ORIGINAL PAPER
The radical and requisite openness of viable systems: Implications for healthcare strategy and practice
Felice Borghmans,
Corresponding Author
Felice Borghmans
BSN, GradDip(CritCare), MoL, PhD Candidate
Faculty of Education, Monash University, Wellington Road, Clayton, Victoria, 3800 Australia
Correspondence
Felice Borghmans, Monash University, 7 Heysen Drive, Skye, VIC 3977, Australia.
Email: [email protected]
Search for more papers by this authorFelice Borghmans,
Corresponding Author
Felice Borghmans
BSN, GradDip(CritCare), MoL, PhD Candidate
Faculty of Education, Monash University, Wellington Road, Clayton, Victoria, 3800 Australia
Correspondence
Felice Borghmans, Monash University, 7 Heysen Drive, Skye, VIC 3977, Australia.
Email: [email protected]
Search for more papers by this authorFirst published: 11 May 2021
Abstract
This paper addresses an ontological question about the nature of health and challenges some underpinning assumptions in western healthcare. In its analysis, health in its various statuses, is framed as a naturally occurring complex adaptive system made up of dynamically interacting subsystems that include the physiological, psychological, and social realms. Furthermore, openness in complex systems such as health, is necessary for the exchange of energy, information, and resources. Yet, within healthcare much effort is invested in constraining systems' behaviours, whether they be systems of knowledge, health, healthcare, and more. This paper draws on the complexity sciences and Levinasian philosophy to explicate the essential role of system openness in individual, population, and systemic viability. It highlights holism to be “not whole-ism”, and system openness to be, not just a reality, but a critical feature of viability. Hence requisite openness is advocated as essential to efficacious and ethical healthcare practice and strategy, and vital for health.
CONFLICT OF INTEREST
The paper’s author has no conflict of interest to declare.
Open Research
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no new data were created or analyzed in this study.
REFERENCES
- 1Sturmberg JP. Evidence-based medicine-not a panacea for the problems of a complex adaptive world. J Eval Clin Pract. 2019; 25(5): 706-716.
- 2Gatrell AC. Complexity theory and geographies of health: a critical assessment. Soc Sci Med. 2005; 60(12): 2661-2671.
- 3 J Haupt, ed. Applying Complexity Theory to Health and Healthcare 2003. Centre for the Study of Healthcare Management; 2003.
- 4Howell MD, Stevens JP. Understanding Healthcare Delivery Science. New York: McGraw-Hill Education; 2020.
- 5Eckersley R. Beyond inequality: acknowledging the complexity of social determinants of health. Soc Sci Med. 2015; 147: 121-125.
- 6Byrne D. Complexity Theory and the Social Sciences: An Introduction. New York: Routledge; 1998.
- 7Bhaskar R, Hartwig M. Enlightened Common Sense: The Philosophy of Critical Realism. New York: Routledge; 2016.
10.4324/9781315542942 Google Scholar
- 8Maturana H, Dávila Yáñez X, Muñoz SR. Cultural-biology: systemic consequences of our evolutionary natural drift as molecular autopoietic systems. Found Sci. 2015; 21(4): 631-678.
- 9Chu D, Strand R, Fjelland R. Theories of complexity. Complexity. 2003; 8(3): 19-30.
10.1002/cplx.10059 Google Scholar
- 10Cristancho S, Field E, Lingard L. What is the state of complexity science in medical education research? Med Educ. 2019; 53(1): 95-104.
- 11Levinas E. Totality and Infinity. Pittsburgh: Duquesne University Press; 1969.
- 12Beer S. The viable system model: its provenance, development, methodology, and pathology. J Oper Res Soc. 1984; 35(1): 7-25.
- 13Lipsitz LA. Understanding health care as a complex system: the foundation for unintended consequences. JAMA. 2012; 308(3): 243-244.
- 14Harvey DL, Reed MH. The evolution of dissipative social systems. Journal of Social and Evolutionary Systems. 1994; 17(4): 371-411.
10.1016/1061-7361(94)90020-5 Google Scholar
- 15Burcher P. The noncompliant patient: a Kantian and Levinasian response. J Med Philos. 2012; 37(1): 74-89.
- 16Bircher J, Hahn EG. Understanding the nature of health: new perspectives for medicine and public health. Improved wellbeing at lower costs. F1000 Res. 2016; 5: 167.
