Not a single thing you can lay your eyes upon is genuinely static. The glass is a liquid, ever so slowly oozing its way toward the bottom of the window, which is why old window panes are rippled. The paint, the wood, the fabric, all of these organic materials are slowly converting their volatile organic components via chemical reactions into gas, which is evaporating into the air, some of which you're inhaling. Every scrap of metal is like the glass, congealed into solid metal only because of how cold it is, but someday, sooner or later—a thousand years, a million, a billion—the metal will be hot again and will resume its liquid flow, and until then electrons readily flow within many metals creating electrical currents. Certainly all living things you can see are always engaged in both internal flow and many cyclic flows of interactions with the greater world around them. Seven years from now, some of their physical makeup will be the same—lead or mercury poisoning unfortunately—but most of their cells will have been replaced with new ones.

Stasis, things holding still or being what they are and only what they are, is partly an optical illusion, like a single frame of a motion picture, a moment caught in a strobe light. Seen for a brief enough instant of time, even a river appears to be a complex frozen ripple, in a photograph or the blink of an eye. Seen for a long enough period of time, the misunderstanding that a glacier is merely an enormous frozen river breaks down and the river of ice it truly is can be seen to flow, which it is always doing regardless of our limited perception of it. As Homer wrote, all human beings are ephemeroi, creatures of a season, like leaves on a tree. Our lifespans are far too short to see any but the fastest flows; the apparent stillness of so many things that our flashes of life illuminate are optical illusions, a trick of mortal perspective.

Heraclitus expressed this form of dynamism in several ways:

One can grasp no mortal substance in a stable condition.

It scatters and gathers, it forms and dissolves, approaches and departs.

Everything flows and nothing abides.

You cannot step twice in the same river.

Second, the pace of change does actually accelerate or slow in response to another layer of flow under the physical surfaces of the cosmos. Physical forces and organizational principles of the cosmos conflict with one another, subvert one another, tangle and release, and otherwise interact in complex, shifting ways so that the pace of change for any given thing is sometimes rapid, sometimes so slow as to create near stillness. When things are briefly still, it is because the forces within them are balanced enough to convert their dynamism into internal stresses instead of external motion.

Like a taut bowstring, these kinds of situations are pregnant with energies waiting to be unleashed. To a literal-minded person, a bow held undrawn and a bow held drawn are both just things, objects, static, but to one with eyes to see, the drawn bow is a wound-up explosion of change about to happen. Viewing the world in terms of the objects or things leaves you perpetually surprised by earthquakes, tsunamis, wars, terrorist attacks, and other kinds of sudden change, but truly it is during the apparent still periods preceding those disasters that the problems were created, that the invisible energies tangled up and pulled one another into tension. Part of the secret to the cosmos is that the visible things we cherish or fear are merely the side effects of the movements and conflicts of the deeper principles that underlie everything. That is, as important as it is to come to understand the flow of the things that make up the visible cosmos, it is the invisible flow of the principles and forces of the cosmos that actually produces everything we take for real.

Heraclitus wrote about this form of dynamism too, as an endless war that creates and sustains the harmony of the cosmos:

It should be understood that war is the common condition, that strife is justice, and that all things come to pass through the compulsion of strife.

Homer was wrong in saying, "Would that strife might perish from amongst gods and men." For if that were to occur, then all things would cease to exist.

It is in changing that things find repose.

Opposition brings concord. Out of opposition comes the fairest harmony.

People do not understand how that which is at variance with itself agrees with itself. There is a harmony in the bending back, as in the case of the bow and the lyre.

The hidden harmony is best.

Fluxus quo cannot be stopped to create stability, nor can it be ignored since it permeates and shapes all things, yet these are the two strategies most people try. Nevertheless, if we want to produce anything lasting in this world we cannot just go with the flow, or else the first form of dynamism created by fluxus quo will simply scatter our efforts in the river of time, but the second kind of dynamism it creates can and does paradoxically produce a dynamic kind of stability, what Heraclitus calls the harmony in the bending back.

