Abstract
At the dawn of the twentieth century, the Flexner report catalyzed a transition in medical thought toward science-based research and practice. That paradigm shift resulted in a substantial improvement in human health. However, the advances that accompanied a biomedical reductionist paradigm—an approach to health concentrated on physiological minutia, professions working in silos, and a focus on episodic treatment—which surged exponentially after Flexner’s report are not adequate for the complexity of today’s health challenges. In this chapter, we make the case that we need a change in mindset similar to what resulted from Flexner’s report: a historical paradigm shift from biological reductionism toward a complex social systems approach to health improvement. We introduce three overlapping and emerging perspectives that provide the theory, language, tools, and methods suitable for today’s challenges: systems thinking, complexity thinking, and adaptive design. We also argue that some combination of these perspectives and approaches will provide the paradigm for the next century.
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Change history
09 March 2019
This book was inadvertently published without updating the following corrections. The chapter has now been corrected and approved by the chapter authors.
Notes
- 1.
A point already apparent some 20 years after the release of his report, Flexner himself observed: …the very intensity with which scientific medicine is cultivated threatens to cost us at times the mellow judgement and broad culture of the older generation at its best. Osler, Janeway, and Halsted have not been replaced [Flexner A. Universities, American, English and German. New York: Oxford University Press, 1930].
References
Flexner A. Medical education in the United States and Canada: a report to the carnegie foundation for the advancement of teaching. New York: Carnegie Foundation; 1910.
Hiatt MD, Stockton CG. The impact of the Flexner Report on the fate of medical schools in North America after 1909. J Am Phys Surg. 2003;8(2):37–40.
http://www.abms.org/member-boards/specialty-subspecialty-certificates/. Accessed 21 Aug 2017.
http://www.acr.org/Advocacy/Economics-Health-Policy/Billing-Coding/Prepare-Now-for-ICD10. Accessed 21 Aug 2017.
https://report.nih.gov/categorical_spending.aspx. Accessed 21 Aug 2017.
Merriam-Webster. Merriam-Webster’s collegiate dictionary; 2004.
Williams B, Hummelbrunner R. Systems concepts in action: a practitioner’s toolkit. Standford: Stanford University Press; 2010.
Plsek P. Appendix B: redesigning health care with insights from the science of complex adaptive systems. In: Committee on Quality of Health Care in America - Institute of Medicine, editor. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academy Press; 2001. p. 309–22.
Bogren MU, Berg M, Edgren L, van Teijlingen E, Wigert H. Shaping the midwifery profession in Nepal - Uncovering actors’ connections using a Complex Adaptive Systems framework. Sex Reprod Healthc. 2016;10:48–55.
Caffrey L, Wolfe C, McKevitt C. Embedding research in health systems: lessons from complexity theory. Health Res Policy Syst. 2016;14(1):54.
Bernstein M, Linsky M. Leading change through adaptive design. Stanford social innovation review. Winter 2016. https://ssir.org/articles/entry/leading_change_through_adaptive_design.
www.revolutionizehealth.org. Accessed 21 Aug 2017.
Nichols B. Malnutrition in children in resource-limited countries: clinical assessment. UpToDate®. http://www.uptodate.com/contents/malnutrition-in-children-in-resource-limited-countries-clinical-assessment.
Trochim WM, Cabrera DA, Milstein B, Gallagher RS, Leischow SJ. Practical challenges of systems thinking and modeling in public health. Am J Public Health 2006;96(3):538–46.
Vollmer S, Bommer C, Krishna A, Harttgen K, Subramanian SV. The association of parental education with childhood undernutrition in low-and middle-income countries: comparing the role of paternal and maternal education. Int J Epidemiol. 2016;46(1):312–23.
Reynolds M, Sarriot E, Swanson R, Rusoja E. Evolution and application of systems ideas: toward principles for systems thinking in health practice. J Eval Clin Pract. 2018. doi: https://10.1111/jep.12856.
Sturmberg JP, O’Halloran DM, Martin CM. Understanding health system reform - a complex adaptive systems perspective. J Eval Clin Pract. 2012;18(1):202–8.
Lauffenburger JC, Choudhry NK. A call for a systems-thinking approach to medication adherence: stop blaming the patient. JAMA Intern Med. Published online May 21, 2018. doi: https://10.1001/jamainternmed.2018.0790.
Peters DH. The application of systems thinking in health: why use systems thinking? Health Res Policy Syst. 2014;12(1):51.
Rutter H, Savona N, Glonti K, Bibby J, Cummins S, Finegood DT, Greaves F, Harper L, Hawe P, Moore L, Petticrew M. The need for a complex systems model of evidence for public health. Lancet. 2017;390(10112):2602–4.
Lipsitz LA. Understanding health care as a complex system: the foundation for unintended consequences. JAMA. 2012;308(3):243–44. doi: https://10.1001/jama.2012.7551.
Greene JA, Loscalzo J. Putting the patient back together-social medicine, network medicine, and the limits of reductionism. N Engl J Med. 2017;377(25):2493.
Swanson RC, Cattaneo A, Bradley E, Chunharas S, Atun R, Abbas KM, Katsaliaki K, Mustafee N, Mason Meier B, Best A. Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change. Health Policy Plan. 2012;27(suppl 4): iv54–61.
Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet 2010;376(9756):1923–58.
http://beyondflexner.org/. Accessed 21 Aug 2017.
http://www.thenextsystem.org/next-health-system/. Accessed 21 Aug 2017.
Halfon N, Long P, Chang DI, Hester J, Inkelas M, Rodgers A. Applying a 3.0 transformation framework to guide large-scale health system reform. Health Aff. 2014;33(11):2003–11.
Perry H, Robison N, Chavez D, Taja O, Carolina H, Shanklin D, Wyon J. Attaining health for all through community partnerships: principles of the census-based, impact-oriented (CBIO) approach to primary health care developed in Bolivia, South America. Soc Sci Med. 1999;48(8):1053–67.
http://jamkhed.org/about/. Accessed 21 Aug 2017.
Lindberg C, Hatch M, Mohl V, Arce C, Ciemins E. Embracing uncertainty: complexity-inspired innovations at billings clinic. In: Sturmberg JP, Martin CM, editors. Handbook of systems and complexity in health. New York: Springer; 2013. p. 697–713.
Acknowledgements
We gratefully acknowledge the work of Eliza Swanson in preparing the figures for this manuscript. We also thank Curt Lindberg and Jennifer Potts for their comments on the Billings Clinic section.
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Swanson, C., Widmer, M. (2018). Transforming Health Education to Catalyze a Global Paradigm Shift: Systems Thinking, Complexity, and Design Thinking. In: Sturmberg, J. (eds) Putting Systems and Complexity Sciences Into Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-73636-5_9
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