Networks for Local and Global Health Improvements
April 4-5, 2019 — Knoxville, Tennessee
Selected Presentations can be downloaded in the RESOURCE SECTION
[pdf-embedder url=”https://www.isscsh.org/wp-content/uploads/2019-Programme-Overview-Final.pdf” title=”2019 – Programme Overview Final”]
Abhi Mukherjee is CFO of a hospital in a semi-urban community with a population of 65,000 residents in Ontario, Canada. His insights working in the hospital sector shaped his dream of on Un-Hopsital – a network of trained (healthcare and allied) professionals working with the community and actively engaged in keeping the population healthy. – Healthcare in Canada is predominantly (70%) publicly funded through tax dollars. It is estimated that health spending in Canada will be $228.1 billion in 2016, or approximately 11.1% of GDP, the majority of which goes to hospitals (29.5%), drugs (16%) and physicians (15.3%). Less than 5% is spent on public health, health policy and research. The basic principle behind universal coverage is to provide for medically necessary health care services on the basis of need, rather than the ability to pay. The Ontario government had started on a journey of funding reforms in 2011. With a change in government, there is likelihood of further changes. However, the basic principle remains the same – “funding following the patient”. What this translates to is that funding is provided to healthcare providers based on volume. In other words- “more the patients, more the money”. As a result, hospitals get larger and more complex as more patients are treated and more funding comes in- and the cycle sustains itself. Unless! Unless we ask the question – are we in healthcare, or are we in “sickcare”? We seem to have created a system that rewards healthcare professionals for treatment of disease state. Who gets rewarded or incentivized for keeping people healthy and away from the hospital? And so – can we create an “un-hospital” system that would keep people healthy? The presentation shares some high level ideas on what an “un-hospital” system would look like and what could be some potential barriers.
Dr. Laura Hoemeke has worked for over 15 years for an NGO in various francophone African countries. She will provide an overview of the role of international non-governmental organizations (INGOs) in strengthening health systems. As significant actors in global health and development, INGOs can help strengthen health systems in the countries in which they operate. INGOs sometimes, however, engage in practices that weaken health systems, including creating additional management burdens and distorting labor markets, as well as exacerbating inequities by offering higher quality care to some segments of a population. Health systems strengthening (HSS) is an evolving concept and, while little agreement exists on effective HSS metrics, there is consensus in the global health community that strong health systems are essential to achieve global health goals. INGOs can mitigate potential negative impact of their work by engaging in more systems thinking and self-analysis to develop greater awareness of their effects on health systems, especially their work on projects that are disease-focused or implemented in selected districts and not nation-wide. Donor agencies can facilitate INGOs’ work to mitigate potential negative impact by dedicating funding to HSS, especially—but not only—in vertically funded projects, and creating more flexible funding mechanisms that allow for systems investments. In countries where ministries of health have greater management capacity, the work of INGOs and all health sector partners contributes more efficiently and effectively to HSS.
Prof Bruce Ramshaw will share his experience of applying Complex Systems Science to surgical whole patient care. Bruce will describe the principles and tools of complex systems science and show examples of the benefits to our healthcare system when these tools are applied to real patient care – a simultaneous decrease in cost of care delivery and an increase in the quality of care and patient healthcare experience.
Prof Bruce J. West is a senior scientist in mathematics and researcher at the Army Research Office of ARL in Research Triangle Park North Carolina, and has an extensive research record covering complex phenomena in the physiology of health and disease. He will focus on the inevitability of complexity entailing paradox in the scientific modelling of complex phenomena, independently of whether that complexity occurs in the physical, social or life sciences. We examine how encountering a logical contradiction (a paradox) in the interpretation of experimental data using simple models, forces the development of next generation mega-models, or theory. The new theory addresses emergent properties by identifying macro-variables for their description, which are independent of the dynamics of the micro-variables they replace. The collective behavior captured by the macro-variables is often at variance with the more familiar reductionist theories with which we are more comfortable. How does cognitive dissonance through paradox play a role in innovation, heroic acts and creative behavior? More fundamentally how does criticality resulting from complexity generate paradox? The empirical basis for paradox is the observational fact that people hold contradictory beliefs, even though such beliefs are logically incompatible and cannot both be true at the same time. We have recently shown that one resolution of such paradox rests on a two-level network model of cognition; one subnetwork models emotion-based decisions, the other subnetwork models rationality-based decisions, and the interaction of the two subnetworks adapts the internal dynamics of decision making to simultaneously cope with both sides of a paradox. This is the self-organized temporal criticality (SOTC) model. Identifying and resolving the paradoxes generated by complexity leads to not just new knowledge, but to new kinds of knowledge that is incompatible with prior understanding. The emergent macro-behavior resolves paradoxes and invariably produces a new way of thinking about familiar phenomena, one that could not be envisioned prior to the resolution. The logical contradiction is resolved by direct calculation, using the SOTC model, which is an instantiation of Kahneman’s Thinking Fast and Slow. The SOTC model shows how one may formally overcome a paradox by replacing an either/or with a both/and way of thinking.