Think Differently, Play Together
Over the past couple of decades, I have invested my energies in understanding complex enterprises in terms of the multiple levels of phenomena that underlie corporations, cities, countries, and even climate. These levels include people, processes, organizations, and society, all of which both enable and constrain each other. Ignoring any of these levels risks devising policies, designs, or interventions that will be undermined by those levels ignored.
A significant portion of my endeavors have focused on healthcare, initially particular morbidities such as cancer, diabetes, and heart disease, and more recently population health, broadly defined. In all of these efforts, we have encountered the highly fragmented nature of the health system in the US. Providers, payers, and regulators at federal, state, and local levels operate rather independently and, as many of them have told us, try to stay in their own swim lanes.
However, population health is about whole people in social circumstances, economic situations, and health conditions. The delivery system needs to address people’s circumstances, situations, and conditions in a holistic, integrated manner. The farmer’s market model is not effective – buying tomatoes at one stall, cucumbers at another, and strawberries at yet another does not work for health.
There has been substantial progress in recent years in understanding how to address multi-level enterprises and improve the portfolio of policies, investments, operations, and outcomes across the multiple levels. The National Academies of Science, Engineering, and Medicine recently completed a study of a National Cancer Control Strategy, with support from the American Cancer Society, Centers for Disease Control and Prevention, and National Cancer Institute. I was fortunate to be a member of this study committee.
Central to our recommendations is multi-level modeling approaches as applied to the complex adaptive system of cancer control – a federation of millions of, usually well-intended, entrepreneurs with no one in charge. A couple of weeks ago, we briefed senior staffers of Senate and House committees on our recommendations. One staff member asked if we could summarize our recommendations in one sentence. Having thought about this, I responded immediately, “Think differently, play together.”
