The End-To-End Problem

As a business consultant I am very often confronted with a problem that I would name the “End-To-End”-Problem.

“End-to-End” from my perspective means examining a process, a problem, or even an illness from a holistic point of view or in other words, from its start (first symptoms or before) to its end (cure).

According to my experience, these kind of observations, in business and medicine, are rarely carried out in a truly accurate manner.

While working with my customers (in the role of an “organizational doctor”) I mostly start by generating an end-to-end picture of the actual customer’s situation and from there we start thinking together about how to achieve the wanted goal by resolving systematically what is hindering us to do so.

At this point the first question raises up: “What is our goal?”

Very often the answer is: “Making more profit!”

Note: This specific goal definition is not without problems, because short-term profit is usually easy to achieve, but can later take negative revenge (analog please see “Timeless Secrets of Health and Rejuvenation” by A. Moritz about the suppression of healing effects by frequently taking pain killers as short-term solutions).

So a much better question from my perspective is: “What makes my “company/organisation/body” viable (and healthy) for the future?”

This automatically includes “profit”, because it is a factor of viability, but not the only one!

What brings me to the next question: “What is constraining this goal of viability and is the major constraint inside or outside the system (company, body, etc.) we are looking at?”

An Outside Constraint (see figure below Pos 1) could mean we don’t have have enough orders, but enough ressources to deal with the existing ones.

An Inside Constraint (see figure below – Pos 2) would i.e., mean we have much enough customer orders but, we can’t deal with them in an economical way, because of missing capabilities inside of our company.

Note: Constraints can be seen as a sequential chain of constraints, like in a water tube, the major constraint always defines the maximum output of water, no matter what constraint comes next downstream. Solving the major constraint does not automatically mean that all other downstream constraints are solved too. (If you are interested in more information on this topic please see also E. Goldratt’s “Theory of Constraints”.)

What has this all to do with health and AFib?

The first problem is that I nearly never have met a doctor from Western Medicine that has really pictured an “end-to-end”-perspective for me as a patient.

Mostly we were talking about isolated values like blood-pressure, liver values, etc. without considering my personal strengths and condition at any time etc. . The unsatisfying result was, as I felt about it, a “nothing” fits all solution.

From my point of view it is dramatically important to take many more internal and external factors and their relation to each other into consideration for really healing a patient or fixing a problem in a sustainable way.

Facors resulting of the question:

• How and what do you eat and drink?
• How do you sleep?
• What do you do over the day?
• Are you moving your butt frequently enough?
• Do you get enough sunlight on your skin?
• Are you happy with your life/job, etc. ?
• What kind of meds do you take and if so why?
• When did the “problem” start?
• Are there are other symptoms that have appeared earlier showing you that something is out of balance (Anxiety, Depression, Pain, …)?
• …

By asking the right questions an end-to-end picture of the persons life concept will appear, that provides a much better overview answering the question what might have caused his/her problems and how to put things back into balance.

The question of internal and external factors (constraints) also arises in equal measure. Does a person have access to healthy food and water. What is their stress level and how do he/she deals with it, etc.?

The traditional Ayurveda, an Indian healing art thousands of years old, for example, is a concept that incorporates these holistic aspects, but also classical homeopathy knows a very detailed anamnesis (patient analysis). (Note: From my point of view these concepts could be combined with some parts of western medicine to create a real strong new healing system. But sadly the actual business model of western medicine might block such an innovative approach.)

Another problem is occuring when the measurement of success is also not done properly end-to-end.

Example: What does it help if the surgery was “successful” by definiton, but the patient is still ill or more- To be more specific gets an AFib-Episodes again after a short time after surgery.

Another important point is that when “solving problems” regarding health or organizations, we mostly deal with very complex dynamic systems which carries the danger of approaching the analysis and control of a system with far too simple solutions.

Let us take a short look at a quite simple example taken from industry, showing a “controlled” dynamic system we all know: The heating of our homes.

In this following example we define a temperature by what the thermostat controller opens (or closes) a furnace valve as a result our home gets warmer or colder. As a next step, a temperature sensor measures the outcome and tells the thermostat controller to heat up or cool down. This is an example for a simple control loop.

For this simple case it might work quite well.

(Note: You might ask now what really is the desired temp, is it based on energy consumption, health, …? If you ask these questions, I got you into the right direction for the next point.)

By the way we have endless of these kinds of control loops in our bodies, but they are much more complex than this one and mostly also interconnected to each other.

Now let’s take a look to my favorite example next (see figure below), the “treatment” of high blood pressure. We again use the simple control loop example to make transparent what we are talking about.

What we can see in the figure above is that Western Medicine has exactly adopted the simple control loop example from (heating-) industry.

But here comes the problem with it:

1. Who defines (accurately) what is the desired blood pressure for your dynamic specific body condition?
2. How exactly is a “statically administered blood pressure drug” supposed to control a dynamic system accurately?
3. How can one assume that an arbitrary static intervention in a highly complex process does not cause serious disturbances?
4. What if the “measurement unit” is not working correctly?
   (Even approx. 5% measurement error could define people as “ill” without them really being so.)

The answer from my perspective is: It can’t be done accurately in this way, the complexity of the measure must fit to the system that should be controlled! (Note: If you are interested in the topic of an scientific approach in controlling complex system I can recommend “Designing Freedom”, etc. from Stafford Beer.)

You can adapt this example to many more treatment plans and measures that are done by medical industry, especially if you are searching for answers regarding: “Why do things so often end up in a catastrophy?”

To sum it up (what I would do):

• Taking the whole picture as complete as possible into consideration.
  What means to find out where the constraints (inside/outside) of your “system in view” might be, like:
  • Is your nutrition plan including water intake well balanced (containing vegetables, fruits, etc.)
  • Do you train your body enough and in the right way,
  • Is there maybe a detoxification of the body necessary (i.e., after a history of the intake of strong meds.).
  • Do you follow a natural behaviour that is close to the specification of your body?
    (Do you walk outside into nature, letting sun shine on your skin, etc..)
  • …
• Do not accept “success” where no success is, only because others have defined it in their “business model”. (A fixed blood pressure by meds is not a “solution” if your real problem is dehydration.)
• Get sceptic if a complex system is “controlled” by too simple parameters!

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