Health Care as a Complex Adaptive System: Implications for Design and Management

For several years, the National Academies has been engaged in a systemic study of the quality and cost of health care in the United States (IOM, 2000, 2001; National Academy of Engineering and Institute of Medicine, 2005). Clearly, substantial improvements in the delivery of health care are needed and, many have argued, achievable, via value-based competition (e.g., Porter and Teisberg, 2006). Of course, it should be kept in mind that our health care system did not get the way it is overnight (Stevens et al., 2006). Many studies by the National Academies and others have concluded that a major problem with the health care system is that it is not really a system. In this article, I elaborate on the differences between traditional systems and complex adaptive systems (like health care) and the implications of those differences for system design and management.