Monday, September 18, 2017

The Energy, Metabolism and Entropy Within Organizations

October 26, 2017

Nilza I. Cruz Ruiz 
939-644-7683



"Philosophy is written in that great book which ever lies before your eyes – I mean the universe… This book is written in mathematical language and its characters are triangles, circles and other geometrical figures, without whose help… one wanders in vain through a dark labyrinth."

"With regard to matters requiring thought: the less people know and understand about them, the more positively they attempt to argue concerning them."

– Galileo Galilei


The "Macro" Picture

 Life: quite probably the most complex phenomenon in the Universe. It takes on an impressive variety of forms, properties, functions and behaviors over a huge range of scales. Each of the organisms that constitute the biosphere have evolved by the process of natural selection following a unique historical path. Then, add to the biological life, the underlying complexity related with social life, which we, as humans have introduced into the planet, especially in the form of cities, and all the astounding phenomena they encompass: culture, commerce, organizations and architecture.  A common property shared by humans, cities, and organizations is that they are complex systems. The cities created by humans have a bright side representing economic and academic development, innovation, and also opportunities for development as engines of wealth and politics which will open the door to POWER (which may approach the not so bright side). On the darker side, cities represent an opportunity for crime, poverty, pollution and consumption generators of energy and other resources.

The related challenges and threats we are facing nowadays are not new. All have been with us since the beginning of the Industrial Revolution, but because of the exponential or highly accelerated rate of urbanization, they feel like catastrophe is highly predictable within the interrelated (one has led to the other) perspectives of social, economic and long term climate changes we have been confronting. This does represent and opportunity to think about, create, develop and study a "science of cities" and by extension a "science of companies". In other words, a formal framework for understanding their landscapes, dynamics, growth and evolution. Similar to the framework used to study the environments, growth, dynamics and evolutions of us as humans. The point of convergence of cities, companies and humans: Complex Systems.

Dynamics and Non-linearity in Complex Dynamical Systems

A universal characteristic  of a Complex System is that the whole is grater than, and significantly different from, the simply linear sum of its parts. In many instances the whole seems to take a life of its own, almost dissociated from specific characteristics of its initial building blocks. Furthermore, even  if we understood  how the individual agents interact with one another, predicting the systemic behavior as a whole is not usually possible. "Conspiracies" within the agent dynamics also occur at moments in time in space which are naked for the human eye. Agents may auto-organize to produce outcome. This collective outcome, in which the system manifests a significantly different behavior than that of the individual parts, is called emergent behavior. Non-linear systems are dynamical systems. It is a recognizable characteristic of economies, financial markets, companies and organisms.

Energy, Metabolism,  and Entropy 


From the human or social life perspectives, there is an amount of energy needed for survival. For humans, this is quantitatively expressed in terms of a metabolic rate, which is the amount of energy needed per second to keep an organism alive. As social mammals now living in cities, we require homes, lighting, heat, automobiles, roads, computers, and so on. These represent the social metabolic rate. The social metabolism and human energy invested in the development of cities, countries, etc. should positively correlate with the society and city infrastructure which we use to promote growth.
Thus, energy is processed as part of the metabolic or social metabolic rates.
When energy is processed, there is always a price to pay. Because energy underlies the transformation and operation of almost everything, no system operates without consequences. There is a law of nature: The Second Law of Thermodynamics, which states that whenever energy is transformed into a useful form, it also produces "useless" energy as a degraded by-product: "unintended consequences". For example, as humans we need to eat in order to stay alive, but after eating, sooner or later you would have to go to the bathroom for a physical manifestation of your personal entropy production!
The word Entropy is the literal Greek translation of "transformation" or "evolution". So, in making order, or in a closed system, disorder is inevitable. To maintain order and structure in an evolving system requires the continual supply and use of energy whose by-product is disorder. In organizations, implementing order produces disorder as a consequence. As we know the saying: "No pain, no game" This is why as humans, in order to stay alive,  we need to continually eat to combat the inevitable, destructive forces of entropy production. This is no different for organizations or cities, which require more energy for innovation, maintenance and growth.
The battle to combat entropy by continually having to supply more energy for growth, innovation, maintenance, and repair, which becomes increasingly more challenging as the system ages, underlies mortality, resilience and sustainability, whether for organisms, companies or societies.

