Management for Healthcare Facilities: Is there a role for Holism?

Holism is the idea that all the properties of a given system (be it biological or social) cannot be explained by its component parts alone. Although the general principle of holism was concisely summarized by Aristotle in the Metaphysics: "The whole is more than the sum of its parts", it is a concept that has not been wholeheartedly embraced by the medical fraternity.

Holistic healthcare receives some skepticism in mainstream medicine, predominantly due to the term being used as a catchword in a wide variety of disciplines, including mysticism. However, the benefits of holistic health are appreciated by consumers, with the resulting complementary medicine market showing strong growth over recent years. In addition, the linear method of treating disease in sequence is being joined by a holistic one, but with decisions still based on empirical evidence guided by the scientific method.

Irrespective of whether holism is that scientific, there are definitely principles that can be applied to management of a healthcare facility that takes into account the complexity of outcomes from relatively simple components. For instance, a hospital may make a concerted (and successful) effort at improving service to patients, yet the operation may be no more healthy than before. Considering the needs of patients and their families may make for a healthier environment, but without taking into account all the contributory factors for success, the outcome is often a superficial event with transient effects.

In the same way that a physician could evaluate the entire system of the individual, systems theory has become a valuable tool for management. A systemic view on organizations is transdisciplinary and integrative, in other words, it transcends the perspectives of individual disciplines. This might be difficult to appreciate in a clinical environment where specialisation is the norm (and a crucial reason for the efficacy of modern treatment). However, a systems approach considers the interrelationships between the elements, not just the elements themselves.

Some terms in systems theory that find application in healthcare facilities management:

Adaptive capacity: An important part of the ability of systems to continue to operate in the face of a disruption. The dynamic nature of serving healthcare needs is a continuous test of the suitability and capability of the systems that exist in the facility. Although planning can never foresee actual events, it is always the goal to design maximum adaptive capacity into the system that you do have.

Cascading failure: This refers to a system of interconnected parts, where the service provided depends on the operation of a preceding part, and the failure of a preceding part triggers the failure of successive parts. A chain is only as strong as its weakest link, and if attention is not given to all components of the system, a facility that may be outstanding in certain areas, can provide poor returns due to the presence of capability gaps in the chain.

Feedback: A feedback function only makes sense if the monitoring signal is looped back into an eventual control structure integrated within a system. This can serve as a crucial guide for corrective action to the system - the trick is to design a relevant and implementable feedback warning system.

In the same way that the human system is addressed in holistic medicine, where the modern physician works towards wellness of the entire individual, so too should management of the healthcare facility appreciate that the whole is greater than the sum of its parts.