Don’t Blame the System; They’ve Chosen the Wrong One

While trying to represent patients in the design of integrated care, I have heard the words 'system', 'systemic' and 'holism' used frequently. Few of those using the words seem to be aware of the history of systems thinking, or its principles. Health interventions are instead designed using logic modelling, which is aholistic and disintegrative. This concern is illustrated in relation to the UK’s Better Care Fund, which was an attempt to reduce hospital admissions by co-ordinating care. Systems thinking is then used to provide a possible distinction between three operating systems for the UK’s National Health Service (NHS). The first, an ideal market operating system, is inherently fantastic, and doubly so when it is impossible to determine who has contributed what to which outcomes. The accountable professional operating system may re-emerge as the rational option. However, weak analysis can lead to the emergence of a quasi-market operating system, which lacks the capacity to integrate the essential elements of a viable system. The fault lies not with systems thinking, but with the failure to study how viable systems are constructed.