This is the secret to harnessing fluxus quo, to achieving success with something as complex as VISTA. If we try to stabilize the things in the VISTA community that we want, our efforts will be swept away, but we can instead bend back the underlying forces that produce and organize those things so they conflict with each other to produce a harmony, a dynamic, self-reinforcing stability. In such a harmonic configuration, the flow of fluxus quo strengthens the stability instead of breaking it up.

A bow may be dynamically stabilized with two primary counter-reacting forces, from the wood and the string—with additional forces introduced when it is drawn, of course—but for something as complex as VISTA we need a more complex harmony between more forces. That would seem to reduce the odds we can keep them stabilized, but another field of study reveals that even complex harmonies can be achieved using a specialized method of bending back the forces upon one another.

The field is biology. The method is homeostasis.

Yours truly,
Rick

What is Fluxus Quo?

Supposed bust of Heraclitus from the Villa dei papiri in Herculaneum (bronze, Roman), Naples National Archaeological Museum

Dear Reader,

Just as Parmenides and Plato were the preeminent Hellenic philosophers advocating a static understanding of the cosmos, so Heraclitus was the preeminent Hellenic philosopher advocating a dynamic understanding of the cosmos. Although dismissed by the ignorant as a philosopher asserting that all things were made up of the element fire, Heraclitus actually strove to use the metaphors of fire, water, and many other things to try to capture the idea of the cosmos as a domain of radical transformation and flow, in which not only does nothing stay what it is eternally but also nothing is what it appears when you look below the surface, that everything that seems even briefly static is only kept that way temporarily through the intense dynamism of shifting, contesting cosmic forces.

Twenty-five hundred years of progress have not made any easier the difficulty Heraclitus experienced, the struggle to help people see past the sometimes static surfaces of things to understand the seething, roiling storm underneath. Even our very language works against us, as we find comfortable and therefore readily adopt terms like status quo that reinforce our attachment to the illusion of stasis while resisting terms like fluxus quo that might be the keys to unlocking our ability to see things as they truly are.

My first exposure to this term was in the summer of 1999 when I read a philosophical column in a magazine. Here was the crucial paragraph for me, a concise statement that captures the Hellenic view of the cosmos as a realm of change:

Nature is understood in at least two profound senses, becoming and intrinsic validity, which to the Greeks are equivocally the same. The first sense of nature, as physis—"becoming," "growing," the gerundive or process-form of the verb phuo—describes the domain of relentless, tidal mutation: nature is the realm of all things generated and perishable where nothing can remain simply what it is (we have our word "nature" out of Latin as Cicero's invention, by analogy with physis, from the past participle of the verb nascere, natus = having been born). All natural existence is pregnant with its other, incubating cryptic forms of future order and orientation which are presently unthinkable: to exist in nature is to be variable and subvertible—all that is natural changes, falls prey to the fate of alliosis or "othering." All of natural existence is thus in motion, on the way from one state into another: Heraclitus' incisive dictum Panta rhei—All things flow—captures for all time the quintessence of ancient dynamism: the world as "fluxus quo."

——from "End Times: Millennia in Microcosm, Ancient Civilization Part 1: Nature as Becoming and as Intrinsic Truth" (Kenneth Smith, originally written 15 February 1997, published in The Comics Journal #215, August 1999)

Like most reasonably educated people, I knew the term flux, certainly in two senses from the Oxford Dictionary of the English Language—(1) the action of flowing, and (2) a continuous succession of changes of condition, composition, or substance—but when I read Smith's definition of fluxus quo above it was a revelation.

Here, I thought, was a term we badly needed in English, a term that in a nutshell captured an essential but hidden truth about the cosmos, a term that was especially vital for understanding the VISTA software lifecycle. Eventually I came to understand that it was not just VISTA but all medical informatics that were driven by the principle described by this term. The practice of medicine continually changes and flows as our understanding of it improves, so medical software, too, has to continually change and flow.

