Living with the ‘Next New Normals’ – Leading in Times of Uncertainty
November 10-11, 2021
3 pm EST US; 8 pm GMT UK; 7 am AEDT the following day AUS
|3:00 pm||8:00 pm||7:00 am||Joachim Sturmberg||Introduction and Foundation: The Role of Systems and Complexity Science for Health|
Joachim Sturmberg is an A/Prof of General Practice, College of Health, Medicine and Wellbeing, The Newcastle University, Newcastle – Australia.
For over 30 years Joachim is practicing family medicine at Wamberal Surgery, Wamberal – Australia. He is the Foundation President of the International Society for Systems and Complexity Sciences for Health (ISSCSH), and he remains actively involved in the Royal Australian College of General Practitioners as well as co-leading the special interest groups in complexity in WONCA, ESPCH and NAPCRG. He has been instrumental in initiating the International Conferences for Systems and Complexity Sciences for Health.
His research interests relate to the application of systems and complexity principles to health care delivery, health policy and health systems organisation. He has been invited to speak on these topics in Europe and North America, he has published extensively on these topics in peer-reviewed journals and has contributed several book chapters on these topics.
Current research collaboration focuses on the nature of multimorbidity from an interconnected physiological perspective, the study of aging as reflected in heart rate variability, and the systemic failing of nursing home care.
|3:30 pm||8:30 pm||7:30 am||Carmel Martin||‘Superutilizer’ Intervention Framework and the COVID-19 Pandemic: Understanding ‘Outlier Care’ for High-risk Populations with Complexity Science|
|The Pareto Problem|
Superutilizers or high-cost outliers have existed across the spectrum of payment models in the US and internationally. In the US 25% of health care expenses are incurred by 1 % of the population, 50% of expenses are incurred by 5%, while 50% of the US population incurs only 3% of total health care expenses. Super utilization is greater in disadvantaged communities. and defined by the AHRQ as Medicare or Medicaid patients with 4+ more hospital admissions or privately insured patients with 3+ hospital admissions annually. A power law or Pareto distribution of utilization begs the question of what is natural to human systems and what should/could be improved.
Pre-Covid multiple interventions and service changes aimed to reduce emergency department visits, emergency hospital admissions rates and length of stay. There is difficulty demonstrating sustained successes and extrapolating success criteria from diverse interventions. Regression to the mean is a key factor (super utilization reduces over time) and non-medical factors and social determinants of health are not directly amenable to clinical interventions.
Acute hospital utilization for non-Covid conditions in the US and internationally fell dramatically with the onset of the coronavirus 2019-2020 (COVID-19) pandemic. In the US declines in non-COVID-19 admissions were similar across patient demographic subgroups and exceeded 20% in April-June 2020. The rates of some serious conditions such as acute coronary syndromes decreased by up to 40% across multiple countries. By late June/early July 2020, overall US non-COVID-19 admissions were substantially lower for patients residing in majority-Hispanic neighborhoods. While mental health and drug admissions were stable through the pandemic, serious medical admissions declined. To date they have not returned to pre-Covid pandemics levels.
A Cusp Catastrophe situation
Covid-19 has tipped some super utilization into possible underutilization? What changed? Is it locus of control? Patients with mental health, drug-using and alcohol disorders experience less loci of control and no care alternatives, while others made choices about risk management? Did those with greater locus of control instigate better self-care? Was there a change in the mind-sets or help-seeking behaviours of communities at risk based on social determinants in ‘hotspots’ of high utilization? Is it disease-related? Did COVID infect those who might have presented with cardiac, respiratory and sepsis disease obscuring these diagnoses? Is it service related? Did telehealth create better access to care? Were many previous medical admissions necessary? Were people better at home even with significant morbidity without the stresses of hospitalization?
COVID-19 is a game changer in super utilization. Complexity science provides a framework with which to explore its impact.
I am Associate (Adj) Professor of Medicine, Nursing and Allied Health at Monash University and Visiting Medical Consultant to Monash Health and Ballarat and East Grampians Health Services Victoria Australia. I am active (2.5 days a week) in clinical general practice.
The main focus of my work is the experience of illness and wellness and biopsychosocial care of unstable complex health conditions that often fall between. My research in Australia, Canada and Ireland has focussed on transitions to universal primary health care and improving chronic care encompassing personal health experiences. I am co-editor, with Joachim Sturmberg, of the Forum on Systems and Complexity in Medicine and Healthcare in the Journal of Evaluation in Clinical Practice.
