Ashby's Law

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V(c) ≥ V(e)/V(g) V=the number of distinct states a system can be in (a measure of complexity) in a given period of time g=system goal(s) e=the environment c=the control system When the budget is the goal, we have a very low V(g) with variety system near 1. The control system V(c) is also a low variety system because the company has limited choices and states. The environment is a very high variety system, getting higher all the time. Therefore, since a small number can never be ≥ a large number, the budget as a target or goal is always destined to fail. That is why no one rally pays much attention to them (except to game them)--otherwise they would be fired or replaced. There has to be enough flexibility (managerial choice, variety) within the organization to deviate from the details of the budget. In reality, managers are allowed considerable freedom to deviate within their budget allocation and that is true all the way up. So it works because it is only a negotiable framework. The CFO always has "hidden" pools of money to even things out. Even the board can chose to obtain more money mid year if they so decide. So there you go, much ado about nothing. For what it is worth, I never once looked at the details of any of my directors budgets. And I frequently got them extra money when they needed it and I even had them return money when they had spare money. They knew the game as did everyone else. The budget just allowed earlier signal detection and encouraged conversations for adjustment not punishment. We were managing a hospital.

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The law is about how people can effectively deal with what is otherwise overwhelming complexity. In my experience the US medical system and the latent system of health are massively complex and things are getting worse every year. I have some thoughts on the Medical and Health Systems.

The Law: "variety absorbs variety, defines the minimum number of states necessary for a controller to control a system of a given number of states."

Conant's Good Regulator Theorem explicates Ashby's Law thusly, "every good regulator of a system must be a model of that system". That is, any regulator that is maximally successful and simple must be isomorphic with the system being regulated.

My primary example of Ashby's Law at work: The Clinical Care Specialist role (Community Health Worker) is the missing piece in the medical system. That role absorbs huge amounts of variety that cannot be absorbed by physicians, hospitals, or payers.

It is not surprising that this role was the primary request from patients when asked seriously what is needed to redesign the US medical system. This is the first time that I think I really understand Ashby's Law. And the patients knew that the physicians and the hospital could never understand their situation well enough. But the Clinical Care Specialists almost always could and they could form the link because they also understood the physician's situation and the hospital's situation.

Critically, we need to never conflate or confuse Medical Care with Health Care. Medical care is for the diagnosis, treatment, palliation and to a limited extent the prevention of illness.

Health Wikipedia is living well. It is not the absence of illness. Absence of illness requires a near absence of living and a near total resource allocation toward diagnosis, treatment, palliation, and prevention. There are social and personal choices to be made. Where is the balance? What view of living do you/we culturally or personally ascribe to?

Death is a part of health, not its opposite.

Illness is a part of life and not its antithesis.

The Clinical Care Specialist or Community Health Worker is a critically missing layer in the nested recursions of our current health system. Thus the current system is nonviable as a health system. However it is terribly viable as an autonomous, extractive, Parasitic Metasystem.

For people with chronic and recurrent medical conditions, this role was the high leverage point in the system of care. It worked so well that the money counters did not want it to succeed as it resulted in fewer and less expensive encounters with the medical system.

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