In a discussion of Roger Howes aptly titled book, Where Have We Failed?, Antal Solyom, a professor of medical education at the University of Virginia at Charlottesvilles Center for Biomedical Ethics, refers to healthcare in the U.S. as a patchwork nonsystem (that is) morally abhorrent. This view appears to be quite prevalent among academics and clinicians alike. By all current definitions, though, healthcare in this country can and should be viewed as a system.
Despite numerous attempts over the years to control the various elements of the U.S. healthcare system, many would agree the system has failed and may be broken. Can current efforts by the systems stakeholders (the federal government, insurance companies, healthcare providers, prescription drug companies, patients, etc.) fix it? Or is any attempt to remedy the system doomed to fail? I believe that part of the answer may lie in an unlikely field of studychaos theory. In considering what changes to make to healthcare, the next president may need to understand this complex theory, or at least have someone on board who does. What chaos theory would tell the new president is that any change to a system, however minor, must account for the possibility of unintended downstream consequences.
In her piece entitled Chaos and Complexity, in the Journal for Healthcare Quality, Heidi Benson, the director of quality and accreditation services at NorthCrest Medical Center in Springfield, Tenn., states although the term chaos generally connotes disorder and confusion, chaos theory is actually founded on the notion that even the most seemingly disordered processes involve a great deal of underlying or hidden order.
Stuart Davidson, an author and consultant on clinical technology, offers the following observation in an article entitled Healthy Chaos, in Health Forum Journal: Inside a hurricane all appears to be randomness and unpredictability. To someone trying to choose a particular tree as shelter in the storm, the idea of randomness is vivid indeed since there is no way to judge the survivability of that tree in advance. But while local or up-close, unpredictability is a fact that does not mean that randomness prevails in a hurricane. On a higher level, a weather satellite will see and report the storm as orderly and predictable for at least a few hours, or maybe days. Thus towns in the hurricanes path can be notified of the approaching danger.
In the book Roundtable Viewpoints on Organizational Leadership, editor Joyce Huth Munro, dean of the School of Graduate Studies at Chestnut Hill College, Philadelphia, noted a similar occurrence when viewing galaxies as well as biological systems. Researchers, utilizing natural and biological sciences and quantum physics, have increased our awareness of patterns in the midst of confusion and of order despite irregularity.
In her book entitled Leadership and the New Science, Margaret Wheatley, president emeritus of the Berkana Institute, observes that A system can descend into chaos and unpredictability, yet within that state of chaos the system is held within boundaries that are well-ordered and predictable. Wheatley argues that there is an inherent orderliness of the universe, of creative processes and dynamic, continuous change that still maintained order, which created a world where change and constant creation were ways of sustained order and capacity.
Chaos theory argues that continued attempts to control various portions of an integral system can lead to unexpected results. Benson, citing multiple references, describes a popular chaos-theory metaphor: the butterfly effect, which arises from the notion that a butterfly flapping its wings in one part of the world could cause a tornado or hurricane in a distant location. Benson notes that targeting precise improvement strategies toward singular root causes may result in the unpleasant and unexpected emergence of new problem-laden systems. Chaos theory argues for caution when trying to change, control, or even fix any or all elements of an integral system.
The next president, along with being the leader of the free world, will be in a position to make significant, lasting changes to this broken, morally abhorrent healthcare system. There appears to be a significant chasm between the parties as it pertains to healthcare. Arguably the Republican approach to healthcare is not much different from the current system, mainly focused on a market-driven approach, but John McCain would alter the current employer-based insurance system by dropping the tax exclusion for health coverage for workers. In contrast, the Democratic agenda could result in drastic changes to our healthcare landscape. Democrats are calling for a move toward more government-sponsored healthcare, often depicted as universal healthcare or socialized medicine, depending on your point of view. Our country is certainly not alone in looking to the government to fund healthcare. Real-life studies of universal healthcare exist in countries such as Canada and France. Although, admirably, all citizens are insured, government-led universal healthcare does not appear to be the utopian society to which many attest. There appears to be many issues related to availability of medical care in both models, although the causes are certainly different.
With integral systems, notes Wheatley, There is so much order that our attempts to separate out discrete events create the appearance of disorder. Likewise, attempts to control minute portions of the system may have unexpected adverse effects. With respect to the current healthcare debate in the U.S., Wheatley may say it best: To be responsible inventors and discoverers, we need the courage to let go of the old world, to relinquish most of what we have cherished, to abandon our interpretations about what does and doesnt work. What we must let go of is the notion of control. Both socialized and market-based models of healthcare inherently offer control, yet the vehicle is quite different.
The next president must acknowledge the ideas related to systems thinking. Additionally, he or she would be well-advised to understand this notion of chaos theory when contemplating any changes, no matter how minute, to the integrated system known as healthcare. As rough as the healthcare environment is today, we certainly do not want to cause hurricane-like conditions as a result of small, butterfly-like changes to the integral system we call healthcare.