Reviewed 04/2008

If you cut off a Spider’s head, it dies; but if you cut off a starfish’s leg, it grows a new one, and that leg can grow into an entirely new starfish. The authors use this to expound on a topic that may be both stimulating, but also unsettling. Traditional top down organizations are like spiders, but newly evolving decentralized organizations are challenging tradition and changing the face of the business world.

This book is an entertaining, clearly written description of the movement from traditional hierarchical organizations to decentralized, loosely configured confederations. Using examples from outside health care—Wikipedia, craigslist, Skype—the authors explore the fundamental principles surrounding the decentralization revolution, which focuses on the power of peer relationships rather than the hierarchies most of us have lived in for the majority of our careers.

While not focused on health care, one can see the potential applications, and perhaps also the limitations of such a system. Traditionalists will be horrified by some of the principles, but the rapidly changing environment in which we live will cause all of us to reassess how we look at our existing structures and processes. Through entertaining and vivid examples, the authors make a strong argument for moving away from the centralized mode presently seen in most organizations.

But for those fearing anarchy, the authors speak of “hybrid” organizations, and how they may confront the challenges of our changing world. The power of catalysts that have an uncanny ability to bring people together is described and resonated with me both personally and professionally. Their description of the characteristics of this catalyst is worth reading itself.

I recommend this book for those who are willing to put the traditional view of the world aside, and consider the implications of a “starfish” type of health care system. Those who’ve read this book find their thinking changed as we move forward—some with a sense of hope and some with a sense of fear and apprehension. Either way, you’ll benefit from the clear, succinct style of the authors in presenting this evolving alternative to organizational structure.