Why Health Care Insights are Needed
The health care system is a complex collection of interactions that continually change. In centre stage is the healing interaction between clinician and patient. These central roles are surrounded by people systems and processes that provide the means to support this healing. But navigating the health care system is an increasingly difficult and frustrating task. This is true for patients, carers, clinicians, policy makers, funders, politicians and citizens. A continual stream of new technologies and health conditions adds the dynamic dimension to this confusing world. The current health system has grown enormously from a cottage industry to large complex social and technical structures….’just grown like Topsy’. Advances in biomedical knowledge and technologies have forced specialized clinicians and policy makers to focus on understanding and analyzing the parts of the system rather than taking an overall systems approach.
In all nations there are chronic persistent problems of cost control, safety and quality of care, equitable access to skilled health professionals and a search for better ways to organize and fund health services delivery. Tools and methods for understanding complexity and designing social systems are being developed and applied, particularly in the systems science and engineering disciplines. Their use in health care is increasing with the wider availability of powerful computer simulation tools and success stories in understanding systems biology and furthering the climate change debate. However uptake has been slow due to health professionals’ lack of familiarity with the concepts, technical language and tools required to tackle the dynamics of complex systems. One such tool is system dynamics modeling. Systems thinking in medicine has a long history. Indeed Aristotle’s father was a physician. Physiologists such as William Harvey Claude Bernard and Walter Cannon applied concepts of dynamics and homeostasis to the human body. Leaders influencing systems thinking in medicine, public health, health policy and health systems design include biologists, psychiatrists, evolutionists, environmental scientists, sociologists, anthropologists, management scientists, economists and engineers. More recently formal computational models in systems biology have accompanied the genomics and associated physiome, phenomics and other “omics” advances. Now there are a broad range of systems thinking and formal modelling activities in multiple disciplines from cells to society or even from protons to politics. Concepts from these multiple levels of abstraction are beginning to be clarified and linked across multiple time and spatial scales using applied systems science. Recent NIH and CDC activities have badged these activities as systems science in health and include system dynamics, network sciences and agent based modeling methods and tools. To support this wide range of application areas there are tools to clarify concepts, formulate problems and develop, test and experiment with computer models of health and health care problems. For instance concept maps and ontologies describe and link phenomena of the external world, the mental world and the social world across multiple disciplines and multiple levels of abstraction, combining both synthesis and analysis to explain differences and aggregate similar things. A general area of applying the combination of computational models and computer simulation to understanding predicting controlling improving and designing health systems and subsystems has evolved over the years in various organisations in practice, teaching and research. Interdisciplinary and inter-professional integration across basic and applied biomedical, clinical practice, basic physical and social sciences, humanities, technology and engineering disciplines remains a significant and ongoing challenge. Health care theory and practice has become huge, complex, fragmented and specialized. The healthcare system of providing, funding, delivering, and accessing personal and public health services now encounters a broad range of conflicting interests.
Significant long-term changes in health care, together with more frequent and ongoing disruptive short-term changes in technologies are reshaping health systems around the world. However the chronic problems of cost, quality, access and organization of health systems for fair, efficient, effective and humane care of individuals and communities persist. We believe that computational modeling can help overcome the limitations of our mental models and popular inquiry methods. In this collection, we introduce the approach of using simple system dynamics model examples for health professionals to perform relevant what-if experiments. Zooming out on problems using system dynamics tools and trying out solutions in computer simulations can avoid doing harm through unintended consequences and help us learn to jointly how to build more sustainable, humane, health care systems. Healthcare reforms will be designed and implemented if a broad range of health decision makers learn to share experience and insights in both the real and virtual worlds. Participants in these virtual experiments include patients, carers, practitioners who help each other live better lives and payers, planners, managers and regulators of public health and health care who manage systems that should support them.
Systems Thinking World Discussions
Questions & Comments to Geoff McDonnell