Whenever I am outdoors and alone I usually have buds stuck in my ears and I am listening to something. Chopping, moving and stacking wood demands that I am simultaneously listening to something interesting. I was delighted when an hour or so into my task “Radiolab” from WNYC popped up on New Hampshire Public Radio.

If you have an hour to kill I would suggest that you suspend reading this until you listen to the same program. Better yet, go to the website, download the podcast and then load it up on whatever device you use to carry your tunes when out walking, and then go for a walk. Covering three or four miles while you listen to this remarkable program is a treat that you owe yourself. You will thank me for the suggestion and it will help you feel much better about all the food you ate yesterday.

http://www.radiolab.org/story/91500-emergence/?utm_source=local&utm_medium=treatment&utm_campaign=daMost&utm_content=damostviewed

Despite the fact that I later learned that the show was an almost decade old “rebroadcast” from about 2005, the program spoke to me for several reasons.

First, it was the answer to the arrogance of my neurophysiology professor who in the spring of 1968, at the time of the assignations of Robert Kennedy and Martin Luther King, Jr., gave my class a lecture on neurotransmission and action potentials and then announced that in the context of how neurons worked in the brain there could be no such thing as “free will”. I was upset and even then conceptualized that there must be ways in which the hundreds of millions of neurons must interact beyond his simple concepts of electrophysiology and neurotransmitters to produce “free will”, consciousness (which he could not really explain), creativity, and things as necessary as art, love and empathy. Without free will how could we have accountability? If there was no free will, all of the expectations of personal responsibility, rules and regulations that are the foundation of our society seem founded in a cruel hoax.

Second, I have long been a fan of E.O. Wilson and his concepts of sociobiology and have especially enjoyed his recent writing including The Social Conquest of Earth. Somehow I had missed out on his thinking about “emergence” until his recent book, The Meaning of Human Existence, where he talks about “emergent evolution” (p. 165) as he tracks the development of human consciousness. Quoting Wilson:

“The second point of entry into the realm of consciousness and free will is the identification of emergent phenomena–entities and processes that come into existence only with the joining of preexisting entities and processes.”

And third, the program connected with my interests in networks, complex systems, systems learning and the origins of improvement and innovation. The program included interviews with Wilson and other scientists interested in the social behavior of ants, bees and things and it also introduced me to Steven Johnson whom I had not read and who is the author of several books on the intersection of human experience with science and technology.

Johnson–a web-based guru who writes in Wired and other periodicals–also wrote about emergence in a well-received book in 2001 entitled, Emergence: The Connected Lives of Ants, Brains, Cities and Software. His bibliography since 2001 will keep me busy for a long time. The show also had a brief interview with James Surowiecki, who writes regularly in The New Yorker but also wrote an impressive book in 2004 that includes concepts of emergence, The Wisdom of Crowds: Why the Many Are Smarter Than the Few and How Collective Wisdom Shapes Business, Economics, Societies and Nations.

So what is emergence? Is it a concept that offers any understanding to the challenges of healthcare? In a very boring way, Wikipedia says:

“…emergence is conceived as a process whereby larger entities, patterns, and regularities arise through interactions among smaller or simpler entities that themselves do not exhibit such properties.”

The “Radiolab” segment describes it in more interesting ways like “order out of disorder” or “mystery, beauty, and order arising from the group”. Phenomena like “leaderless progress” arise from studies of both ants and the Internet as well as the evolution of distinctive neighborhoods as “error creates architecture.” In emergence the creators are everybody and nobody. The magic emerges out of how a group lives and behaves and how its members interact with one another. In the end it is a form of group learning and advancement built on error and random deviation; perhaps if attached to a value system, you could even say good luck or serendipity.

Even before the discussion got to theories of consciousness and how free will emerges out of the interaction of the relatively unidirectional neurons connected to our senses where thoughts are not stored in any neuron but arise from the interactions of tens of thousands or millions of neurons, my own mind was trying to apply these concepts to healthcare. Over the last decade we have noted evolutionary progress toward better care that is consistent with the Triple Aim. Is that because we are embedded in a process that is driven by emergence?

Progress occurs when we work together. Progress is fueled by our errors as much as it is by our occasional breakthrough thoughts and actions. It is amazing to see the progress that occurs when the leaders step out of their offices and go to the gemba to see what is really happening and then, while in the gemba, pause to ask those doing the work for their ideas. Lean leaders allow and foster the emergence of the wisdom of the crowd.

Isolation undermines the process of emergence. Individuals resistant to interacting with the group are limited in their ability to evolve and participate in the progress that can be made much more predictably by the group. If you live in a cave (or in your office with your head down doing only what you have always done) and never come out and participate, nothing will emerge.