I studied Medicine at the University of Queensland and after registration worked and trained as a GP and Public Health Physician in London. My research work started with my own experience of chronic illness that became my PhD – The Care of Chronic Illness in General Practice – Australian National University 1994-1998 https://openresearch-repository.anu.edu.au/handle/1885/147963. I am now operationalising this work through the Patient Journey Record System program. Practically this work is now being conducted utilizing design thinking approaches to improving patient experience, sociology, trajectory analysis, natural language processing, machine learning and artificial intelligence. I have a strong health service evaluation background around primary (health)care reforms.
On return to Australia from the UK after 10 years, I was an inaugural member of the GP Evaluation Program, Technical Advisory Group which oversaw the first Australian wave of primary care reforms. While a Senior Medical Advisor to the Australian Department of Veterans’ Affairs (DVA), I setup the inaugural DVA health care planning and enhanced primary care DVA and Medicare payments and Australian Coordinated Care Trials.
I participated in the evaluation of Pan-Canadian Primary Health Care Transition Fund initiatives in Canada 2001-2006 and the Pan-Canadian Aboriginal Health Care Transition Fund initiatives as the internal evaluator for the Inuit 2005-2009. After developing and evaluating chronic illness system software in Ireland and the USA, I returned to Australia and began working in the MonashWatch service http://monashhealth.org/services/services-f-n/monashwatch/ funded through the Victorian Healthlinks Chronic Care Program https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/healthlinks . I am Chief Medical Officer to PHC Research Pty Ltd which is a research and development company focussed on developing software to improve the care of complex illness.
|4:00 pm||9:00 pm||8:00 am||Chris Peterson & Christine Walker||Universal Healthcare and COVID-19: A View of Systems and Complexity|
|Sturmberg and Martin’s application of systems and complexity theory to understanding Universal Health Care (UHC) and Primary Health Care (PHC) is evaluated in the light of the influence of political and economic factors on health systems. These factors have been recognised for a number of decades. They attempt to understand economic, social, political, historical, and cultural factors influencing health. Furthermore, the development of forms of governance which have led to increased inequities is seen as a key challenge for UHC. The COVID-19 pandemic reveals the inequality inherently reproduced by policies of maximizing freedom of markets, with little government control and spending, and low levels of taxation. In the pandemic morbidity and mortality is worse for migrants, black people, indigenous people and those who have been discriminated against or marginalized. Disease risk is greatest in precarious work and for groups such as mobile workers. COVID-19 has led to the poor and marginalized suffering disproportionately. Countries having insufficient vaccines and medicines will have least political and economic bargaining bases. Another facet of forms of governance that create and preserve inequality and affect access to healthcare generally is decreased social services. Australia serves as an example of this. Unemployment benefits as well as other social services have been lowered to force people to seek employment, but when COVID 19 meant people were not able to work, governments recognized the need to offer increased assistance including higher unemployment benefits and housing assistance. COVID-19 has emphasized long standing discrepancies in health and these disadvantages require government will and cooperation together with adequate social services to redress these discrepancies in UHC.|
Dr Chris Peterson – firstname.lastname@example.org
Chris Peterson has a PhD in health sociology and works in the Department of Social Inquiry at La Trobe University in Australia. He has previously worked at the National Centre for Epidemiology and Population Health at the Australian National University, and in General Practice as well as Education at the University of Melbourne. He has gained a number of grants including from the National Health and Medical Research Council which were for patient self-management of chronic illnesses and also the communication of risk of operative procedures to patients . He has researched extensively and published in the areas of Stress at Work, gender at work and the experiences of health workers. He has also researched and published on Occupational Health and Safety in Australia and internationally. In Epilepsy he has researched and published on quality of life and psychosocial health. He has also published extensively on Chronic Disease. He has published a number of books, the most recent for Routledge London, (ed) Identification and Management of Risk at Work: Emerging Issues in the Context of Globalisation.
