Health Service Networks
It is increasingly recognized that health is maintained and improved not only through the advancement and application of health science, but also through the efforts and intelligent lifestyle choices of the individual and society. According to the World Health Organization, today the main determinants of health include the social and economic environment, the physical environment, and the person’s individual characteristics and behaviors.
The factors that affect health conditions today are multidimensional, complex and dispersed, as a consequence, they require an approach to health that is likewise distributed. Instead of always thinking of a centralized system as the solution we need to shift our mentality to think distributed systems first; moving from a centralized model by default to a decentralized peer-to-peer model, looking at health and health systems as networks of interacting elements.
On the level of an individual’s health management, this means shifting to thinking about health as a function of a multiplicity of overlapping networks; social, ecological, physical etc. From thinking of one’s health in terms of linear cause and effect to thinking and managing it in terms of one’s whole environment and the health outcomes that emerge from a multiplicity of interacting factors in that environment. On the level of whole health systems it means moving away from the monolithic systems of the past to designing modular networks for health provisioning.
The current model for the design of health systems is vertical in nature, due to its centralized and hierarchical structure of organization. The national health systems of today are organized around geographic localities, with each geography providing the same set of basic services while huge transaction costs between a multiplicity of centralized systems render current health systems inert, fractured and costly.
This problem in healthcare shows up in many different forms, on the clinical side it can be seen in lack of interoperability between procedures, revenue cycle problems, supply chain problems for the movement of pharmaceuticals and supplies across the healthcare industry, misalignment between insurers and healthcare providers etc. but all of these problems come down to one core issue and that is transactional inefficiency. It is almost impossible to avoid transactional inefficiencies, the provision of even the simplest procedure in healthcare triggers a transactional cascade of administrative interactions between multiple parties and stakeholders to deliver that care to a patient, but due to the current structure of the system huge amounts of friction between those entities exist and huge amounts of administrative and service redundancy is created when looked at as a whole system.
The vertical approach results in duplication of services, huge redundancies, lack of interoperability that creates border frictions and excessive costs. In a world of low connectivity, it makes sense that each organization build and operate its own solutions because it is costly to connect into another system. In a world of high connectivity having each organization recreating the wheel within its boundaries makes little sense and we start to get high levels of redundancy and waste through duplication.
A value-based approach requires collaboration across all actors to achieve the desired outcome. It requires that we actually organize around connections rather than vertical domains and departments; that we build healthcare systems as service networks, where the primary aim is open standards and common protocols for enabling interoperability. To move to a model that is truly centered around the user and focused on delivering maximum value to them requires shifting the locus from the centralized organization towards open networks that enable anyone to connect into and provide a service, with the end user then bundling those services according to their own specific needs in a modular fashion, so that they are not just presented with one monolithic system that does it all for them, stipulating the specific processes, rules, and providers.
A user-centric system is a flexible system that empowers the user by enabling them to pull together the resources from a health network that are required to meet their specific needs instead of a homogeneous system that simply pushes standardized solutions out to them, trying to get people to fit into the standardized model. The emphasis shifts to how we can defined common protocols and interfaces that enable different components in the health system to be easily and seamlessly connected towards providing the required service that is customized by the end-user. Rather than focusing on reducing the costs of any given component or increasing their efficiency, focusing on interoperability to reduce border frictions and redundancy of services.
The increase in connectivity brought about by information technology will inevitably turn the vertical organizations of today into networked organizations, this creates huge opportunities to rethink the basic structure of health systems. As a consequence, the challenge in this world of networks is no longer one of how to build a better drug or how to pay for more medical staff but it turns to one of organization – interoperability, modularity, interfaces and how to integrate different systems. Given the current state of our industrial healthcare systems, this alone could achieve major improvements in outcomes for end users.