Healthcare is a complex system where the general mind set is at first, ‘do no harm’.
Traditionally, we require an evidence base to prove models and to implement change to ensure that it is based on peer review knowledge and experience. The trouble with this approach is how do we work with innovative change in a system that is inherently risk adverse, slow to respond and implement, and resistant to change because of the many moving parts and competing interests? How do health leaders and decision makers know what is the right solution? There are many solutions that implement innovations that deliver incremental improvements and better services and care models.
Examples in both private and public sectors include collective information and service resources for chronic disease, collation and integration of services such as primary care, pharmacy, and hospital services to encourage connected services, and end of life care alliances enabling greater consumer choice and coordinated care management among others. Whilst these achievements are noteworthy and admirable, are they enough of a change to address the broader healthcare system issues?
If you try to do it all (multiple system changes) the dialogue is difficult and causes confusion and ultimately a lack of uptake. That leaves decision makers with making incremental changes that are smart within the confines of the current system, rather than radical changes to address sustainability of the system. Lining up institutional support is important with any innovative policy change and implementation in healthcare in Australia. Both Sweden and Spain have examples of new policy and funding model changes which are encouraging bottom-up community led change, rather than top-down change from the bureaucracy. We can look to and learn from these examples about other ways of incentivising health system change through funding and payment mechanisms.
We need a circuit breaker to leave the provider capture model, and to better enable and involve practitioners, patients and consumers to move towards a more sustainable health system. These circuit breaker solutions need to be valuable across multiple stakeholders and be able to drive the politics of the day.