Dr Christine Walker – email@example.com
Christine Walker holds a PhD in health sociology and was until recently Executive Officer of the Chronic Illness Alliance Inc., a peak body representing some forty consumer and advocacy organisations for people with chronic illness. She continues to work with the Alliance to build a more nuanced understanding of the needs of all people with chronic conditions and for health policies and health services to reflect this. In this role she has conducted projects on the value of peer support in improving the lives of people with chronic illnesses and partnered in many research grants to ensure the perspectives of people with chronic illnesses are included. She is a researcher with Australian Epilepsy Longitudinal Survey, a community-based project to explore the social impact of epilepsy and has published extensively on these and other research activities.
She is a member of the board of the Epilepsy Foundation and the associated Australian Epilepsy Research Foundation; a member of the Melbourne Genomics Health Alliance Community Advisory Group; a board member of Consumers’ Health Forum and serves on the Medical Services Advisory Committee Evaluation Sub-Committee in Dept of Health. She recently became an honorary research fellow in School of Medicine, University of Melbourne.
|4:30 pm||9:30 pm||8:30 am||Michele Battle-Fisher||Lessons in the Reduction of Health Disparities in COVID-19 by the Application of the Critical Systems Thinking|
|The Black, Indigenous and People of Color (BIPOC) communities in the United States are disproportionately affected by COVID-19. Health inequality of populations that are oppressed did not start with COVID-19. COVID-19 exasperated the problem of inequality. According to Braveman, the designation of health disparities does not apply to all statistically significant population-level health differences. At a more granular level, health disparities must be a “difference in which disadvantaged social groups… persistently experienced social disadvantage. A system of inequality is one where multiple elements such as racism, unfair policies, and income inequality adapt and react to the “(inequitable) pattern (of COVID-19 burden) these (social determined) elements create.” This pandemic exposed a public health crisis within a crisis that will continue to worsen without mindful, systemic intervention.|
Epistemic humility is at play as our grasp of understanding an event such as COVID-19 as being incomplete as well as socially and individually interpreted. Our understanding of the pandemic is provisional. The escalating pandemic is deemed traceable and measurable with “hard” methods such as epidemiological methods and modeling with the ascertainment of risk, odds, dependence of variables, association in variables, and measures of prevalence and incidence. The social vulnerability of BIPOC during COVID-19 is not adequately understood with the sole reliance on conventional statistical methods or traditional paradigms. The pandemic is a critical epoch that must not exclusively utilize one paradigm such as “hard systems thinking”. Science is not immune from making misguided judgments which magnify decisions are made, particularly when made under extreme duress. Likewise, systems thinking is not immune from the possibility of blind missteps with unintended consequences. Critical Systems Thinking (CST), as a divergence from predictably normalized methodologies, responds to heightened complexity within global crises than traditional paradigms. When a method is used on its own, such an approach lacks sufficient rigor to confront resistant problem situations, in this case, reversing socially ingrained, historical marginalization of already oppressed people.
Michele Battle-Fisher MPH, MA is the Associate Director of Research with Equitas Health Institute in the United States. She is a doctoral candidate (ABD) in Systems Science at the University of Hull. She is adjunct faculty at Temple University Lewis Katz School of Medicine (Urban Bioethics) and Wright State University (Population and Public Health Sciences). Boonshoft School of Medicine. She is a member of the Bertalanffy Center for the Study of Systems Science. She is the author of Application of Systems Thinking to Health Policy and Public Health Ethics- Public Health and Private Illness (Springer), a 2016 Doody’s Core Title. She was a TEDxDartmouth speaker in 2018. She was one of 45 selected for the National Institutes of Health (NIH) Institute for Systems Science and Health. She was a Visiting Scholar at the Hastings Center (U.S.).
