Understanding health system reform – a complex adaptive systems perspective
Article first published online: 5 JAN 2012
© 2012 Blackwell Publishing Ltd
Journal of Evaluation in Clinical Practice
Volume 18, Issue 1, pages 202–208, February 2012
How to Cite
Sturmberg, J. P., O'Halloran, D. M. and Martin, C. M. (2012), Understanding health system reform – a complex adaptive systems perspective. Journal of Evaluation in Clinical Practice, 18: 202–208. doi: 10.1111/j.1365-2753.2011.01792.x
- Issue published online: 5 JAN 2012
- Article first published online: 5 JAN 2012
- Accepted for publication: 22 September 2011
- complex systems;
- health care reform;
- health policy;
- health systems;
- non-linear dynamics
Background Everyone wants a sustainable well-functioning health system. However, this notion has different meaning to policy makers and funders compared to clinicians and patients. The former perceive public policy and economic constraints, the latter clinical or patient-centred strategies as the means to achieving a desired outcome.
Design Theoretical development and critical analysis of a complex health system model.
Results and conclusions We introduce the concept of the health care vortex as a metaphor by which to understand the complex adaptive nature of health systems, and the degree to which their behaviour is predetermined by their ‘shared values’ or attractors. We contrast the likely functions and outcomes of a health system with a people-centred attractor and one with a financial attractor. This analysis suggests a shift in the system's attractor is fundamental to progress health reform thinking.