- 17Churruca K, Pomare C, Ellis LA, Long JC, Braithwaite J. The influence of complexity: a bibliometric analysis of complexity science in healthcare. BMJ Open. 2019; 9(3):e027308.
- 18Pype P, Mertens F, Helewaut F, Krystallidou D. Healthcare teams as complex adaptive systems: understanding team behaviour through team members' perception of interpersonal interaction. BMC Health Serv Res. 2018; 18(1): 570.
- 19Manson SM. Simplifying complexity: a review of complexity theory. Geoforum. 2001; 32(3): 405-414.
- 20Luhmann N. Introduction to Systems Theory. Malden: Polity Press; 2013.
- 21Gear C, Eppel E, Koziol-Mclain J. Advancing complexity theory as a qualitative research methodology. Int J Qual Method. 2018; 17(1):160940691878255.
- 22Brockelsby J, Cummings S. Designing a viable organization structure. Long Range Plann. 1996; 29(1): 49-57.
- 23Coyle FJ. It just doesn’t seem to fit. Environmental illness, corporeal chaos and the body as a complex system. J Eval Clin Pract. 2009; 15(4): 770-775.
- 24Lanham HJ, Leykum LK, Taylor BS, McCannon CJ, Lindberg C, Lester RT. How complexity science can inform scale-up and spread in health care: understanding the role of self-organization in variation across local contexts. Soc Sci Med. 2013; 93: 194-202.
- 25Manning E, Gagnon M. The complex patient: a concept clarification. Nurs Health Sci. 2017; 19(1): 13-21.
- 26Persaud DD. Enhancing learning, innovation, adaptation, and sustainability in health care organizations: the ELIAS performance management framework. Health Care Manag. 2014; 33(3): 183-204.
10.1097/HCM.0000000000000014 Google Scholar
- 27Sturmberg JP, Martin C. Handbook of Systems and Complexity in Health. Berlin: Springer; 2013.
10.1007/978-1-4614-4998-0 Google Scholar
- 28Cat J. The unity of science. In: EN Zalta, ed. The Stanford Encyclopedia of Philosophy; Online: Stanford Center for the Study of Language and Information; 2017. https://plato.stanford.edu/archives/fall2017/entries/scientific-unity/.
- 29Adkoli B, Parija S. Systems approach in medical education: the thesis, antithesis, and synthesis. Trop Parasitol. 2019; 9(1): 3-6.
- 30 Orissa-Post. Science behind fireworks. Orissa Post. 2019.
- 31Homann E. The Rorschach omnipotence scale and closed-system processing. Psychoanal Psychol. 2018; 35(4): 454-461.
- 32Huber M, Knottnerus JA, Green L, et al. How should we define health? BMJ. 2011; 343:d4163.
- 33Kunz G. Interruptions: Levinas. J Phenomenol Psychol. 2006; 37(2): 241-266.
10.1163/156916206778876326 Google Scholar
- 34Vagle M. Crafting Phenomenological Research. 2nd ed. New York: Routledge; 2018.
10.4324/9781315173474 Google Scholar
- 35Cogan J. Phenomenological reduction. In: J Fieser, B Dowden, eds. Internet Encyclopedia of Philosophy; Online: Stanford University Press; 2020. https://iep.utm.edu/phen-red/.
- 36Simon HA. Invariants of human behavior. Annu Rev Psychol. 1990; 41: 1-19.
- 37Stanford K. Underdetermination in scientific theory. In: EN Zalta, ed. The Stanford Encyclopedia of Philosophy; Online: Stanford Center for the Study of Language and Education; 2017. https://plato.stanford.edu/archives/win2017/entries/scientific-underdetermination/.
- 38Prigogine I. Exploring complexity. Eur J Oper Res. 1987; 30(2): 97-103.
- 39Heath I. Complexity, uncertainty, and mess as the links between science and the humanities in health care. In: J Sturmberg, CM Martin, eds. Handbook of Systems and Complexity in Health. New York: Springer; 2013: 19-24.
10.1007/978-1-4614-4998-0_2 Google Scholar
- 40Creath R. In: EN Zalta, ed. Logical empiricism. The Stanford Encyclopedia of Philosophy. Online: The Stanford Center for the Study of Language and Information; 2020. https://plato.stanford.edu/archives/sum2020/entries/logical-empiricism/.