Where status quo is best understood as things being the way they are because they are standing still, fluxus quo describes things as being the way they are because they are changing.

The best way, though, to understand this or any other cosmic principle is not through a description of it, since principles are not things, but through a description of what it does, how it acts, how it changes the world, because principles are agents of change that generate patterns of flow in the cosmos.

So what about fluxus quo, the principle underlying all other principles? How does it work?

Yours truly,
Rick

What is Status Quo?

Dear Reader,

The philosopher Plato did two-thousand-plus years of damage with his attractive but ultimately false view of the cosmos, and medical informatics suffers from his philosophy even today.

Plato was not comfortable with changes. He felt that a cosmos in eternal flux could not be comprehended. He wanted a world of fixed, stable, enduring ideas that could be used as a frame of reference, so he postulated the idea that change is an illusion, a mere flickering of shadows on the walls of the human cave, and the truth is fixed, eternal, unchanging—indeed, that the true cosmos is made of eternal unchanging ideas that are casting these shadows.

It's all very pretty and vivid but utterly false. The man was more poet than philosopher, in the end, and all his philosophies suffer from holding more beauty than truth (apologies to Mr. Keats).

Plato was not the first to try to bury his head in the sand - Parmenides before him had even more radically denied the existence of change and asserted that all is one and unchanging in defiance of the evidence of our senses - but it was Plato who developed the philosophy of stasis in the form that continues to trip us up today.

The problem with Plato's ideas is that they are an attractive nuisance. Any idiot can see change all around them all the time, but when someone is under the right kinds of pressure the rejection of change can be extraordinarily attractive.

Project managers, for example.

When you are being battered from every side to meet a deadline, the desire to pin down your targets to create a fixed frame of reference for managing the chaos can be overwhelming. In this way, most project managers become neo-Platonists, struggling against change.

The Oxford Dictionary of the English Language defines status quo as The existing state of affairs, a definition that is expressed in Platonic terms because it obscures the underlying principle unconsciously assumed to be at work by those who speak of a status quo: stasis.

status and stasis both derive from the same Latin/Greek root sta-, meaning to stand, as in to stand still, to hold, to be where and what you are in an unchanging fashion. You see, status quo seems to be a neutral phrase meaning "the way things are" because we ourselves are immersed in the philosophy of stasis—we take it for granted—and so cannot perceive that it really means "the way things are because they are standing still," that is, when things are the way they are because they are unchanging.

The extensive influence of mathematics in our education—which was advocated by Plato, by the way—exposes us deeply to simplistic math, the mathematics of is, of A equals A and A does not equal not-A, but cuts most of us off before we ever get into the mathematics of flow and change and flux from calculus on. We come to have a taken-for-granted worldview that understands a Newtonian and Cartesian fixed, mechanical universe far more easily than we can grasp the flow and flux of relativity and quantum physics because our math never went that far. Therefore, however much we may have thought we hated or resisted math in school, we pick up there and from the culture at large that the idea of a cosmos in which things are what they are and not what they're not just makes more sense than a cosmos in which everything is in continual flux.

The proof?

When under pressure, most of us seek security in some kind of fixed safety rather than by immersing ourselves more deeply into the flow of life. Stasis just feels safer to us, when push comes to shove. It feels more safe, more right, more natural, more real, more true.

So when we become project managers, we design our projects around fixed targets and seek to fight change to arrive at our fixed destinations. We are mercenaries who sell our services for money, and our services are that we promise to deliver a desirable fixed state by breaking down the gap between here and there into a series of manageable quantum steps. And at the end, we promise that the client will have been shifted into the new state they desire, they will have the things they want.

They will have a new status quo.

Too bad it's all a delusion, because Heraclitus was right: panta rhei, that is, everything flows.

Which brings us to the point of this series of essays: what is fluxus quo?

Yours truly,
Rick