21st Century Systems (United States)

Abstract This chapter explores the interdependence of the six principles introduced in Chapter 2, culminating in the construction of “The Thread”—a conceptual framework for navigating complexity. Using the Logosofia platform, the authors examined whether the adoption of one principle enhances the adoption of another by posing the question: “If we implement Principle (X), will it significantly enhance Principle (Y)?” The analysis revealed a hierarchy in which Principle 1—Situational Complexity—forms the foundation. It enables the adoption of all other principles by fostering awareness of three types of observational complexity: objective, subjective, and intersubjective (Principle 2). This, in turn, supports the effort to objectify intersubjectivity through inclusive deliberation (Principle 3). Together, these principles enable the implementation of ephemeralization (Principle 4) and systemic thinking and design (Principle 5). The synergy of these five principles reinforces Principle 6, empowering communities to navigate what is referred to as the Labyrinth of complex challenges. The chapter also introduces the Situational Complexity Index (SCI), a metric designed to assess the complexity of collaborative processes. SCI is calculated using four parameters: the number of proposed ideas (N), their divergence (D), the number of ideas retained (R), and the number of interconnections (K). Data from eight application cases are analyzed to demonstrate how the use of “The Thread” results in a significant reduction of complexity, as measured by SCI.

Abstract In this paper, we revisit lessons learned regarding the process of Structured Dialogic Design in the arena during the past 50 years. Thirteen Lessons are presented with the intent of helping stakeholders design a strategy for escaping the labyrinth (vicious cycle) produced by the strong interactions among three issues: (1) the critical role of inclusive deliberative dialogue; (2) the dependency of inclusive deliberative dialogue on the application of a systemic methodology for supporting its authentic implementation; and (3) the commitment by organizations to inclusive deliberative dialogue. This paper will also discuss the development and deployment of Logosifa, the latest software platform to support the process and the enhancements (including improved metrics and a facilitator dashboard) informed by the lessons learned.

PurposeMultiple sclerosis (MS) prognosis is often uncertain. This literature review considers patients’ understanding of, and perspectives on, MS progression to better comprehend the unmet needs of people with MS (PwMS), in order to improve treatment adherence and quality of life (QoL).MethodsLiterature searches for peer-reviewed papers concerning patient perspectives on the progression of MS and comparable conditions, published between January 2000 and January 2020, were conducted.ResultsLittle qualitative evidence exists that examines PwMS’ perspectives on MS progression. The understanding and meaning ascribed to terms such as “disease progression” vary. Some PwMS find disease labels stigmatizing, confusing, and disconnected from reality. The lack of a clear definition of progression and discrepancies between PwMS and healthcare professional (HCP) perspectives may contribute to misunderstanding and poor communication. Patient descriptions of progression and relapses include symptoms in addition to those evaluated by standard severity and disability measures. Compared with HCPs, PwMS are still focused on relapse prevention but place higher priority on QoL and ascribe different relative importance to the causes of poor adherence to treatment plans. PwMS want to discuss progression and likely prognosis. Such communication needs to be personalized and delivered with sensitivity, at an appropriate time. Poor treatment adherence may arise from a lack of understanding and poor communication, particularly around treatment goals. The few studies that directly considered patient perspectives on the progression of comparable conditions supported and extended the perspectives of PwMS. Lack of adequate communication by HCPs was the most common theme.ConclusionPatient perspectives on disease progression in MS and other chronic progressive conditions are under-investigated and under-reported. The limited evidence available highlights the importance of providing adequate information and effective HCP communication. While further studies are needed, the current evidence base offers information and insights that may help HCPs to enhance patient care, well-being, and treatment adherence.

New Perspectives QuarterlyVolume 36, Issue 1 p. 36-38 Original ArticleFree to Read How The Unthinkable Happened In Brazil FERNANDO HENRIQUE CARDOSO, President of Brazil from 1995 to 2002. He is a member of the Berggruen Institute's 21st Century Council.Search for more papers by this author FERNANDO HENRIQUE CARDOSO, President of Brazil from 1995 to 2002. He is a member of the Berggruen Institute's 21st Century Council.Search for more papers by this author First published: 24 January 2019 https://doi.org/10.1111/npqu.12192AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume36, Issue1January 2019Pages 36-38 RelatedInformation

IntroductionEffective communication between patients and healthcare professionals (HCPs) is important to enhance outcomes in multiple sclerosis (MS). However, in practice, patients often report a disconnect in communication. Communication tools to aid patient–HCP communication have a long history of use in many chronic conditions. For example, symptom diaries have been shown to enhance outcomes in cancer, headache and sleep disorder management. MS in the 21st Century, a Steering Group of HCP specialists and patients with MS (PwMS), has created two communication tools designed for use by both patients and their HCPs.MethodsThe Steering Group first identified prominent issues in patient–HCP communication through group discussions and survey data. Following this, a series of workshops led to the development of two communication tools as potential solutions to these identified issues in communication.ResultsThe two most prominent issues identified were HCP time constraints during appointments and the misalignment of patient and HCP priorities—the communication tools developed through the workshops were created to address these. The “myMS priorities” tool [see supplementary materials] is designed to maximize the use of consultation time while the “myMS commitments” tool [see supplementary materials] aims to improve patient–HCP shared decision-making.ConclusionsThe MS in the 21st Century Steering Group adopted a broad, iterative and collaborative approach in the development of these tools to help ensure they would be as useful as possible to both HCPs and PwMS. These tools have been developed through shared patient–HCP expertise and are based on existing tools in other therapy areas as well as a review of the existing literature and data from MS in the 21st Century Steering Group surveys. The next steps will focus on the validation of these tools through testing them in real-world environments and clinical trials.FundingMerck KGaA, Darmstadt, Germany.Electronic Supplementary MaterialThe online version of this article (10.1007/s12325-019-01071-9) contains supplementary material, which is available to authorized users.