Energy, Metabolism,  and Organizations 

As humans, after growing rapidly in their youth, almost all companies with sales of over about $10 million end up floating on the ripples of the stock market. This is a precarious situation because if a big wave comes they can drown. If companies are left alone while suffering losses (even if profits are growing exponentially),  companies become vulnerable if they are unable to keep up with the growth of the market. A sizeable fluctuation in the market or some unexpected external perturbation or shock at the wrong time can be devastating to a company whose sales and expenses are balanced. This sequence of events is not very different to the process that may lead us, humans to our own death. We too, are finely balanced between metabolism and maintenance costs. Ultimately, we reach a stage where even a small perturbation just as a minor cold or heart flutter can lead to death.
The death of a company may refer to their disappearance because of a merger or acquisition, rather than by liquidating or going bankrupt. A useful definition is to use sales as the indicator of a company's viability, the idea being that if it's metabolizing, it's alive! Birth would be defined as a time when organization first reports sales and death when it ceases to do so.
In synthesis, organizations, as humans, are born, require energy, maintenance, metabolize, stay alive, suffer diseases, survive, or not; (i.e; die). They are, as us, complex dynamic systems which adapt to changes.  They also consist of  agents interacting non-linearly with properties and behaviors which interact, and even conspire within each other in a self organized manner. The emerging behavior is often not possible to predict, even though tools as agent based modeling and systemic dynamics can help simulate the behavior of these systems. We need to continually strive to think this way, to understand emerging behavior is not the linear result of the system's agents or constituents. Non-linear systems are dynamical systems, and dynamical systems, as for example differential equations, are used to study the instantaneous rates of change within systems. For example, in organizations, we focus on financial results and economic behavior, but not on the rate of change of these results, and the associated underlying factors [regulation, operational infrastructure, technology, human capital, etc.] associated with these rates of change are seldom addressed. We may refer to these underlying factors as the organization's genetic code. In this case, the organization's economic behavior would be a function of the rates of change associated with the dynamics resulting from the interactions of its genetic code. This, within existing landscapes.


Next week we'll talk more about Dynamical Systems, Non-Linearity  and Applications


Monday, September 11, 2017

Yes...WE CAN !

September 11, 2017

Nilza I. Cruz Ruiz

939-644-7683



The overall circumstances and unique social, cultural and economic situations we’ve been facing in Puerto Rico have served as motivation for sharing my story. I do have to take one moment and commend the all the staff in public and private hospitals, firemen, policemen, maintenance personnel, and a very special thanks to our brothers and sisters who have risked their lives representing the Puerto Rico Electric Power Authority and our Puerto Rico. I feel very proud, and we ALL should.... Bravo!

Also, our ongoing prayers to our less fortunate neighbors, families and friends in the Caribbean, and Florida; whom we are helping from our island.


New York, New York

In June 1966, I began my physical journey into this world born in the Jacobi Hospital located in the Bronx, NY to my beloved parents Manuel and Carmen. Both, Puerto Rican immigrants who moved to New York in the quest of the American Dream. I have an elder sibling, Manuel Jr. Dad, a hard-working butcher who worked mainly at racetrack restaurants and mom, a housewife; who departed to another beautiful life in December, 2013, but is always in my heart. Neither completed high school before migrating to the big apple. They spoke very little English. We lived in the Bronx, at 525 Rosedale Ave. Apt. 1G. It was a two (2) room apartment one (1) bathroom, small living room and very tight kitchen/diner. My brother and I shared one bedroom. This was part of a housing project (like the caseríos in PR) surrounded by “bodegas”, people who would call us “fucking Porto Ricans” each time the saw us, and other nicer folks. I was never allowed to go out and “play” unless accompanied by one of my parents; oh, and because I was a girl and “girls were never to be left alone”. I wasn’t even allowed to go to a baseball game with dad and my brother just for being a girl!

With much sacrifices, they (my parents) sent my brother and myself a couple of years to Holy Cross, a catholic school in the Bronx. I loved the school. I remember my teachers were “Brothers”, “Sisters” and a faculty composed mainly of Jewish, Polish and/or Italian backgrounds. This intrigued me. I loved the fact that my gym teacher was “Brother Frank” (with the long brown cloak), my math teacher was “Sister Christopher Joseph” (a nun), and my math teacher was not a nun, but Polish, and very “smart”; at least, from my perspective.  For another couple of years, when Dad couldn’t afford Holy Cross, my brother and I attended PS 169, a public-school right across the street from our previous one. It was hard, but we had to adapt, the hard way; either do it, or do it! But not going to school was NOT an option. 

