Complexity of Health Care Systems: An Initial Analysis

Keeping these comments in mind – with their saturation in hope and delight—we can turn in a preliminary manner to the pressing matter regarding how Miller and Page’s insights relate to our understanding of and attempt to reform and improve contemporary health care system. We build on the analysis of complex health care systems that we offered in our previous essay (Fish and Bergquist, 2022).

Mind of Their Own

First, the leaders of mid-21st Health Care Systems need to recognize that they are dealing with complex adaptive systems. These systems tend to have “a mind of their own.” They are self-correcting and self-organizing. Furthermore, they tend to be strongly influenced by initial conditions (the moment when the parts first came together), as well as emerging decision horizons. As Miller and Page note, profound and rapid disruptive and unexpected change can occur in an adaptive system if a powerful organizing factor suddenly enters the system’s “playing field.” Earthquakes take place as the system adjusts to the intrusive event or force and as it pulls for greater attention (acting as a “strange attractor”). In contemporary health care systems, this earthquake has been centered on Covid-19-responsive measures and models.

We have already noted in our previous essay (Fish and Bergquist, 2022) that the world of health care is filled with complex, multi-tiered problems and dilemmas that do not yield to simple solutions (as is the case with health care puzzles). Not only are problems and dilemmas quite complex—these challenging issues also require multi-disciplinary perspectives. They often incorporating financial and interpersonal matters as well as matters related to medicine and the specific care of patients.

In the case of dilemmas, there is also the challenge of discovering that several viable solutions exist regarding the issue(s) being addressed. Competing priorities and differing perspectives and practices compete for our attention. They often are distilled into a set of two competing priorities. We swing back and forth in considering the benefits and drawbacks concerning the perspectives and practices to be found in each polarity. We suggest that the world of polarities often accompanies the complex adaptive system in which we are operating as leaders and operatives in contemporary health care.