Healthcare in the US Chapter 1

Ludwig von Bertalanffy
- Articulated and popularized General Systems Theory in 1968.
- Book: General System Theory aimed to unify the field of science.
- Unique contribution: Understanding parts of a system and their interactions through recurring patterns to produce a whole.
- Previously, theories focused heavily on individual parts without considering the relationship to the whole system.

George Engel, a physician, identified subsystems of the human body (e.g., cardiovascular, endocrine, nervous systems).
Developed the biopsychosocial model in the 1970s to better understand disease expression, integrating:
- Biological factors (age, gender, genetics, physiological reactions, tissue health).
- Psychological factors (mental health, emotions, beliefs, expectations).
- Sociological factors (interpersonal relationships, social support, socioeconomic status).
This model exemplifies systems thinking in health, recognizing diverse factors affecting health outcomes.

A system incorporates the essential factors of health outlined in the biopsychosocial model.
The framework aligns with systems theory and will be discussed later in the chapter.

Systems theory has become a prevalent method for understanding various systems, including the U.S. health system.
Recent articulations of contemporary systems build on the foundational work of von Bertalanffy.

Bellinger: A system is “an entity that maintains its existence through the mutual interaction of its parts.”
Anderson and Johnson: A system is defined as “a group of interacting, interrelated, or interdependent components that form a complex and unified whole.”

Organizations, particularly health organizations, can be viewed as complex adaptive systems (CASs).
Attributes of CASs:
- Composed of diverse, interconnected elements that are equally important.
- Adaptive to environmental changes and capable of learning from experiences.
- Continuously adjust in response to feedback from their environments.
Complexity Science: Emphasizes that change is inevitable; thus, seeking a stable state is futile.
- Changes in health policies exemplify how CASs adapt to medical realities.
- Policies that fail to respond to health realities result in persistent health challenges.

Agents: Large groups of diverse agents (individuals) who process information.
- Diversity is crucial for generating new solutions and making decisions.
Interconnections: Nonlinear relationships among agents.
- Inputs do not directly correlate to outputs; small changes can lead to significant effects.
- Effective inter-agent interactions contribute to a health organization’s success.
Self-Organization: Order arises from the properties of the system rather than external control.
- CASs use decentralized processes; examples include how nursing staff organize among themselves based on roles.
Emergence: System behaviors emerge not from individual parts but from interconnections among agents.
- Safety and clinical success viewed as emergent properties lead to better learning from past behaviors and developing new strategies.
Coevolution: CASs change and influence their environments, interacting dynamically with their context.
- An example includes health organizations adapting to payer reimbursement systems.

The U.S. health system is fragmented without a single coordinating agent, resulting in:
- High costs.
- Unequal access.
- Average health outcomes.
Current efforts aim to enhance system integration, improving patient care experiences, population health, and reducing costs.
- These efforts leverage complex systems characteristics.

Self-Stabilizing: Maintains balance through feedback loops.
Purposeful: Subsystems work in concert towards broader goals.
Feedback-Driven: Uses both internal and external feedback to adapt and innovate.
Environment Influence: Capable of modifying the environment through interconnected behaviors.
Self-Repairing: Engage in transformation to reinvent or reengineer themselves.

Systems Thinking in Healthcare: Essential for improving population health, enhancing patient experiences, and reducing costs.
Interview 1-1: Discusses James F. Geiger and Madeline Kemp on systems thinking's application in strategic healthcare initiatives.
- Geiger’s Perspective:
- Emphasizes identifying relevant variables and consequences in decision-making.
- Systems thinking moves beyond traditional approaches, fostering holistic views of healthcare processes.
- Kemp’s Insights:
- Differentiates between systems thinking and strategic planning; includes both perceived and tangible benefits in healthcare projects.
- Advocates for involving multiple stakeholders early in complex processes to facilitate change.

Barriers:
- Traditional organizational structures encourage isolated problem-solving.
- Funding models that do not incentivize broader system initiatives.
Solutions:
- Integration of case studies in training to showcase systems thinking applications in real-life scenarios.
- Emphasizing the importance of community needs assessments and incentives for implementing complex projects in healthcare.

Systems thinking aids healthcare leaders and clinicians in addressing complexities in the healthcare system.
- Allows systematic analysis for innovative solutions through the assessment of interactions and dependencies.
- Encourages the emergence of community-based solutions through careful analysis of interconnections at various levels of healthcare.