Our daily journey to school was a fifteen (15) minute daily walk in the morning, and in the afternoon. Mom would always walk us! I loved to learn, discover, and be creative; especially in math and science! I remember asking so many questions. All related to the why, how, when where, etc. I was (still am) a dreamer. This was (is) my nature. Many times, transposing concepts or the abstracts I thought about or created about certain conceptions; (many of them math or science related), into new “things” I could discover, “see” and just continue to think about.  Then the intersections of what I could “see” with experiences in my daily life, and other concepts I either read or was introduced to in school, or simply by speaking with the owner of the nearest bodega; Mr. Abelardo. I loved this feeling, and oh, I was very insistent in understanding. How? I would always read, and like to draw my interpretation of what I read and understood, and then connected with the existing and other logical concepts. Then I looked at myself in the mirror and I would narrate what I understood, looking for my own approval and meeting of my own mind with that of the author’s. It was a kind of game; the game of understanding which required a hell of a lot of perseverance. Oh, and I never left from the front of that that mirror until I was fully satisfied with my performance!!!

At home, it was both my parents, and my parent’s family and friends in New York, speaking Spanish all the time. As for the music, it was Willie Colon, La Fania, Hector Lavoe and salsa all the way. It was an exquisite menu of rice and beans, fried eggs, corned beef, salami, Italian bread (which I loved), and especially for dad, Colt 45, Budweiser or Schaeffer. During the weekends, I would bring beer to my dad, open them, and of course, grab a sip! It was cold as hell during the winter and dry hot during the summer, my favorite part of the year. We would visit Orchard Beach with a pot of rice, cheese puffs, beer, and a blanket for the family. And oh, the Puerto Rican parade. That was it! The people, the colors, the loudness!!  I could understand Spanish, but hardly speak it. My frustration, I was never allowed to a ballgame with my dad and brother because I was a GIRL!!! Really?? Yes....



Off to “Porta Rico”

Spring 1976. For reasons I have to be frank about and confess I still do not entirely understand, mom decided my brother and myself would re-locate or move with HER to Puerto Rico. She said the island was beautiful and we would live a much better life in a beautiful “private home”, different from the projects we were living in. She would also tell us about the “flamboyanes” and beautiful beaches. So off we were to the island in July 1976. We arrived at Puerto Rico to the town (county, if you will) of Cabo Rojo. In Cabo Rojo, we lived in a neighborhood (“barrio”) named “Parabueyon”, a rural area with a lot of sugar cane and dirt streets.  A small town located at the south west part of the island and minutes away from beautiful beaches. We moved in with mom’s father (elderly 78 year old-“Jovino”, whom my brother and I had never met before), and her youngest brother, my uncle “Tato”.  The house, a three room wooden home with a zinc roof. The side wood had quite a few holes, and the floor was also wooden with many holes as well.  The foundation of the wooden house was composed of a few wooden plinths (zócalos) embedded in clay. It was full of bugs and during the evenings, bats and giant cockroaches would make frequent visits. This pretty much framed the beginning our new environment. Mom, my brother and I slept in the same bed with a mattress that was terribly uncomfortable. At the time, I was 11 and very upset. It was soon to be August and on the island school would begin in this month.

So off we went to Saint Augustine School in Cabo Rojo. Even though mom didn’t have a job, she relied on the fact that dad would send her enough money to make monthly payments for my brother and I catholic school tuition. Off we went.  We began in our new school. I didn’t speak the language, I lived in a very poor home in a very poor “barrio” and here I was in a private school commencing my 6th grade. But of course, the kids at school named me “la jíbara muda de parabueyon” (the country mute girl from the “hood”). I didn’t even understand what this meant, but I remember the deceptive laughs and making fun of me. There was a lot going on. The radical environment change, the school, the mean kids, and the economic limits. You see, many years later I learned dad was either unemployed or employed with less income, and it was extremely hard for him to keep us with private school payments, food, etc. Oh, and mom didn’t work. Shortly after, mom was on welfare. She received food stamps and health benefits from the Puerto Rico Commonwealth.  I clearly recall one day I went with her to the supermarket for groceries. In a particular aisle, I spotted a “Cosmopolitan” magazine with an executive image of a woman on the cover. I immediately said to myself, “I don’t know how, but I am going to be an executive”. Even though mom was receiving assistance from the government, I was just not happy with the feeling of dependence. I felt embarrassed. But this was my Reality, and I had to cope with it and move on.

