What's needed to create change in complex healthcare systems

I recently came across an article in the British Medical Journal by Jeffrey Braithwaite, a professor in health systems research from Macquarie University in Sydney. In his article, Braithwaite very nicely sums up why system-wide progress has been so elusive. And this is from a jurisdiction (Australia) that has made more progress than most! 

Braithwaite argues that structural healthcare changes on their own produce little gain because of the complexity of the underlying health systems.

As he notes, “No other industry or sector has the equivalent range and breadth – such intricate funding models, the multiple moving parts, the complicated clients with diverse needs, and so many options and interventions for any one person’s needs... The various combinations of care, activities, events, interactions, and outcomes are, for all intents and purposes, infinite.”

He also identifies (correctly, as I see it) that most positive change emerges locally, so that purely top-down approaches often do not work well.

However when it comes to suggestions for moving forward more effectively, the paper, in my view, falls short. Braithwaite seems to suggest that relying on local innovation and developing a culture that supports it will somehow be sufficient to accelerate progress.

I believe that healthcare complexity, which stymies top-down approaches, also creates barriers for jurisdiction-wide spread and scale of effective local health system innovation.

Consequently, an effective central infrastructure that enables spread and scale is essential to implementing change at the system level.

The essence of CCO's work

This jurisdiction-wide implementation role, to me, is the essence of CCO’s work. 

We work closely with many partners in the health system to promote and evaluate local innovation, look at evidence from research and from other jurisdictions, and then plan which improvement initiatives should be the priorities for spread and scale across the province.

We then work to advance these improvement initiatives by securing government investment, providing support with good data and information, implementing technology where appropriate, and engaging with health system partners, including patients and families. It typically takes several years of this type of collaborative effort to implement broad-based change.

True, our health system is incredibly complex. But working together, with an effective central infrastructure to drive province-wide implementation, we can accelerate progress and realize improvements for all.

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