Reforming the Healthcare Economy

Tom Bowden, Vice President, MSIA.

There is an emerging view that a country’s healthcare system should not be thought of as an industry or even a marketplace but rather as a healthcare economy.

Managing an economy takes quite a specific approach.  As we have seen, in the recent PIP payments initiatives, giving carefully formulated benefits to one part of the healthcare system, in the hopes that these will stimulate progress in another, needs to be carefully thought through if it is to have any likelihood of success.

Some useful international work has been done on understanding how to use economic drivers to achieve health sector transformation.   In 2013 when the United Kingdom’s National Programme for Healthcare Information Technology (NPfIT) collapsed under its own weight leaving the British taxpayer counting the cost of a bunch of innovative, elaborate and ultimately foolhardy ventures, a new school of thought emerged.  The new thinking arrived from a venerable source.  The King’s Fund, established in 1877, is an independent charity working to improve health and care in England. The Fund’s goal is to ensure that the best possible health and care is available to all.

Having looked on in dismay while the NPfIT slowly failed, wasting an enormous sum of money, (at least £7 billion in total), analysts and researchers at The King’s Fund began to look at alternative options for managing large scale information technology transformation.

What came from The King’s Fund was a new approach for encouraging automation, employing ‘polysystems theory’.  A ‘polysystem’ is a complex ‘system of systems’, for example a modern healthcare system.  ‘Polysystems theory’ provides an alternate approach to changing a complex ‘system of systems’ from one state to another, for example, for changing a health system from a non-automated state to an automated one.

Developed by Professor Itamar Even-Zohar at Israel’s Tel Aviv University, ‘polysystems theory’ advocates the following approach to achieving systemic change in a complex environment:

  • Clearly defined, achievable objectives, reviewed regularly
  • A minimum set of hard and fast rules/boundaries
  • Effective incentives and disincentives;
  • Strong leadership, supported by periodic reviews, informed by commentary and with constant feedback and comparisons from all stakeholders.

The basic concept begins with clear agreement on what needs to be achieved and plenty of flexibility as to how progress is made, with a leadership approach that encourages stakeholders to work together in a collaborative and simultaneously competitive environment.  Progress is monitored via periodic reviews, to make minor adjustments to emphasis and focus.

Those of us in the IT space will be familiar with what is essentially an “Agile” approach.

This is in stark contrast to the highly prescriptive, meticulously detailed, strongly regimented health IT transformation plans we are more familiar with.  Using a polysystems approach is highly collaborative and fosters innovation and competition, over time, achieving far better results.  It is notable that the shift in emphasis we have seen in the United Kingdom over the past five years has yielded far better results than before they made this change.  The UK is now achieving better results than those countries that insist on steadfastly maintaining a rigid centralised planning and implementation model.

It is noteworthy that The Australian Digital Health Agency (ADHA)’s latest forays into industry collaboration are following a similar approach.  The MSIA salutes ADHA for doing that.  We will continue to offer whatever support we can.   It may just be that by working together using new and innovative approaches, we can achieve some worthwhile change, for the benefit of the Australian healthcare system.

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