- 41Sassen B. 18th century German Philosophy prior to Kant. In: EN Zalta, ed. Stanford Encyclopedia of Philosophy; Online: Stanford Center for the Study of Language and Information; June 2017. https://plato.stanford.edu/archives/sum2015/entries/18thGerman-preKant/.
- 42Stevens H. From medical gaze to statistical person: historical reflections on evidence-based and personalised medicine. Aust Fam Physician. 2016; 45(9): 632-635.
- 43Huber E, Kleinknecht-Dolf M, Kugler C, Spirig R. Patient-related complexity of nursing care in acute care hospitals: an updated concept. Scand J Caring Sci. 2020; 35: 178-195.
- 44Davis H. Social complexity theory for sense seeking: unearthing leadership mindsets for unknowable and uncertain times. Emergence. 2015; 17(1): 1-20.
- 45Foucault M. The Order of Things: an Archaeology of the Human Sciences. New York: Vintage Books; 1970.
- 46Searle JR. Mind, Language, and Society: Philosophy in the Real World. New York: Basic Books; 1998.
- 47Cenci S, Song C, Saavedra S. Rethinking the importance of the structure of ecological networks under an environment-dependent framework. Ecol Evol. 2018; 8(14): 6852-6859.
- 48Prigogine I. The Laws of chaos. Review. 1996; 19(1): 1-9.
- 49Boisot M, McKelvey B. Complexity and organization-environment relations: revisiting Ashby’s law of requisite variety. In: P Allen, S Maguire, B McKelvey, eds. The SAGE Handbook of Complexity and Management. London: SAGE; 2011: 279-298.
- 50Ashby W, Goldstein J. Variety, constraint, and the law of requisite variety. Emergence. 2011; 13(1/2): 190-207.
- 51Ashcroft R, Van Katwyk T, Hogarth K. An examination of the holism paradigm: a view of social work. Soc Work Public Health. 2017; 32(8): 461-474.
- 52Gaines AD. Socio-cultural construction of medical knowledge. In: H Kristian, ed. International Encyclopedia of Public Health. Cambridge: Academic Press; 2017: 612-616.
10.1016/B978-0-12-803678-5.00420-3 Google Scholar
- 53Ariew R. Pierre Duhem. In: EN Zalta, ed. The Stanford Encylcopedia of Philosophy; Online: The Stanford Center for the Study of Language and Information; 2020. https://plato.stanford.edu/archives/fall2020/entries/duhem/.
- 54Quine WV, Ullian JS. The Web of Belief. New York: Random House; 1970.
- 55Rovesti M, Fioranelli M, Petrelli P, et al. Health and illness in history, science and society. Open Access Maced J Med Sci. 2018; 6(1): 163-165.
- 56Chin-Yee BH. Underdetermination in evidence-based medicine. J Eval Clin Pract. 2014; 20(6): 921-927.
- 57McDaniel RR, Lanham HJ. Evidence as a tool for managerial action: a complex adaptive systems view. Health Care Manage Rev. 2009; 34(3): 216-218.
- 58Beckman JP. Health care under market conditions: an ethical analysis. In: H Albach, H Meffert, A Pinkwart, R Reichwald, W Eiff, eds. The Boundaryless Hospital. New York: Springer; 2016: 41-56.
10.1007/978-3-662-49012-9_3 Google Scholar
- 59Sturmberg JP, Miles A. The complex nature of knowledge. In: J Sturmberg, CM Martin, eds. Handbook of Systems and Complexity in Health. New York: Springer; 2013.
10.1007/978-1-4614-4998-0_4 Google Scholar
- 60Weatherall D, Greenwood B, Chee HL, Wasi P. Science and technology for disease control: past, present, and future. In: DT Jamison, JG Breman, AR Measham, et al., eds. Disease Control Priorities in Developing Countries. 2nd ed. Washington: Oxford University Press; 2006: 119-137.
- 61Scambler G. Health-related stigma. Sociol Health Illn. 2009; 31(3): 441-455.
- 62Franklin M, Lewis S, Willis K, Bourke-Taylor H, Smith L. Patients' and healthcare professionals' perceptions of self-management support interactions: systematic review and qualitative synthesis. Chronic Illn. 2018; 14(2): 79-103.
- 63Harrison SL, Robertson N, Apps L, C Steiner M, Morgan MD, Singh SJ. "We are not worthy"--understanding why patients decline pulmonary rehabilitation following an acute exacerbation of COPD. Disabil Rehabil. 2015; 37(9): 750-756.
