Yaneer Bar-Yam, Multiscale analysis of the healthcare and public health system: Organizing for achieving both effectiveness and efficiency, New England Complex Systems Institute Technical Report 2004-07-01 (2004).
Despite expansion of medical knowledge and technology, the healthcare system as a whole is under performing in terms of quality of care and number of medical errors. Complex systems concepts can be used to examine the healthcare and public health system and to provide direct insight into the organizational and behavioral changes needed to accelerate quality improvement. Using such concepts, one can trace the origins of quality and medical error problems in the system to a mismatch between the large, simple financial flows and the complex treatment of individual patients by individual doctors. Implementing cost controls through standards setting and resource allocation leads to poor quality of care and resistance to quality improvement efforts. The solution to this problem requires two parallel, but linked systems with distinct organizational forms: (a) a high efficiency system that performs relatively simple repetitive tasks such as diagnostic screening tests, inoculations, and generic healthcare, and (b) a high complexity system that treats the complex medical problems of individual patients. Making this change in structure will better match the healthcare system to the large financial flows and the complex tasks it performs.