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Part I- Why Sandpile?

In trying to provide tools and a map to survive the patient journey, maybe we should first reflect on the whole idea of the Health care “system”. Ideally, our healthcare safety net, as a complex system, would have many of the interconnected moving parts working synergistically for a common outcome. In practice we know that whether due to funding, professional territoriality, politics, geography, structure, governance…. to name but a few, the Canadian Healthcare system is completely fragmented and silo’ed.

In the fascinating book “How Nature Works” (1996) by physicist Per Bak, he talks about the “Sand Pile effect” which is a metaphor for complex self- organizing systems which are susceptible to unpredictable collapse - think Avalanches, earthquakes, World Wars, the Stock Market Collapse of 1929, the US Banking system collapse in 2008. All are, or were, complex systems with numerous interconnected parts. The more complex the system, the greater the chance of a catastrophic collapse. These “avalanches of change” are not outliers or “the straw that breaks the camel’s back”, but are indeed inevitable. Not to be all doom and gloom, but it is from these rare but high impact events come stability and the source of true innovation.

So where would the Canadian Healthcare system be in this metaphor, particularly from the patient perspective. By the nature of the theory of the Bak’s Sand Pile effect, we would never really know when or how the whole thing could come crashing down. Fact is, it doesn’t matter, sooner or later it will. In the mean- time, as a patient, one needs to acquire as much knowledge, skills, tools and mental resilience as possible to manage their journey.

There are 3 elements of our approach which will also wind its way through our patient narrative to help bring a consistency, or a strategic “stake in the ground” to ensure we successfully work our survival skills in this context. Interconnectivity; system navigation and most importantly, giving a voice to the patient.

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