|5:00 pm||10:00 pm||9:00 am||Borwornsom Leerapan||How Systems Respond to Policies: Intended and Unintended Consequences of COVID-19 Lockdown Policies in Thailand|
|5:30 pm||10:30 pm||9:30 am||Thomas Fröhlich||Pivotal features of mutually adaptive and contextually sensitive convergence – the semantic systems approach|
|In a semantic systems approach, we introduce an interaction-based model of active system elements. Each element is seen sourced in its underlaying potential. The potential guarantees the element’s distinct insideness. Also reigning its interactional specifics, it allows each coherent inside to specifically combine with other insides, to create larger coherent systems via adaptive convergence. Issuing distinct, but not isolated insideness, our model allows access to the topic of individuality, understood as enacting personhood in specific interaction with a context, and with a manifold of parallel contexts.|
In the practical approach, we strengthen context-sensitive individuality in care and healthcare settings. This goal is achieved by interacting in groups emerging from voluntary engagement and participation. To avoid psycho-bubble and potentially deleterious disclosure of personal topics, we use as-if techniques in the form of improv theatre and a range of similar techniques. The intended atmosphere is one of relaxation and fun. An island of freedom apart from, and not dominated by, the overregulated realm of institutional metrics: this is, what may emerge from this specified interaction. “Laugh along the way” gives the semantic energy input necessary to re-define individuality and personal resources in a contextually adapted, meaningful form. In not denying, but ironizing other coherences’ negative impact, participation in these free groups helps surviving in the New Normal, the authoritarian, mandate- and exclusion-based climate of current political mainstream.
As a biology student, I was awarded with a Max Planck Gesellschaft scholarship, Department of Biophysics, Max Planck Institute for Medical Research, Prof. Kenneth C. Holmes, Heidelberg. Using enzyme kinetics on the steady state, the second and the millisecond range, I was able to detect the mechanism allowing Adenylate Kinase to operate fast also near equilibrium of its target molecules. Switching to medicine, I became head of the Heidelberg University Children Hospital’s Allergology department and simultaneously continued laboratory work in the nearby Max-Planck Institute. As a pediatrician, I studied Analytical Psychotherapy of children and young adults, now working as a pediatrician, allergist and psychotherapist in a private practice near Heidelberg. Interested in philosophical anthropology and its relation to science, I started a cooperation with the Heidelberg Philosophy Department, Prof. Reiner Wiehl and the chairs of Medical Informatics, Physiology, Psychosomatic Medicine, and others. This interdisciplinary group started publishing in 1997. In a continued effort, we evolved a transdisciplinary model of biopsychosocial interaction, supported by a range of experts in different fields of humanities, as well as by mathematicians. Applying this model in the realm of care and healthcare was the aim of joining the European Society for Person Centered Healthcare, of which I became the Western Europe Vice President. Right now, we are engaged in introducing a quality-sourced model of physical interaction, with the so-called semantic body engaged and embedded primarily in this non-metric matrix. Based on that model and considering also contextual metric aspects we start action groups of care and healthcare workers to allow for self-reflection and a balanced empathy. Using the friendly sound and meaning of my second name, and in parallel to the well-known Balint groups also named after an individual person’s second name, we call these groups Fröhlich Groups.
|6:00 pm||11:00 pm||10:00 am||Kevin Nortrup||Reductionism and Holism: Family Feud, or Family Reunion?|
|The world must face present and coming “next normals” that are characterized by VUCA: Volatility, Uncertainty, Complexity, and Ambiguity. Mindsets and methodologies that worked well in the past are often insufficient to understand, navigate, and influence this greater complexity. It is essential that we cultivate greater literacy of systems and complexity, both as individuals and in our societal structures.|
However, such transformational thinking requires change; change generates conflict; and conflict is not something that people tend to handle well or to leverage successfully. Too often, proponents of systems-and-complexity literacy impede their own efforts at outreach, through missteps in framing and managing the conflict between existing and desired paradigms and practices.
This presentation and subsequent discussion will seek a systemic framework around systemic discussions and transformational change; they will examine common obstacles to outreach on complexity; and they will explore how reductionism and holism can be viewed as complementary, not as competitive.
Kevin Nortrup, CSEP, CPHIMS, LSSGB, FHIMSS, DSHS, graduated summa cum laude from the University of Illinois in computer engineering and has extensive experience in designing, implementing, analyzing, and troubleshooting complex sociotechnical systems. As Principal at Sugar Creek Solutions, he champions a transdisciplinary systems approach to transform process-improvement into systems-improvement in healthcare and in other industries. He is a Certified Systems Engineering Professional and holds a Lean Six Sigma Green Belt in healthcare. Kevin is a director of IISE-Indiana and of ISSCSH; he is a member and former chair of the Enterprise Systems Working Group of INCOSE; and he is a HIMSS Fellow and an SHS Diplomate.
|6:30 pm||11:30 pm||10:30 am||Joachim Sturmberg||Conclusion: Emergent Themes and Opportunities for Outreach|
|7:00 pm||0:00 pm||11:00 am||Close|