Book Review: [iii] Health System Redesign - Part 2

In part 2 from chapter 5 the focus is "Best Adapted" Health System. Such a system simultaneously addresses person-centredness, equity and sustainability. The healthcare system is one of many subsystems of a complex adapted health system, comprised of primary, secondary and tertiary care. Quaternary prevention may deserve mention? The quaternary approach being sympathetic and resonating with the book's aims as a whole (scope: humanistic - mechanistic and sustainability) .

Chapter 5 uses the Vortex model to represent the vision of a seamlessly integrated complex adapted health system from that which so often exists. The graphics are small but there is a url (Figure 5.1). Several avenues of continuity and links to part 1 are provided, disease, the purposes and goals of existing health systems versus the new vision and the values and need to disambiguate between patient needs and wants. This calls for definitions which are also provided; to logically lead to underlying philosophies which are extended in the addenda.

Chapter 6 prepares the reader for some real world examples to follow. I have long found discussion of scale fascinating. The levels here extend across:

• Macro
• Meso
• Micro
• Nano

"Food regulation" is rendered as an influence diagram showing the various agents and their operations. Copious tables shed light in the four levels. The real world examples in chapter 7 are geographically, Kenya and Brazil concerned with AIDS and the NUKA primary care system in Washington (USA). Sturmberg contrasts the possibly theoretical emphasis of the previous two chapters with this more practical focus. The visualisation methods vortex and Cynefin models are well used here. The case studies help to reveal different degrees of complexity while also showing what they have in common.

You cannot move in social media without reading or hearing about leaders and leadership. Chapter 8 is not paying lip-service to this cultural preoccupation, but marries how can we better understand what is unpredictable. Sturmberg explains VUCA, that is, volatility, uncertainty, complexity and ambiguity; wicked problems and how we can use VUKA and transform these challenges into understanding for learning and transfer of knowledge. Again the book carries the content forward, combining four learning frameworks to shift mindsets and world views through use of the Cynefin framework.

In the management of system constraints a multidiscipinary (multi-domain) approach is used, as in leadership involves psychological work. To better appreciate leadership, leaders are contrasted with managers (Table 8.2, p.139). An example of contrast is also used characterising organisations as Banyans (which expand their own empires) and Dandelions (which while prolific allow others to thrive). The references range in chapter 8 from 1958-2017 - Argyris, Mintzberg, Polyani and Schön. The addenda closing chapter 8 and part 2 are once again philosophical - "History of Reductionism" and very much add to the text.

There's an important quote on page 140:

"It is the common cause of an organisation that defines its identity and must reside in the heads and hearts of its members. Thus, in the absence of an externalised bureaucratic structure, it becomes more important to have an internalised cognitive structure of what the organisation stands for and where it intends to go - in short, a clear sense of the organisation's identity. A sense of identity serves as a rudder for navigating difficult waters.'

I think 'identity' for the individual (micro) and organisation (meso-macro) levels could be emphasised more and should be indexed. Parts 3 & 4 follows.

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

See also:

Book Review: [i]

Book Review: [ii]