Mom defaulted at our school payments. With luck, my brother received a sports scholarship at Saint Augustine and even though I was also in the volleyball team, (yes, me), the scholarship was just for one; my brother. So mom continued defaulting on my payments and there were many times I was scolded by school administration in front of my classmates because my mom didn’t pay. At home, it was eating whenever there was food depending on food stamps, grabbing mangos, "guanábanas" and coconuts from nearby trees, and supporting the most terrible menstrual pains with no medication what so ever. Mom just said: “there’s no medicine, take the pain” ("carajo, aguanta y no te quejes"). Tough for a teen!  But there’s something I could tell you, again, this was reality. And it was up to myself to be / or not, whatever it was I wanted to become in the future. Of course, there were days with no food, embarrassments, no money, bugs, bats, cockroaches and a lot of fear. Mom did what she could. Dad, also. It was NOT their fault.  I had a great cousin who was kind enough to help me in my Spanish, and in school, I focused on getting good grades (studying twice or maybe triple as hard because lectures were in Spanish), and in volleyball. Boy did that volleyball help me focus. The sport exploited my competitive side and shielded my poverty. I felt like the “Queen of el Barrio Parabueyon”.  I always wanted to help and lead. I was president of my class at the 11th grade and fought for equality amongst my classmates. I almost got expelled from grade 11 for not agreeing with naming a student who was included as member of the National Honor Society with a GPA of 2.50 , but his parents were very generous in $ contributions to the school. Of course, I was punished with not being part of the Honor Society myself at senior year with a 3.55 GPA and complied with all requirements. Also, I was demoted to VP of my class. What was new? I did get the message across!

After so much adversity, I managed to graduate thanks to Sister Anne Eugene Vivas, school director at the time, who pardoned my mother’s tuition debt with the school and my “faulty” actions with the National Honor Society kid incident. She understood I was a leader and she believed I would someday be very successful. Thanks Sister Anne!!!

I applied to the University of Puerto Rico, Mayaguez Campus. I wanted to study Pure Mathematics just because I loved math, it satisfied my intellectual challenges, and I understood it could help me establish a frame of mind or thought for my ongoing curiosity of things and inquisitive thoughts, imagination, and creativity. I was accepted!!! So in August, 1984 I began my undergraduate studies. I would rely on public transportation, the food stamps mom continued receiving, state health program, the federal Pell grant, and a part time job at Almacenes Rodriguez (shoe & purse store) at the Mayaguez Mall as a cashier for the next four (4) years. To make ends meet, I learned how to sew my own clothes (using an old Singer sewing machine Dad sent me from New York) to go to work at the Mall.  I didn’t sleep at least 3 out of 7 days a week. I helped support mom as well. There were times I cried and cried, because sometimes it seemed impossible, but I graduated from Pure Mathematics with a minor in Statistics in May, 1989, even though I completed required undergrad credits in December 1988. In May, 1989, I received a job offer from the NSA, which I refused just to stay in PR and support mom. I know, it was a tough decision, which I don’t regret! I enrolled in graduate school at the Mayaguez Campus to pursue my MS in applied statistics in August, 1989. During this time, I was a TA at the Mayaguez undergrad school of mathematics. At the same time, I taught Geometry and Pre-Calculus at a private high school at Mayaguez. It was a nice experience, up until the director of the school instructed me to change a student’s grade from 81% to 91% in Geometry because the student wanted to pursue studies in engineering in the US and 81% in Geometry (what was earned) wouldn’t help much. This was a huge deception for me yet a great experience; of life. This happens! I denied the petition and handed my letter of resignation effective immediately. This was totally against my work ethics; and most important; to my understanding, this action would not help this student.



Bull’s Eye

By 1991, I was convinced I wanted to move from the southwest part of the island  to the capital of Puerto Rico (which I had never visited!): San Juan. My brother’s mother n’ law sent me a newspaper add which stated that the Office of the Commissioner of Insurance in San Juan was seeking for an ”Auxiliary Actuary”. So I went for it. I embraced a three hour ride from Cabo Rojo to San Juan in my 1979 Omega which lacked air conditioning. And there it was! I got the job which would pay me (net) $630.00 a month. This, for rent, food, gas, etc. But from this point on, I entered the insurance industry as an Underwriting Trainee, then Commercial Lines Underwriter, Quality Administrator, and at 30 years, I was Vice President at a Multinational Insurance Company. Excellent pay, benefits, Banker’s Club privileges, great office, parking, golf. Oh, and in the Financial District of PR in San Juan!
Bull’s eye!! I was finally the executive woman I had pictured back in 1981! In parallel, I completed an MBA and graduate certification in the Insurance Institute of Philadelphia and the College of Insurance in New York.  Not to mention my traveling to home office in Miami and great worldwide learning experiences!

