While Case Management has been a hot topic in the past year, there are various modifiers put in front of it: Advanced, Dynamic, and Adaptive. In this post I attempt to explain why “Adaptive” is the right concept and why that is so important.
In A Nutshell
Whenever you hear about an adaptive system, you should think about muscles. If you want to increase the size or strength of a muscle, you exercise it. The use of a muscle triggers a response to build the muscle. Conversely, lack of use causes muscle atrophy.
Adaptiveness is not simply the capability to increase or decrease muscle size. Instead it is more about the ability of the muscle to self-modify to fit the situation; the ability to sense a need, and to respond to it in a kind of feedback loop. Organizations are naturally adaptive if you have experienced people in management and they are getting accurate information about the situation.
Homeostatis is the idea that an adaptive system responds to external changes in such as way as to keep certain aspects constant. Your body maintains a constant temperature by various mechanisms that respond to temperature change. A retail stores that can detect the increasing popularity of an item will order larger quantities in order to keep the number on the shelf constant.
When we talk about a case management system being adaptive, the complete system includes the case managers as well. Humans are not excluded from the feedback loop. We talk about a good ACM system facilitating what the professional wants (needs) to do. Professionals play active roles in adapting the system to their needs. We can think of this as being self-modification because there is no external software professional, or process analysts, needed: the professional can adapt the system anyway necessary to meet the constantly changing requirements. For example, when a doctor gets the idea for a new treatment plan, they can institute that new plan without involving a software expert.
Examples Adaptive System
There are three good examples of adaptive systems we all are familiar with: the human body, the human brain, and an ecosystem.
Not just the human body, but all life forms have aspects of adaptiveness. Your DNA specifies how to form all the various muscles, but it does not include complete specifics on size. Instead a feedback loop is used to find the optimal size. There is no need to predict ahead of time exactly the amount of muscle needed. Each muscle is built with the ability to measure the amount of use and respond by growing, or shrinking, appropriately. This simple mechanism eliminates any necessity to predict up front precisely how much is needed.
Adaptive systems optimize themselves. Take for example someone who suffers the tragedy of losing the use of their legs. The muscles that are no longer used will reduce in size, while the muscles in the arms will increase to accommodate the increased use.
There are many such systems in the body. The skin responds to light exposure by varying the amount of melanin at the points that received the exposure. This saves one from having to figure out in advance which parts of the skin should be more and less pigmented. Body temperature is maintained at a homeostatic constant through a number of mechanisms including sweat glands shivering.
The concept of “practice” pertains exclusively to adaptive mechanisms. Want to learn the piano? The sit down at the keys and practice, practice, practice. Want to learn to play tennis? Start playing hitting the ball and practice the right moves. Practice only works because the system is adaptive.
The brain is another example of a complex adaptive system. The child learns the language that they hear spoken around them. We study subjects in order to learn them. The concept of “learning” is again something that refers only to an adaptive system.
Going beyond simple learning, there is ample evidence that the brain itself changes structure in response to environment. Large parts of the brain (e.g. the neocortex) appear to be able to take on substantially different roles depending upon the need. When a person suffers the loss of a limb, the part of the brain that used to control that limb appears to be reallocated to do other functions. There is a great book on such neuroplasticity by Norman Doidge called “The Brain That Changes Itself.” The brain allocates space to those functions that need it. In doing so, it optimizes the resources in the brain without needing to predict in advance exactly how much processing power is needed for each function.
Forest fires will occasionally burn every tree off the top of a mountain, and yet, the following spring there is plenty of new life growing. In New Mexico, where I grew up, the Aspen trees are the first to grow after fire has made a clearing. In 5 to 10 years you have what used to be a clearing filled with Aspen trees which turn golden yellow in the autumn. The mountains appear patched in different colors. Small pine trees need the shade of the Aspens to get started, but they eventually grow more substantial and crowd out the Aspens. The colorful patches are eventually filled in with the darker green pines — until the next forest fire.
The diversity of different organisms that thrive in differing conditions form a adaptive network, each organism dominating different aspects of the ecosystem when the conditions permit. The forest as a whole is extremely robust due to the adaptive nature of the biodiversity.
Enterprise as Adaptive System
Human organizations are also naturally adaptive. The day to day decisions are decentralized and delegated to front line workers. Different divisions compete for scarce resources, and good management will shift resources as needed. There may be a centralized view and control at a very high level, but generally this is very much abstracted away from the details of day to day operations. The parts of the organization are sensing and responding to their situation. There is a nested, recursive aspect of this, so that as you get to smaller parts of the organization, the sensing and responding is more finely tuned and detailed.
Organizations are constantly changing, and responding to that change. When a single person leaves a position, that may change the jobs of dozens of others. When an individual is promoted, dozens or hundreds of people will change their own behavior in response.
Yet the organization is stable. Adaptiveness does not cause constant fluctuation in the organization as a whole. In fact, it is well know that it is incredibly difficult to change an organization once it is in place. Adaptiveness presents a kind of homeostasis that allows an organization to keeps its character and form over the years even though people within the organization are constantly coming and going.
The Right Concept for Case Management
For case management to be successful, it needs to be adaptive. It needs to be under the control of the case managers to be in a position to sense and respond to the situation.
- simplified deployment: the case templates do not need to be designed in advance to fit the situation. You deploy an uncustomized system into the organization, and then it is adapted by the case managers themselves as needed.
- exercise: The system is not “designed” by a central planner, but instead it is trained by exercising it. Those parts that get the most use, and have the most need of improvement, will get the most effort.
- learning: the system as a whole learns how to support the organization. Instead of designing for a theoretical idealized business case, it learns from the real business cases, with the real people working on them.
- practice: the training is accomplished by doing the work, and without the need to make an abstract theory about the underlying mechanisms.
- stability: the system can be extremely stable because it senses and responds to perturbations automatically. The case managers themselves can shift behavior as needed, without waiting for programmers or other specialists.
- optimized: each part of the organization can optimize use to their particular needs, for their particular part of the business, and their particular employees and skills. This level of optimization can only be achieved through self-modification.
That is why I and my colleagues have persisted in calling this capability “Adaptive Case Management“. Others use the term “Dynamic” or “Advanced”. At a high level, we know we are talking about the same thing, so in some sense the exact term does not matter. But this lack of coordination on the name does confuse the audience.
My friends at Forrester have latched onto the term “Dynamic Case Management.” Perhaps they feel that changing would be a sign of weakness. But “dynamic” means only that something “moves” and “changes”. The term dynamic tells you nothing about the agent causing the change. An oppressive dictator can be dynamic, but never adaptive. The idea of self-change, self-regulation, and self-control is a very key concept, central to enabling case management. If dynamic requires a programmer, then it can never be adaptive for the knowledge worker.
I understand the need for analysts to maintain consistency over time. Documents are useful over a period of many years, and changing terms can create undesirable internal problems. Having invested so much into the term “dynamic,” they might be concerned that they would be losing some of that investment. However, in the long term “adaptive” is the right term that describes the right idea. They must decide the right tradeoff between loss of respect by changing a term, vs. loss of respect by stubbornly holding onto an outdated term. I would invite, in the friendliest of terms, to rally around the idea that case management is best when adaptive.
However, my goal with this post is not to change terms in use, but instead to simply give people an easy way to understand what the concept of adaptive.
When you hear that something is adaptive, think about how muscles respond to use by growing, how exercise is used to increase strength, and how practice is the way to learn to do things.