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Next guest post by SPM member and former health system executive @NickDawson.

Ilya Prigogine received in the Nobel Prize in Chemistry in 1977. His work largely focused on Non-equilibrium thermodynamics. What he found is as fascinating for scientists and non-scientists alike. It turns out, according to Prigogine, closed systems are destined to collapse or fail. Open systems, by contrast, will usually grow and evolve[1][2].

Healthcare is notorious for its closed systems. We see painful reminders in restrictions on accessing our own health data. And it goes deeper. The processes, experiences and governance of health systems has also been, historically, closed. Today, healthcare represents a huge 18% of our gross domestic product. And, according to the WHO, the United States is 37th in the world in terms of outcomes.

It would seem Prigogine is correct. Closed systems tend to fail. Thankfully, that is changing.

In 2012, a consortium called d*collab put forth a challenge: design a better health record. The challenge had 4 objectives:

  • Improve the visual layout and style of the information from the medical record
  • Create a human-centered design that makes it easier for patient to manage their health
  • Enable health professionals to more effectively understand and use patients’ health information
  • Help family members and friends care for their loved ones

The results are on display on the Health Design Challenge site.

What is so compelling about this idea is its openness. The various designs are all freely available. George Bernard Shaw is credited with the maxim: “If you have an apple and I have an apple and we exchange these apples then you and I will still each have one apple. But if you have an idea and I have an idea and we exchange these ideas, then each of us will have two ideas.”

Design challenges, like the Health Design Challenge, offer an opportunity to freely exchange ideas. These are inherently open systems where ideas are traded and built upon like Lego blocks. The fantastic thing about a design challenge is that it does not have to be limited to visual elements, such as medical records.

Processes, doctor patient communication, billing cycles, and entire organizational strategies can be openly designed. There is an important role for patients in these design challenges too. One can imagine a time when open, patient-driven design challenges are part of a competitive edge for savvy healthcare organizations. And, according to Prigogine, those are the systems which remain viable now and into the future.

  1. Al Gore Has Big Plans. New York Times, May 20, 2007
  2. Gore, Albert. The Future: Six Drivers of Global Change. (2013). Random House. Available at Amazon.


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