Hospital Culture Constituents of Complex Environments in Health/Social Care

USA's National Academies have, for numerous years, been conducting systemic researches into the nation's healthcare cost and quality (Building a Better Delivery System, 2005). Plainly, considerable improvements are required in healthcare delivery. Many assert that these may be attained through competition of a value-based nature among healthcare delivery organizations. One must, of course, remember that the American system of healthcare didn't achieve its present state overnight. The nation's National Academies as well as other parties have conducted several studies and arrived at the conclusion that a key issue facing the U.S. healthcare delivery system is: it isn't a system, in truth (Rouse, 2008). This paper will address two issues: 1) how conventional systems differ from CAS (complex adaptive systems) (e.g. healthcare); and 2) the differences' implications on health delivery system planning and management.

The U.S. healthcare system would be faced with discontinuous, disruptive change, owing to the eventual downfall of expert-based medical/clinical practice, even if the present healthcare structure offered services of satisfactory quality, access, and affordable cost. Cognitive studies indicate that our brain is capable of handling 5-9 facts within one decision. Despite the current clinical phenotype descriptions, the amount of facts that bear on individual decisions can already go beyond this capacity, resulting in medical care's underuse, overuse, and misuse (Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary, 2011). Added structural genetic information will likely subject one to 10 facts for every decision. Complete information on an individual's functional expression can increase the facts for every decision by ten times; protein data might increase them by a further ten times. It is hard to envisage a physician coping with this huge amount of information within the typical 15-minute patient appointment. Clearly, there appears to be a need for a novel decision-making paradigm in clinical settings. This unavoidable change will present a once-in-a-hundred-years' opportunity of healthcare role and culture reconsideration.

Out of every factor responsible for the current escalating healthcare expenses, technological growth is undoubtedly the most significant. Indeed, this has numerous benefits. One can find several examples of technological advances that have brought about appreciable healthcare improvements. However, prior to adoption of any new technology, an assessment must be carried out for deciding if it will produce actual benefits for patients, outweighing all potential risks. At present, the health sector is witnessing a swift technological proliferation for illness diagnosis as well as treatment (Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary, 2011). Imaging is one major example; its rates have drastically risen in the last few decades. Cardiac imaging, for instance, has witnessed a 24% yearly growth in the last ten years. Medicare data between 1999 and 2003 reveals a 45% increase in cardiac imaging.

Significant improvements in the American healthcare system necessitate easy stakeholder access to data regarding the overall system's (or any of its subsystem's) performance and state, together with data on best clinical practices at every level. This data would be employed for assessing present and emergent situations in this system, leading to modifications in inhibitions and incentives for motivating behavior change in stakeholders, to increase value constantly (Building a Better Delivery System, 2005). Incentives are, in general, vital to such CASs. There should be "incentivization" of both activities and outcomes. Provider payments ought to reflect outcome value (risk-adjusted), irrespective of what it cost to reach them. Further, a "disincentivization" of outdated and poorly informed practices is required. High-performing healthcare providers ought to secure significant rewards, while poor performers ought to fail. This way, a continued rise is expected in average level of performance. Wellness, which influences productivity, must be incentivized as well. Building on Californian Milken Institute's (DeVol et al., 2007) recent report, an economic paradigm may be designed, of wellness's relationship with productivity, for providing a base to ascertain the amount of funds to be allotted to public education and awareness. This paradigm would, further, form the base to devise tax incentives for organizations that provide wellness packages and whose workers take part in them. This is also applicable to the area of social care.

Competing Agencies/Collaborative Relationships

In the last many decades, state and federal policymakers have put forward various initiatives for reforming the U.S. system of healthcare and curtailing costs. One of the ideas has been instilling healthcare market competition, for allowing the sector to function more like traditional markets (Dayaratna, 2013). Theorists like Kenneth Arrow have presented a classic case that the healthcare sector inherently differs from the remaining competitive sectors and, hence, cannot function like them. But, the healthcare sector's evolution, combined with the latest academic literature, proposes that the sector ought to, and can, in fact, function...

