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Three specifications for Patient Activation

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Whether you’re a Minister of Health or a patient, you’ll probably agree that healthcare is complex. Complex systems are unpredictable.  Their outcomes emerge from the interactions among all the people and organizations operating in the system – referred to as ‘agents’ in complexity thinking language.  Healthcare has no shortage of agents; clinicians, administrators and policy makers are just the baseline categories, each of which has many variations across many types of organizations.  Consider the social determinants of health – where you live and work and who you spend time with – and you have a highly complex adaptive system.

This is why the value of detailed planning in healthcare is typically limited.  The assumptions of a detailed plan change almost the moment it is finalized.  Complexity thinking suggests that considering minimum specifications to provide a general sense of direction is better than detailed planning.  Effective minimum specifications can allow individual agents to self-organize and adapt as their context changes.  See Edge-ware: Insights from Complexity Sciences for Health Care Leaders for a more complete description of complexity thinking applied to healthcare strategy.

The principles of minimum specifications trace back to “Boids”, a computer simulation developed by Craig Reynolds in the late 1980s.  Boids are autonomous agents that collectively avoid obstacles by following three simple guidelines:

  • Separation – steer to avoid crowding local flock-mates
  • Alignment – steer towards the average heading of local flock-mates
  • Cohesion – steer to move toward the average position (center of mass) of local flockmates

The resulting behavior is remarkably similar to real birds flocking in nature; a complex behavior pattern without any explicit rules.  These starlings at dusk are a stunning example.

Patients are the central agents in healthcare and individual lifestyle behaviors are by far the most significant contributor to health status.  Patient Activation is now a well proven measure of patients’ skill, knowledge, and confidence in managing their own health and health care.  Improving patient activation has been shown to improve outcomes and patient experience while reducing system costs.  Perhaps health system planners could use the concept of minimum specifications to guide all agents – especially patients – in the general direction of activation.

Of course, I have three minimum specifications for patient activation to offer for consideration:

  1. Education – improve patients’ understanding of their conditions and their role in managing them
  2. Collaboration – improve the ability of clinicians to work as partners with patients
  3. Motivation – provide support and encouragement to patients to help them sustainably change their lifestyle behaviors