Managing Healthcare from the Community Perspective

Traditionally healthcare has been organized around disciplines. Each developed its own science and methods adapted to the problems being treated. As knowledge grew, intradisciplinary hierarchies spawned subdisciplines with specialized research and practices. The result is that today, our default mental model has become a reductionist paradigm of breaking issues into parts and working to understand each part to find a solution. This can cause problems. While medical science has become inarguably more sophisticated, health care remains on an unsustainable track. Something isn’t working. 

Healthcare as a community system: managing the whole  

Health care is not only medical care. Different systems need different approaches. A reductionist approach applied to a Complex Adaptive System (CAS) such as healthcare creates bigger problems; a fact becoming clearer every day. Kurtz and Snowden’s model, the Cynefin Framework , provides a model to help us understand systems in ways that lead to better decisions and outcomes. In the case of healthcare’s complex adaptive system, it is important to realize the system is never truly in equilibrium. Effectively managing it will require more than static scientific knowledge. We must continuously learn and re-learn to apply that knowledge within a dynamic environment. The key is move from a reductionist approach that tightly controls each piece, to managing the whole.

To manage the whole, we must consider all its important parts. The social determinants of health shown in Figure 1 using Kaiser Family Foundation (KFF) graphic, provides a context for understanding the true whole system of health.

Figure 1

What is striking is how little traditional healthcare (medical and dental services) affect premature death. Figure 2 from the same 

KFF issue brief shows behavioral health and social services have a much greater impact and provides a way to prioritize our starting point for whole system health. 

Figure 2

Traditionally we would work to harmonize and merge these disciplines, no matter how noble the motive, such a reductionist approach will not work. True management differences arise from the unique realities of each discipline’s environment which cannot be changed. What will work is to change the game. The community and healthcare is a complex adaptive system that can only deliver what we want when we manage it as a one. With a new approach, we can take advantage of the environment’s complexity instead of wasting resources in vain attempts to make it less complex then it really is.

The Curandi model is a way of approaching healthcare as a Complex Adaptive System (CAS). To understand the power of this approach, see What healthcare can learn from the Internet.

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