Grip on health: A complex systems approach to transform health care

Abstract

This article addresses the urgent need for a transition in health care to deal with the increasing prevalence of chronic diseases and associated rapid rise of health care costs. Chronic diseases evolve and are predominantly related to lifestyle and environment. A shift is needed from a reductionist repair mode of thinking, toward a more integrated biopsychosocial way of thinking about health. The aim of this article is to discuss the opportunities that complexity science offer for transforming health care toward optimal treatment and prevention of chronic lifestyle diseases. Health and health care is discussed from a complexity science perspective. The benefits of concepts developed in the field of complexity science for stimulating transitions in health care are explored. Complexity science supports the elucidation of the essence of health processes. It provides a unique perspective on health with a focus on the relationships within networks of dynamically interacting factors and the emergence of health out of the organization of those relationships. Novel types of complexity science-based intervention strategies are being developed. The first application in practice is the integrated obesity treatment program currently piloted in the Netherlands, focusing on health awareness and healing relationships. Complexity science offers various theories and methods to capture the path toward unhealthy and healthy states, facilitating the development of a dynamic integrated biopsychosocial perspective on health. This perspective offers unique insights into health processes for patients and citizens. In addition, dynamic models driven by personal data provide simulations of health processes and the ability to detect transitions between health states. Such models are essential for aligning and reconnecting the many institutions and disciplines involved in the health care sector and evolve toward an integrated health care ecosystem.

The multiple faces of practical wisdom in complex clinical practices: An empirical exploration

“…Another field of tension is that between the clinical need to individualize care, and the view of professional medical organizations, shared by external supervisory authorities, who emphasize the application of comprehensible standards and guidelines in practices, and carry on audits on this . These standards and guidelines adhere to a “Newtonian/mechanistic paradigm of ‘predictable cause and effect’ relationships,” even though daily reality is characterized by complexity and is therefore consistent with a very different paradigm. Consequently, the guidelines seem to refer to a reality that is different from the one in which practitioners must attempt to act.…”

Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the ‘Black Box’ of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda

“…Moreover, in our approach we stress the fact that an intervention is implemented in a pre-existing system/environment/context; the intervention influences the context, not the other way around. Causal loop diagramming (CLD) is one of the tools from the systems dynamic sub-field used to analyze systems and stems from industrial management research in the 1960s [ 19 ] and organizational learning [ 20 ], but it also has some useful applications in the health sector [ 21 , 22 , 23 , 24 ]. CLD is a qualitative visual aid used to communicate the assumptions of a “mental model of a dynamic system” [ 25 ].…”

Complex adaptive systems approaches in health care—A slow but real emergence?

“…In this Forum, Wietmarschen, Wortelboer, and van der Greef provide a highly accessible vision for the future of complex adaptive systems and why they are needed. They re‐articulate why a shift is needed from static silos of diagnoses and linear structures toward a more integrated biopsychosocial way of thinking about health, using systems thinking approaches.…”

“…To progress, a vision and practical goals for the shift needed from a conservative medical hierarchical disease focus, toward a more integrated biopsychosocial dynamic interactive ways of thinking about health . Tools to enable such implementation are needed, and four different practical approaches to deploy CAS theory in clinical care are highlighted that demonstrate innovation and adaptive thinking.…”