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My view: The Utah health system needs doctoring

By Chad Swanson

Published: Thursday, Oct. 18 2012 12:51 a.m. MDT

We too often only consider a specific policy, patient encounter, disease, or program at a time, leading to unintended consequences — like skyrocketing costs and antibiotic resistance. Causes of ill health and our responses are incredibly complex and require a novel approach.

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As an emergency physician and instructor of a health systems class at BYU, I read the article, "Emergency Room care costs will continue to rise without an alternative" (Sep. 27), with great interest. Regardless of the outcome of the next election, we as a society will face a tremendous challenge to make our health system work for decades to come. I am convinced that there needs to be a historical transformation in the way that we as a society think about and approach health education, research, policy, and practice. We need to think of health and approach its improvement from more of a "systems" perspective.

We too often only consider a specific policy, patient encounter, disease, or program at a time, leading to unintended consequences ?— like skyrocketing costs and antibiotic resistance. Causes of ill health and our responses are incredibly complex and require a novel approach. "Systems thinking," an approach that has been applied successfully to fields such as business and engineering, holds great promise for health as well, and there is growing interest in its application.

The problem, of course, is that we are all to some degree invested in the way things are, the current system. Providers like me are incentivized to give less than ideal care. Health educators are invested in the status quo. Politicians are rewarded for quick solutions. For the sake of our children, we need to change the way things are at a very fundamental level. Utah could lead the nation in catalyzing the development of a health system that would make us all proud.

I suggest three steps: One, replace blaming and political rhetoric with serious consideration of the underlying drivers of ill health and solutions that make sense on a systems level.

Two, complement traditional health education in our universities' curricula with "systems thinking" approaches. Such approaches suggest that in a complex social system like health, we abandon "command and control," agree on a small number of simple rules such as replacing fee-for-service reimbursement with reimbursement for value, and allow local providers to self-organize to meet common goals.

Three, form discussion groups and action organizations that sit at the intersection of community, policy, practice, and academia. These groups could collaborate with other state and national groups and advocate for meaningful, long-lasting change.

If we're serious about transforming our health system, we'll need to transform the way we think and approach health, regardless of the outcome of the upcoming election.

R. Chad Swanson DO, MPH is an emergency physician at UVRMC in Provo, Utah. He received his Masters of Public Health at Johns Hopkins Bloomberg School of Public Health, and teaches health systems at BYU.

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