As Howard Bloom points out in The Global Brain, there are a couple of opposite but essential drivers at the heart of complex systems – conformity enforcers and diversity generators.
We need both. But we need both to work together in an integrated way. If there’s too much of either growth, development and evolution is impeded.
Diversity generators don’t just tolerate difference but give highest value to uniqueness. Conformity enforcers, on the other hand, operate by eliminating difference, setting standards and rules and making sure the whole system is compliant.
In health care, it seems to me, we have an excess of conformity enforcement. The “evidence based” enforcers seek to “eliminate variation” by developing flow chart style protocols where every single patient is entered into the same pathway and is treated according to the same, limited range of interventions. There is a belief that the raw material of patients can be entered into the same machine and will come out the other end with the same product or “outcome”.
But life isn’t like that. Every single human being is unique. There isn’t a single health care intervention in the world which produces the same outcome for every patient who receives it. There’s something essentially dehumanising about the enforcement of conformity on the rich diversity of individuals.
I’m a champion for diversity and tolerance. I think it’s richer than uniformity and conformity. I don’t deny that we need some level of conformity (without it we’d have disintegration and chaos), but I think we’ve gone too far. Not just in health care but in many, many areas of modern society – education, politics, economics…….
Where do you put your energies? Are you throwing your weight behind diversity generation or conformity enforcement?
Heroes Not Zombies 
Gosh, this is a topic that was yesterday at the forefront of my mind!
You see I was with a senior NHS Manager who in describing me kept using the word ‘contrarian.’ This manager was very nice but does not know me. I fear that this is how I am painted by the organisation. Nothing more than a trouble-maker.
I did not say to this senior manager but this is a word that does not describe me or my outlook to healthcare.
That I ask questions of the current NHS drive for conformity ‘enforcement’ and some of prevailing assumptions behind various interventions does not make me a contrarian! Actually I find it upsetting and at times a toll on my well-being to question the conformity.
My true nature is very gentle and as a doctor I will follow the person before me and then consider evidence in the context of the unique richness of that person their life, world and narrative.