Monash University, Wamberal, New South Wales, Australia.
J Eval Clin Pract. 2012 Feb;18(1):202-8. doi: 10.1111/j.1365-2753.2011.01792.x.
Everyone wants a sustainable well-functioning health system. However, this notion has different meaning to policy makers and funders compared to clinicians and patients. The former perceive public policy and economic constraints, the latter clinical or patient-centred strategies as the means to achieving a desired outcome.
Theoretical development and critical analysis of a complex health system model.
We introduce the concept of the health care vortex as a metaphor by which to understand the complex adaptive nature of health systems, and the degree to which their behaviour is predetermined by their 'shared values' or attractors. We contrast the likely functions and outcomes of a health system with a people-centred attractor and one with a financial attractor. This analysis suggests a shift in the system's attractor is fundamental to progress health reform thinking.
每个人都希望拥有一个可持续且运作良好的卫生系统。然而，与临床医生和患者相比，政策制定者和资助者对这一概念有着不同的理解。前者关注公共政策和经济限制，而后者则认为实现预期结果的手段是临床或以患者为中心的策略。
对复杂卫生系统模型的理论发展和批判性分析。
我们引入了医疗保健漩涡的概念，将其作为一种隐喻来理解卫生系统的复杂适应性，以及其行为在多大程度上受到其“共同价值观”或吸引子的预先确定。我们对比了以人为中心的吸引子和以财务为中心的吸引子对卫生系统的可能功能和结果的影响。这种分析表明，要推动卫生改革思维的发展，根本上需要改变系统的吸引子。
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