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Do we have a system of health care?

I haven’t noticed. Mostly we have a collection of disease cures, or at least treatments, often the more acute the better. Overall “health care” favors cure over care, acute disease over chronic disease, and the treatment of diseases in particular over the prevention of illnesses and the promotion of health in general. As for research, development of cure receives much more attention than the investigation of the cause.

A system? 

Calling something a system does not make it a system where it needs to deliver. A system is characterized by natural linkages across its component parts. A cow is a system, since its organs function together naturally. You and I are systems like this, too, at least in how we function physiologically, if not socially. About how much of the field of health care can we say that?

What do we need?

We need more systemic practices in health care, especially to reconcile the delivery of quantity, quality, and equality. Give some physician the time and the fees for some treatment, and he or she may find a lot of illness in need of it. Or give some hospital more beds and it will fill them. Is this a bad thing? Only if the added services are unnecessary or, worse, lead to the diagnosis of conditions that are better left untreated. 

Health care does not need superior leaders, domineering managers, or haughty professionals. Enough of “us” and “them”. It needs all of its people to understand respect, and cooperate with each other. Much of the significant change in health care has to come initially from the ground up, not the top down, let alone from experts who have not practiced health care. To achieve real quality in health care, we require personalized services on a human scale, not impersonal interventions on an economic scale. What the field of health care desperately needs is not more or other kinds of competition so much as a great deal more coordination, cooperation, and collaboration. 

Can health care organization be fixed by managing them more like businesses?

It is time to make the opposite case: that management as now practiced in much of the corporate world is no longer good even for business, let alone for health care and many other social public services.

I am not my doctors’ “customer”, thank you; these people are professionals with whom I trust my health. I don’t give some hospital my “business”, because I’m not a buyer who wishes to beware. Nor do I “consume” health care services, because they might consume me. I hope that my physicians and nurses are not “human resources” who need to be “empowered”, but rather dedicated human beings who are personally engaged. Diseases are not “markets” and professional health care services are not “products” to be plucked off some shelf at arm’s length… Moreover, a free market works when the consumer can use buying power to influence the price and quality of goods…

The field of health care may be appropriately supplied by businesses, but in the delivery of its most basic services, it is not a business at all, nor should it be run like one. At its best, it’s a calling.

Overall, health care is rightly left to the private sector, for the sake of efficiency and choice. Overall, healthcare is rightly controlled by the public sector, for the sake of equality and economy. The issue is not which, but how much of each and where…

Wellness vs Illness

Wellness and illness – the practices of health care

The figure presents a map of wellness and illness that was developed to display in one place the range of practices used in the care of health and the management of disease. Seeing all this together – on one diagram – can be a first step toward a more systemic perspective. (Managing the Myths of Health Care: Bridging the Separations between Care, Cure, Control, and Community Kindle Edition by Henry Mintzberg)

“Systems thinking for health systems strengthening” 

“Systems thinking” is an approach to problem solving that views “problems” as part of a wider, dynamic system. Systems thinking involves much more than a reaction to present outcomes or events. It includes a deeper understanding of the linkages, relationships, interactions, and behaviors among the elements that characterize the entire health care ecosystem. (Systems Thinking for Health Systems Strengthening)

The WHO Health System Framework

The role of data and digital

Digital solutions for health and care can increase the well-being of millions of citizens and radically change the way health and care services are delivered to patients, if designed purposefully and implemented in a cost-effective way. Digitization can support the continuity of care across borders, an important aspect for those who spend time abroad for business or leisure purposes. Digitization can also help to promote health and prevent disease, including in the workplace. It can support the reform of health systems and their transition to new care models, centered on people’s needs and enable a shift from hospital-centered systems to more community-based and integrated care structures. Digital tools can translate scientific knowledge into helping citizens remain in good health, thus helping to ensure that they do not turn into patients. They also have the potential to enable a better use of health data in research and innovation to support personalized health care, better health interventions and more effective health and social care systems. Data is a key enabler for digital transformation. (Shaping Europe’s digital future)

Something practical… Europe’s Beating Cancer Plan?

In February 2021, on the eve of the World Cancer Day, the European Commission presented Europe’s Beating Cancer Plan – a main priority in the area of health of the von der Leyen Commission and a key pillar of a strong European Health Union. With new technologies, research and innovation as the starting point, the Cancer Plan sets out a new EU approach to cancer prevention, treatment and care. It will tackle the entire disease pathway, from prevention to quality of life of cancer patients and survivors, focusing on actions where the EU can add the most value.

EU Cancer Plan | NRETIA Health

Europe’s Beating Cancer Plan is structured around 4 key action areas: (1) Prevention through actions addressing key risk factors; (2) Early detection of cancer by improving access, quality and diagnostics; (3) Diagnosis and treatment through actions to ensure better integrated and comprehensive cancer care and addressing unequal access to quality care and medicines. (4) Improve quality of life of cancer patients and survivors, including rehabilitation, potential tumor recurrence, metastatic disease, and measures to support social integration and re-integration in the workplace. (Europe’s Beating Cancer Plan: A new EU approach to prevention, treatment and care)

To sum up…

It’s not just health care, it’s rather our care of health. It’s also moving the system from cure to care. And indeed, it’s “quite” human, connected with our basic human needs to feel good – “from illness to wellness”. Prevention of illnesses and the promotion of health are key priorities. Systems thinking could strengthen the health systems through data and digital. Digital transformation of health care is critical to make new technologies, research and innovation support informed decisions in the sector. More coordination, cooperation, and collaboration are needed!