It’s not as beautiful as expressed. There were lessons learned the hard way. Components related with internal politics, rules and regulations, culture, and behavior are embedded within performance and results obtained conformed great part of said lessons. Within these organizational frames of work, said components, especially rules and regulations, are meant to be followed. All eyes are on our performance, which means we are not only perceived as the results we obtain, but how are we as leaders, as a function of how well we can “navigate” within the organizational landscapes, and internal politics play a critical role in this navigation quest. What is fair for us may be perceived in a different manner by others, in an intentional or non-intentional manner. It all depends… as a professor, mentor and someone very close whom I’ve learned very much from, has taught me.

I learned that even though I was trained as a scientist, we need not always communicate as scientists, subject to who our audience is. We need to understand and accept that social and cultural components should always be considered in studies we conduct. Also, the art of negotiations. Obtaining balances, and carefully identifying and understanding tradeoffs; from all sides. We need to acquire more perspectives related to Systems Thinking and Complexity Science. Organizations, Cities, as Ourselves are Complex Systems! We need to understand this and think about the fact that even though we as humans, corporations and cities are VERY different, all are born, grow, develop, and die! Just think about it!!! There is genetic code within a person, a corporation and a city. They all need resources, maintenance, investment and development in order to survive! I find this fascinating.....

But as of today, I am part of the big picture: PUERTO RICO. I am continuously conducting research and studies with a group of associates geared towards the interrelations of mathematics, statistics, physics, finance, social sciences, arts, law and economy with the development of organizational landscapes that would promote higher levels of efficiency within government and private ecosystems. In particular, health and academic systems.


Time to Move On

Time continued forward and I have two beautiful kids. Sofi 19, and Jean,  17. After a second Vice President position in another Multinational Insurance Company, I was self-employed for many years. During 2011 and 2012, I worked directly with a special musical project at the PR Conservatory of Music, geared towards providing needy children in PR the opportunity of discovering and expressing their creativity by playing an instrument and forming part of an orchestra. This would also provide them discipline. It was in December 2012 that I was invited to join the management team of the Puerto Rico Medical Services Administration. At first, awkward. But after much thought, I was born in a public hospital in New York, and I was raised under the Puerto Rico’s public health system; at the time; Arbona System. Why not try public service within the public system I myself grew up in? Of course, now the Model was based on the Health Reform System, not Arbona, but why not contribute to make it better? This was my frame of mind and I accepted. But thinking about the job and accepting is one thing, but being part of the system, I mean, is another. Talking with patients and families receiving health services in the emergency room, outpatient clinics, and other facilities within the medical center make you really UNDERSTAND that there are people in need, and expect much from public service employees. We need to continue to be their role models, and continue to research and study alternate and more efficient methods from which they, the people of Puerto Rico, the private sector and all components which constitute our island’s macro-economy can benefit. We need to step up as leaders and be more creative. We need to continually research and study, no matter our age!! Education and leadership are key. It is our responsibility to promote these qualities we all have in a NON POLITICAL MATTER. As Former Medical Service Administrator, I gained knowledge of understand how I can contribute to make Puerto Rico  a better place towards achieving all goals, macroeconomic, financial, organizational, cultural, and behavioral; particularly in achieving an integrated  healthcare, economic, academic and social structure.

This is what I’m focused on along with an exceptional group of professionals. Another thing, we cannot work alone. We are responsible for assembling networks that will help us achieve our endeavors.

I barely slept or ate for a long time, but it wasn’t impossible. As part of our system, there are rules to follow. Following them or not will always generate positive causal loop feedbacks, but we have to increase levels of perseverance, be wise and obtain balances within everything/everyone we work on or achieve. We need to lead, facilitate, coach, and "roll our sleeves". We need to dive into the deepest waters that will only provide us with the most beautiful opportunities of "seeing" in order to understand. You see, we're not entitled to understand something we don't "see". 

Let’s be open to new dimensions, ones that are very close to us and waiting for our attention and implementation.  Only when our minds are open will we see; outside of traditional existing models or frames of work.

Where we are today, or where we’ll be tomorrow, depends on us, and where our minds and creativity position us, along with the intersections we promote with groups of people and other components associated with our islands economic, structural, fiscal, and social landscapes.


 I say, Yes…We Can! 

y Vamos Pa'lante


Next week we'll talk about the astounding similarities within humans, corporations, and even cities within the context of Complexity Science.

