Ulcers and wheelchairs

From time to time I have written about the problems of defining the extent of the "system" that is being studied and modelled in an OR study.  The mantra that was instilled in me as a student and which was reinforced throughout my professional career is this: "Do you want to optimise your part of the system, or the whole system?"  All too often, optimising part of a system is wasteful and conflicts with the needs of the larger system.

Today, a chance conversation gave me another instance of this.  A friend was describing the work that his wife does with those who need wheelchairs, whether because of age or long-term illness.  I mentioned that my late father, a six-footer who needed a wheelchair after two strokes, had been given a chair with a deeper seat and higher back after several months suffering in a standard wheelchair.  The conversation developed, and I discovered that there is a move to restrict provision of wheelchairs to an extremely limited range of sizes.  Somebody is optimising a part of the system, because a limited range gives economies of manufacturing scale.  However, provision of wheelchairs is about people, not economies of scale.  And, if wheelchairs are only available in limited sizes, people suffer, and ulcers are a common problem for people in poorly fitting wheelchairs.  So saving money by restricting the variety of size and shape of wheelchairs puts more burden on health care providers and hospitals, so another part of the system suffers. 

I pointed out to my friend that this was a common situation, and mentioned the mantra of the part versus the whole.  He knew that I was interested in the maths and statistics of everyday life, and told me that I could describe the situation in my blog.

But, my friend went on, there are further aspects to the system.  He drew my attention to another one which he was aware of.  If you can provide high-tech wheelchairs to people, specifically the kind which raise the user from seated to standing, then those users can use work-surfaces and kitchen appliances, which gives them extra independence.  And, those users do not need so much domestic support in their homes, thus saving money in another part of the health care and social services system.   (There wasn't time to discuss further conflicts between managing the provision of wheelchairs and managing the care system for those who need wheelchairs.) 

And his final comment was salutary; if you are working in a system like this, and point out a solution to the conflict between managing your part of the system and giving efficient management to the whole system, then you run the risk of doing yourself out of a job because your part may not need your kind of leadership.  So what is optimal for you (keeping your job?) may not be optimal for the whole system.


Popular Posts