- 64Rynes SL, Bartunek JM, Dutton JE, Margolis JD. Care and compassion through an organizational lens: opening up new possibilities. Acad Manag Rev. 2012; 37(4): 503-523.
- 65Singleton V, Mee S. Critical compassion: affect, discretion and policy–care relations. Sociol Rev. 2017; 65(2_suppl): 130-149.
- 66Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive Summary. London: The Stationery Office; 2013.
- 67Stange KC. The problem of fragmentation and the need for integrative solutions. Ann Fam Med. 2009; 7(2): 100-103.
- 68Edmunds M. Inequitable physical illness and premature mortality for people with severe mental illness in Australia: a social analysis. Health Hum Rights. 2018; 20(1): 273-281.
- 69Sartorius N. Comorbidity of mental and physical disorders: a key problem for medicine in the 21st century. Acta Psychiatr Scand. 2018; 137(5): 369-370.
- 70Priest N, Paradies Y, Stewart P, Luke J. Racism and health among urban aboriginal young people. BMC Public Health. 2011; 11: 568.
- 71Pelzang R. Time to learn: patient-centred care. Br J Nurs. 2010; 19(14): 912-917.
- 72Moran NA. Symbiosis. Curr Biol. 2006; 16(20): R866-R871.
- 73Manderson L, Warren N. "just one thing after another": recursive cascades and chronic conditions. Med Anthropol Q. 2016; 30(4): 479-497.
- 74Mirzaei M, Aspin C, Essue B, et al. A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness. BMC Health Serv Res. 2013; 13(251): 251.
- 75Marmot M. The Health Gap: The Challenge of an Unequal World. Bloomsbury: London; 2015.
10.1016/S0140-6736(15)00150-6 Google Scholar
- 76Quine WV. On empirically equivalent systems of the world. Erkenntnis. 1975; 9(3): 313-328.
10.1007/BF00178004 Google Scholar
- 77Wade DT, Halligan PW. Do biomedical models of illness make for good healthcare systems? BMJ. 2004; 329(7479): 1398-1401.
- 78Moore L, Britten N, Lydahl D, Naldemirci Ö, Elam M, Wolf A. Barriers and facilitators to the implementation of person-centred care in different healthcare contexts. Scand J Caring Sci. 2017; 31(4): 662-673.
- 79Barry M, Edgman-Levitan S. Shared decision making--pinnacle of patient-centered care. N Engl J Med. 2012; 366(9): 780-781.
- 80Marmot M. Humankind neither nasty nor brutish. The Lancet. 2020; 396(10252): 660-661.
10.1016/S0140-6736(20)31832-8 Google Scholar
- 81Fredericks A. Money Driven Medicine. Kanopy; 2009.
- 82Lee K-H. A historical perspective of the barriers to generalism. Aust Fam Physician. 2015; 44(3): 154-158.
- 83Hall J. Australian health care - the challenge of reform in a fragmented system. N Engl J Med. 2015; 373(6): 493-497.
- 84Bleakley A, Bligh J. Who can resist Foucault? J Med Philos. 2009; 34(4): 368-383.
- 85 AIHW. Workforce: Australian Government; 2018. https://www.aihw.gov.au/reports-data/health-welfare-services/workforce
- 86Appleby J. Productivity in healthcare. In: P Spurgeon, RJ Bourke, CL Cooper, eds. The Innovation Imperative in Health Care Organisations. Cheltenham: Edward Elgar Publishing Limited; 2012: 8-22.
10.4337/9781849809856.00009 Google Scholar
- 87Linzer M, Bitton A, Tu SP, et al. The end of the 15-20 minute primary care visit. J Gen Intern Med. 2015; 30(11): 1584-1586.
- 88McKee M, Healy J. The role of the hospital in a changing environment. Bull World Health Organ. 2000; 78(6): 803-810.
- 89Dhillon A. Holistic medicine is “human” medicine. BMJ. 2008; 336(Suppl S4):0804144.
10.1136/sbmj.0804144 Google Scholar
- 90Christopher WF, Espejo R. A new management for enduring company success. Kybernetes. 2011; 40(3/4): 369-393.
- 91Rouse WB. Health care as a complex adaptive system: implications for design and management. Bridge-Wash-Nat Acad Eng. 2008; 38(1): 17-25.
- 92Smith D. Institutional Ethnography: A Sociology for People. Oxford: Altamira Press; 2005.
