People at the centre of complex adaptive health systems reform

Journal of Evaluation in Clinical Practice, 2018

Complex adaptive systems (CAS), to reiterate, are systems composed of many individual parts or agents in which patterns can emerges as a result of agents deploying "simple rules" from the "bottom-up" without external control-CAS are "self-organizing" systems. "Simple rules" in health care would include seeking to optimize both patient wellbeing and the functioning of professionals. If elements of a CAS system

Health System Redesign, 2017

Overview. Health system redesign, as argued in this book, is based on three fundamental assumptions: • The philosophy of medicine-the value of health services arises from its impact on the health of the people we treat • The person/patient is at the centre of a functional complex adaptive health system • A seamlessly integrated health system has to understand its purpose, goals, and values to devise its unique "simple (operating) rules". These together determine the core driver for the "system as a whole" as exemplified by the Mayo Clinic's motto: "The needs of the patient come first" This overarching principle does not prevent a health system's subsystems to adopt their own drivers. However, they need to contribute to the seamless integration of meeting the health system's overall objectives This chapter illustrates how people/person-centred complex adaptive systems thinking and interventions can guide the redesign of novel approaches at every organisational level. At the service delivery (micro) level: • Clinical care in the consultation. Drawing causal loop diagrams can provide important insights into the dynamics of a person's illness. The deeper understanding about the linkages between the biological, social, emotional, and cognitive state of the person's current illness experience allows a clinician to more effectively integrate the management of the personal, environmental, and medical domains • Preventing avoidable hospitalisation of the frail elderly. Monitoring the daily changes in frail elderly patients' health experiences can identify those at risk of avoidable hospitalisation. The main reason resulting in avoidable hospitalisation, surprisingly, is the perception of lack of social support rather than actual deterioration in organ specific function

2013

I am a graduate from Lübeck Medical School, Germany, where I also completed my PhD. Since 1989 I work in an urban group practice on the NSW Central Coast, with a particular interest in the ongoing patient-centred care of patients with chronic disease and the elderly. In 1994 I started to pursue systems and complexity research with an inquiry into the effects of continuity of care on the care processes and outcomes. Since then my research has expanded and includes the areas of understanding the complex notion of health, health care and healthcare reform, showing that health is an interconnected multi-dimensional construct encompassing somatic, psychological, social and semiotic or sense-making domains, that health care has to embrace the patient's understanding of her health as the basis for effective and ef fi cient care, and that an effective and ef fi cient healthcare system ought to put the patient at the centre. I am joint chief editor of the Forum on Systems and Complexity in Medicine and Healthcare in the Journal of Evaluation in Clinical Practice. Together with Carmel M. Martin and Jim Price I chair the Complexity SIG in WONCA.

F1000Research, 2019

Rising healthcare costs are major concerns in most high-income countries. Yet, political measures to reduce costs have so far remained futile and have damaged the best interests of patients and citizen. We therefore explored the possibilities to analyze healthcare systems as a socially constructed complex adaptive system (CAS) and found that by their very nature such CAS tend not to respond as expected to top-down interventions. As CAS have emergent behaviors, the focus on their drivers -purpose, economy and behavioral norms -requires particular attention. First, the importance of understanding the purpose of health care as improvement of health and its experience has been emphasized by two recent complementary re-definitions of health and disease. The economic models underpinning today's healthcare -profit maximization -have shifted the focus away from its main purpose. Second, although economic considerations are important, they must serve and not dominate the provision of healthcare delivery. Third, expected health professionals' behavioral norms -to first consider the health and wellbeing of patients -have been codified in the universally accepted Declaration of Geneva 2017. Considering these three aspects it becomes clear that complex adaptive healthcare systems need mindful top-down/bottom-up leadership that supports the nature of innovation for health care driven by local needs. The systemic focus on improving people's health will then result in significant cost reductions.

Handbook of Systems and Complexity in Health, 2012

Communications of the ACM, 2005

Alan Turing and John von Neumann pioneered the study of complex systems. In analyzing feedback processes, they were interested in how complex interacting systems can respond to new information. Among other things, they found that some systems with many interactions among highly differentiated parts can produce surprisingly simple, predictable behavior (such as a programmable mechanical routine or process), while others generate behavior that may be impossible to predict, even though these systems feature simple laws and few actors or agents (such as an evolving living organism).

Frontiers in Medicine, 2019

American Journal of Operations Research, 2013

Health systems are paradigmatic examples of human organizations that blend a multitude of different professional and disciplinary features within a critically performance environment. Communication failure and defective processes in health systems have a tremendous impact in society, both in the financial and human aspects. Traditionally, health systems have been regarded as linear hierarchic structures. However, recent developments in the sciences of complexity point out to health systems as complex entities governed by non-linear interaction laws, self-organization and emergent phenomena. In this work we review some aspects of complexity behind health systems and how they can be applied to improve the performance of healthcare organizations.

PrimaryCare, 2010

Doctors often use theory to inform medical practice. The current bio-psycho-social model of health may be advanced still further with theoretical rigour. Traditional fields of thermodynamics and newer fields of non-linear dynamics including chaos theory and complex systems science can inform our understanding of the complexity of human health, illness and disease. Commonly accepted aspects of human health may be projected as probabilities over time creating curves of human health potential. Maximum health may be represented by maximum functional complexity. Complexity's relationship to entropy and energy can produce a complex surface that better models the human experience of health and illness from birth to death. Such a potential health trajectory uniting complexity and entropy expands upon earlier theories of health while allowing for unusual predictions and the novel opportunity to test and validate this model of human health.