People at the centre of complex adaptive health systems reform

Abstract

Health systems are increasingly recognised to be complex adaptive systems (CASs), functionally characterised by their continuing and dynamic adaptation in response to core system drivers, or attractors. The core driver for our health system (and for the health reform strategies intended to achieve it) should clearly be the improvement of people's health — the personal experience of health, regardless of organic abnormalities; we contend that a patient‐centred health system requires flexible localised decision making and resource use. The prevailing trend is to use disease protocols, financial management strategies and centralised control of siloed programs to manage our health system. This strategy is suggested to be fatally flawed, as: ➢people's health and health experience as core system drivers are inevitably pre‐empted by centralised and standardised strategies; ➢the context specificity of personal experience and the capacity of local systems are overlooked; and ➢in line with CAS patterns and characteristics, these strategies will lead to “unintended” consequences on all parts of the system. In Australia, there is still the time and opportunity for health system redesign that truly places people and their health at the core of the system.

Multimorbidity and chronic disease: an emergent perspective

“…The papers in this edition provide insights of the workings of these rules, and how they contribute to creating a more patient‐centred health system [26–30].…”

“…• explore the patient's experience and explanation of his illness [20][21][22][23]; and • manage the patient's illness as a whole according to the patient's preferences [22][23][24][25]. 2 The papers in this edition provide insights of the workings of these rules, and how they contribute to creating a more patient-centred health system [26][27][28][29][30].…”

Rural physical health care services for people with serious mental illness: A nursing perspective

“…1) steps forward in some aspects of access (e.g. enabling physical proximity to services) is not likely to lead to better health outcomes; policy might well require a systems approach 10,24 to come to an understanding of the multiple problems and potentials canvassed in this paper. As part of this, rural nurses within mental health care can provide valuable input on the social and economic barriers to overall care and ways to link clients to services.…”

The unsettled baby: how complexity science helps

“…Since the mother–baby CAS is characterised by self-organisation, parents are co-creators of the intervention: health professionals respect the parents' autonomy and understand that the carer's personal experience of the problem is the ‘core-driver’ 67. The inherent resilience of both mother and baby is supported by early identification and treatment of both organic problems in infants, for example, urinary tract infection,10 and maternal health problems, for example, perinatal anxiety and depression;7 8 also by informing families about normal crying in infancy and strategies to manage feelings that could lead to harming the baby 68.…”