Which Priority First? The Adjacent Possible.

The best laid plans....

It's that time of year for personal goal-setting. Similarly many new strategic plans are set in motion or get updated. But, it is always a challenge to determine what to do first. Everything seems to be a priority.

I discovered a term from biology called "adjacent possible" when reading Steven Johnson's book Where Good Ideas Come From that helps in choosing which big thing to do before another. As he explains, "the adjacent possible is a kind of shadow future, hovering on the edges of the present state of things, a map of all the ways in which the present can re-invent itself."

But, only certain changes can happen first. In simpler terms, it's like being in a room with four doors where one door is the best possible to open. The others lead nowhere "on the edges of the present" either because it's too soon for them to be opened or they never were a good idea.

However, once a door is opened the boundaries change and the next big thing might be different than you conceived it to be back in time. A new "adjacent possible" is before you, as if you were on a continuous exploration.

So, what does this mean for setting priorities? Current mind research indicates that we can focus only on about four big ideas at a time. So, narrow down your priorities to something manageable. Then, choose the one which "hovers closest on the edge of the present". The one that will help all the others along.

Project management types might call this breaking things down into milestones or smaller steps. Yes, that's true. But, this is really about what path to choose in the first place before breaking it down further or making a work plan or road map. The priority determines the path. The path shifts the world as you explore.

H1N1 Vaccine Chaos: Business Process Screw-Up

Our family doc led us to believe a couple of months ago that he’d vaccinate us against the H1N1 flu virus. He’s still waiting for his supply. In the meantime, we are being encouraged to join three to six hour line-ups coming to our “town” shortly. Someone has skipped a beat here in common sense planning.

Few if any of us pictured that we’d have to line up en masse on the basis of first come first serve for this vaccination. Make an extra visit to our local walk-in clinic or family physician—yes. According to one of our local clinics, the medical staff does not expect to be receiving any vaccine. How assumptions can be so wrong! Maybe things will change.

We are envious that Sault St. Marie has managed the process by having people book an appointment largely on line and I presume also by telephone. The real story might not be quite as streamlined as not everyone has access to the internet and many shut-ins cannot venture out to a clinic. Plus, the vastness of the north has accelerated the transition to e-records and e-communications ahead of more southerly cities and communities giving Sault Ste. Marie an advantage to start with. However, at this point in the roll-out in Southern Ontario, it is mystifying why the gap in “user-friendliness” is so huge between the north and south.

Understandably a mass vaccination of this type has never happened in anyone’s lifetime. The closest comparator is the polio epidemic in the 1950s where schools were the chief locations for inoculation. The target groups were school-age children not the general population. That then was relatively easy. However, there’s a lesson: implementation was highly de-centralized.

We are being funneled into too few spots as in a traffic jam on highway 401 when the on-ramps feed into narrower parts. I can understand that to take the pressure off the normal conduits for health care like emergency rooms, walk in clinics and primary physicians public health is providing temporary alternatives. Unfortunately, the timing is off as public health is the only source right now.

Where were the computer-modelers when we needed them?

This will get sorted out. The first time is always full of lessons learned. On the side of public health, it is likely hampered by uncertainty about vaccine supplies---how much and when available. Resources too are thin at the best of times.

Nevertheless, why some synergy has not been created at this stage with personnel at easy to access locations where there would be minimal line-ups still makes me scratch my head.