Understanding health system reform - a complex adaptive systems perspective.
BACKGROUND
Everyone wants a sustainable well-functioning health system. However, this notion has different meaning to policy makers and funders compared to clinicians and patients. The former perceive public policy and economic constraints, the latter clinical or patient-centred strategies as the means to achieving a desired outcome.


METHODS
Theoretical development and critical analysis of a complex health system model.


CONCLUSIONS
We introduce the concept of the health care vortex as a metaphor by which to understand the complex adaptive nature of health systems, and the degree to which their behaviour is predetermined by their 'shared values' or attractors. We contrast the likely functions and outcomes of a health system with a people-centred attractor and one with a financial attractor. This analysis suggests a shift in the system's attractor is fundamental to progress health reform thinking.
Monash University, Wamberal, New South Wales, Australia. jp.sturmberg@gmail.com
Joachim P
JP
Sturmberg
Di M
DM
O'Halloran
Carmel M
CM
Martin
D003695:Delivery of Health Care / Q000458:organization & administration*; D018166:Health Care Reform; D006291:Health Policy; D018802:Patient-Centered Care; D013598:Systems Theory