For any health service ecosystem, we can map the practices of actors using this hierarchy. We can also map pathways through them. Doing so provides a universal structure for choosing and organising enquiry and for capturing deep understanding of ecosystem-level problems, patterns, relationships, trends and opportunities.
What’s more, all this can be done before we even start thinking about or assuming what solutions might be best. As well as when we already have a technology, solution or plan. In either case, all this insight can be captured objectively and independent of any bias or assumptions about how to address them.
This means that we can reveal novel possibilities for intervention or change of any kind. Not just for new technology, drug and device innovation but also for innovative provider health services, community initiatives, new forms of collaboration, and new health policies and programmes. We can also learn how to design new health ecosystems altogether.
To know how to do all this more effectively, we need to move along to our final stage-post – ADAPTATION
All natural ecosystems are in various states of dynamic adaptation. Any given state depends on the balance of available environmental resources, the health of the primary producer species, and the presence and capabilities of certain key species and functional service groups.
Some ecosystems are in a sustaining state, some are emergent, others are rigid or collapsing, and may be losing or have lost their resilience to cope with the decline of energy resources or the primary producer. In most cases though, a natural ecosystem contains a mixture of all these states in different degrees.
The same is true of health ecosystems. They too are in various mixed states of evolution, adaptation, stability or decline. Using the structure I have just defined, we can now see if, where and how our individual health ecosystem is changing or evolving.
We can see within-practice level, top-down, bottom-up, adjacent and disruptive forces of change – and respond to the weak signals and realities of those forces – more appropriately.
We can understand the influence, nature, dynamics and consequences of lots of different factors on the nature and form of adaptation – or what is known as the adaptive capacity of the ecosystem. Factors such as:
- Gaps in beneficiary and professional actor capabilities, their knowledge and resources available
- Variation in actor values which can sometimes lead to conflict.
- Resource types, cost and use including technologies
- Care access and equality issues
- The nature and influence of the social determinants in adjacent-to-clinical social contexts and
- The root causes of problems
And most importantly, how they all affect beneficiary actor outcomes, and why and how these outcomes vary. Because when we know these factors more deeply, we can also better discover and assess more, - more valid and more novel opportunities to intervene or improve your health ecosystem – or even transform it.
So instead of thinking in limited terms of improving outcomes and reducing cost – or fixing repair–recovery health care systems through greater efficiency and productivity - we can now adopt a far different and more bolder ambition. One that seeks to understand and advance the adaptive capacity of individual levels or of an entire health ecosystem, the constraints acting on it and the key drivers for evolving it.
And wherever you intervene, each of the levels of the ecosystem tells us which combination of design approaches are most appropriate to deploy, as shown below (examples of design approaches).