Book Review: [i] Health System Redesign - How to Make Health Care Person-Centered, Equitable, and Sustainable

Health System Redesign

The 'summer reading' is almost complete (p.245/290) and described as such due to it being a review and a specific deadline is not helpful. (You may have noticed with Drupal and the new site!). Fortuitously, starting the book coincided with my attending the UKSS conference in Portsmouth. The exposure to systems and complexity - as in complexity science was welcome. I would really like to write a paper on Hodges' model and complexity and this book would be a primary reference.

The foreword is by the President of the Lown Institute, this is a think-tank "advocating a radically better and uniquely American health system that overturns high-cost, low-value care." Sturmberg provides the means for this over-turning whilst beforehand explaining what is happening in the health system and health care systems worldwide. There is a difference, as we must change mindsets and facilitate the health system reducing the impact, dependence and expense of existing health care systems. What we have is no longer sustainable.

Even in Sturmberg's preface I can see why this book through its title had an instant appeal to me and should do so to others in the health, social care, policy and educational communities.

The book addresses three key themes:

1. Understanding complexity—what are complexity sciences, and how does complexity thinking shape our understanding of health
2. Envisioning a “best adapted” health system
3. Achieving a person-centred, equitable and sustainable health system

The promised references follow the chapters (as expected!), but often with addenda that provide more background, insight and further reading if needed. Page 2 provides the first of many figures throughout the book, as with copious footnotes. Some people and publishers find footnotes untidy or contributing noise. I found these informative, pointing in some instance to video resources and copies of diagrams that are too detailed for a book. Inclusion still conveys some meaning given the subject matter of complexity and scale through the levels of nano, micro, meso and macro.

The book is clearly laid out, chapter 1 precedes Part 1 to set the context and agenda. Sturmberg explains this is not a theory book, but the explanations are progressive and a good foundation for further study (that must follow). Some of the challenges in teaching and learning systems thinking and health(care) systems redesign are discussed, as students are bound to encounter them not only in the literature, but in many of the assumptions that they are being socialised into in practice. A good example, is Table 1.1 Disambiguation of systems complexity (p.5). Like the use of figures, tables are liberally but effectively distributed throughout to reinforce the discussion. I like the way that systems thinking tools are set out in Table 1.2 across three pages. The tables and figures are not just page-fillers though, but sources to return to.

The differing sections that apply systems thinking are set with the implications for health care. As already mentioned some of the figures are colour reproductions and suffer due to the print size. To compensate the original source is usually provided (Addendum 2, Obamacare Health System Chart is a prime example that also time places pressure on any text). This works well as the author grapples to illustrate scale from the individual to the organisational level, industrial and processes and policy makers.

I know a review is about the book, but in this case especially I cannot but help see how this topic supports and validates (imho!) my own work and interests. Page 9 confirms how h2cm not only incorporates "design thinking" as it can readily combine the sciences and the arts (as in various blog posts). As I have stated (for 30 years) the POLITICAL domain in Hodges' model is crucial in the 21st century. So, even as I reach Part 1 for this review, the importance of global health; policy, organisations, public engagement are stressed if change is to follow. Many sections have a short introduction that ends with questions for readers to reflect on their own health systems experiences. As a summer reading project through to part 1 I was very pleased to have an 'ice-cream' of my favourite flavour that was going to run and run...

Sturmberg JP. Health System Redesign. How to Make Health Care Person-Centered, Equitable, and Sustainable. Cham, Switzerland: Springer; 2018.

More to follow three - four posts in total?