In this chapter Helen Harte writes of the health care system from the inside and how it can be impacted by taking a complexity perspective. She touches on philosophical issues of relationships and purpose as well as more pragmatic topics of boundaries, rules, and information.
There is no single health care system—that is, no system characterized by parts that suboptimize themselves in the interests of the whole. But health care is provided—or not provided—by multiple interacting complex adaptive systems at various scales in society. There are policies set at the national level, primarily by Medicare; standards set at the regional level, primarily by the area’s medical schools and insurers; and activities and responses at the individual level, determined primarily by the local physician culture and patients’ expectations.
There are millions of agents who fit within the very wide boundaries of health care: governments, doctors, insurers, employers, nurses, technicians, microbes, drugs, and on and on, into oblivion. Indeed, all of the agents at all of the scales are self-organizing constantly in response to the self-organizing decisions of the others in order to get their needs met. And, unfortunately for the individual and for society as a whole, those needs are often in conflict. It is as if dozens of people took turns driving