Literature, in fact, suggests that suitable reforms for directing healthcare along this course would cost-effectively and considerably enhance care quality. FEHBP (Federal Employees Health Benefits Program) and Part D of Medicare represent examples of present-day healthcare competition. Launched in the year 2003, as part of the MMA (Medicare Modernization Act), Part D of Medicare expanded this program, providing seniors with prescription drug allowance (Public Law 108-173 - Medicare Prescription Drug, Improvement, and Modernization Act of 2003). This expansion's basis was competitive bidding, wherein private insurance schemes provide the U.S. federal government with premium proposals, for charging benefits in relation to prescription drug. Depending on those bids, government contribution is calculated, taking into account several regional factors. Subsequently, consumers can opt for one of numerous available plans, having diverse benefits. Instituted by the nation's Congress in the year 1959, the FEHBP serves more than eight million citizens by providing federal employees (including Congress Members) with a wide range of competing private schemes of insurance (Moffit, 1992). An enormous collection of organization-subsidized programs are available for federal employees to choose from, right from conventional fee-for-health-service schemes to different kinds of schemes for managed care. The FEHBP program illustrates competition's effects in the area of healthcare. Numerous changes to this program during the early eighties diversified plan options for retirees and employees, enabling increased cost sharing and reduced premiums. Astounding results were observed -- roughly one million retirees and employees switched plans.
Social and health care collaboration constitutes a fairly new area of study. The first key researches in this regard were conducted in the eighties (Stepney and Callwood, 2005). "Collaboration" is a vaguely defined term, and is often interchanged with terms like coordination, cooperation, integration, and participation. Ever since the National Health Service and Community Care Act of 1990 was put into effect, this concept has been prominently featuring in governmental policy documents, for promoting partnerships, joint working, and 'seamless service' development between social and health care. An evolving idea in the sector of health care is that of healthcare professionals espousing collaboration. Terada stressed the significance of exhibiting professional expertise through the recognition and application of relevant information, for creating a rational, realistic conclusion (The importance of teamwork, collaboration, n.d). The aforementioned approach to professionalism may be termed as "existentialist." Professionals reject dogma and conclusions derived by others until they personally verify them. This existential way of thinking is in line with the evidence-based health care philosophy, which, according to Chichester, Neal, Mann, and Wilder (2002), implied the application of personal resources and scientific evidence to individual patients' expectations and needs. Therefore, a collaborative clinical practice must include healthcare providers who evaluate the diagnostic practices and treatments of each other, to corroborate or improve on those decisions. Collaboration has numerous benefits, which manifest themselves at different levels of the healthcare organization. Social and health care institutions may (Practice development: collaborative working in social care, n.d):

1. Cultivate an organizational culture of constant improvement.

1. Lend an ear to, empower, and value their workforces.

1. Support the adoption of evidence-based practices by their practitioners.

1. Develop a sound focus on organizational purpose and patient health outcomes.

1. Improve organizational processes and structures.

1. Improve service quality.

Collaboration is associated with both challenges and opportunities; these include the following (Practice development: collaborative working in social care, n.d):

- Inter-organizational compatibility --whether it is beneficial to join forces with dissimilar or similar organizations or not, on any given issue, must first be considered.

- Requirement of a total-systems approach -- the approach concentrates only on any one area of a given organization; however, real change must cover every area in the chain. Hence, clinical evidence must be seriously considered and employed for influencing change at multiple levels, thereby producing "ripple effect." "

- The coordinator's commitment, approach and ability form the key to project success.

- One may only expect senior executives to lend an ear to findings and consider making changes. One can't expect them to immediately act on any findings before knowing what they may be. Senior management involvement has its benefits, even if their participation occurs only during the venture's start and ending.

- Sound preparation is essential, for ensuring that every participant clearly understands the recording methods and the process, right from the start.