Monday, September 4, 2017

The Mountains We "Can Not" or "Do Not Want" to See...


Nilza I. Cruz Ruiz
939-644-7683


"The tragedy of bad economic ideas is that once they grab hold of society's imagination, it becomes nearly impossible to persuade people to abandon them. Instead, the ideas must be... disproved by experience".

Thomas I. Palley,,economist and author From Financial Crisis to Stagnation (2012)


Equilibrium is  frequently heard as the heart of modern macro-and microeconomics. Associated models start with the simplest concept of supply and demand. The downward-sloping demand curve intersects the upward-sloping supply curve. The intersection represents an equilibrium point at which supply = demand at a price which results satisfactory to both sides.

In this case, agents are represented by consumers and producers. Equilibrium is reached as a result of the interrelation between these agents in a given environment defined within a landscape which is many times composed of interrelated sub-landscapes. Agent properties and behaviors, as well as environment characteristics may be defined, designed and controlled, in order to "predict" or anticipate "expected" results. This definitely sounds like an optimal scenario. But the truth: the financial system, as many other systems as for example the healthcare system,  are Complex Dynamic Systems.

In particular the healthcare system in the US and in Puerto Rico has been presenting symptoms related with recursive arrhythmia for the past years. A heart attack within the system is very clearly presented within every mountain in the existing landscapes or structural healthcare models. How can the healthcare system  in Puerto Rico reach a point of equilibrium when more than fifty percent (50%) of the island's population is below the level of poverty within a universal third party payer system model the government cannot afford? 

Just last week, I was watching a program in which licensed health care administrators were discussing the financial challenges most of the hospitals on the island (public and private) are facing. It struck me they were focusing on how the number of "empty beds" was increasing, and that "things had to be done". But what, and based on what underlying factors? You see, I'm not focusing on a fish bone cause diagram or what's on the tip of the iceberg; I'm talking about identifying and understanding how the system's genetic code or DNA works. I'm referring to  discovering and "seeing" what cannot be seen! Then interrelate this genetic code, and design conceptual models aided by simulations that would lead expected outputs or results to be different!

The dynamics of complex systems are best understood using Complexity Theory, a hard science that offers the knowledge and tools to see and understand catastrophe coming in advance. Complex dynamic systems (e.g.; healthcare systems) produce unexpected results by means of "conspiracies" developed (intentionally or not) by the interactions of agents that lead to the systems instability resulting in emerging behavior as output.

Internal instability within the state of the system causes ruptures which, as a domino effect, create more recursive ruptures and so forth. Ruptures are really represented as fractals within the system at different scales. A perfect example are the unsustainable financial results emerging from the Government Healthcare System, and how this financial unsustainability is growing exponentially on a yearly time series that has been path dependent. 
The government in its role as a  buyer of health insurance pays insurers to  "assume the risk". The risk defined as providing healthcare services to millions of humans under the level of poverty by a provider distribution network contracted and controlled by insurers. Providers depend on performing healthcare services through different healthcare facilities they don't control unless they own the facilities. Talking about complexity and the dynamics within!!! The most interest part of the system relies on the financial model. Contracted healthcare facilities bill insurers for incurred services through providers based on fixed rates that represent less that $.30 for each $1.00 incurred by the different healthcare facilities (PSG rates have dramatically decreased). Payments or collections are then received by facilities up to thirty (30) days after the services are provided. Think about cash flow and liquidity constraints for healthcare facilities and providers under this system! How's this for equilibrium? Think about which agent is really assuming the risk.

This is the mountain we should all be closely observing and transforming! The existing structure of the healthcare system, including the financial model. This cannot be political, but again, there's a price to pay; by US!  A price related to the consequences associated with the pathway imprinted by administrative deficiencies of many government administrations, associated with politics, governance, inefficient structures, and internal infighting within government entities. Yet, there have been various proposals submitted to the government, legislature, and other entities; but again...silence, and many  don't want to see the mountains!

There is a dissonance between the political world view and the real-world in healthcare, as in economics,  that we need to stand up for! The catastrophe is closer, and the mayor healthcare earthquake is just a matter of time...far more predictable than hurricane IRMA...

We have to see the mountain, acknowledge it, and most of all, master it...

I guess, ideas may after all be disproved by experience.




The Energy, Metabolism and Entropy Within Organizations

October 26, 2017 Nilza I. Cruz Ruiz  939-644-7683 "Philosophy is written in that great book which ever lies before your eye...