Resilience session: Health system resilience - a proposal for the Resilience Session
This is a runthrough of what we are going to do in the resilience session (join here). Executive summary: we will try to design a health care system that would work in a financial meltdown scenario, which could happen just three days after the conference in parts of Europe depending on Sunday's elections in Greece. You will rewire health care to make it low-cost, decentralized and peer-to-peer as much as possible. You will be able to count on Lucas's knowledge of health care systems and on Ben and Gaia's network analysis skills. Let's do it!
Health systems are made of people who have knowledge and work through procedures. They use buildings with machinery that uses consumables and energy.
The scenario is that of a financial meltdown. Even if there’s no money, parts of the system stay in place (people, buildings, machinery, knowledge and many procedures). But some things may become scarce (supplies of consumables and fuel) or will have to change (many procedures).
The overall suggestion is we could look at networks for help. Networks could be activated (or created) in order to look at:
- Supplies (energy, consumables): prioritise transport, synthesise some medication locally, repurpose existing physical resources, etc.
- Procedures: networks look at prioritary aims and adapt procedures: solve things at primary care level if hospital or ambulances fail, boil germs if there’s no electricity, etc.
Personally I’ve been looking at Vinay Gupta’s Simple Critical Infrastructure Maps (SCIM) model for a pandemic, which would be a different scenario.
- The model is simply a spreadsheet of “needs” x “levels”.
- One example of “need” is food, and it’s solved at different “levels”; in my personal case, food is grown internationally and brought to me via international-national-local transport. So, if international markets or transport break, I’d have to look elsewhere or grow food locally. (Poor farmers grow their food locally, and use no transport. In a bad-weather crisis, they need international supplies delivered to them. Or they move.)
- Vinay’s model includes “too hot, too cold, hunger, thirst, disease and injury” (for the individual), “communication, transport, workplace and resource-sharing” (for groups), and up to a total of 18 items for organisations and nation-states.
If the health system is a big organisation (really, a network of many organisations), then we want to look at more specific needs, which are covered by existing provision-systems, and if those provision-systems break then we need to look at alternatives (because needs stay with us!).
- In health systems, the basic needs of the individual (shelter/clothes, water, food) and groups (communications, transport) are still there.
- Specialised needs include: "sterilisation", "main groups of meds" (anesthetics, painkillers, insulin, cancerkillers, etc), "communications" (need can be produced by good protocols for local action), etc. Not a comprehensive list, but the rest can be inferred by analogy.
- If the electric grid fails, "sterilisation" can still be done with generators or boiling. If medicine markets fail, we’d be looking at making them locally if we can, etc.
Here’s how I'd suggest we approach the 2.5 hour session:
- In 15 minutes (or less) I’d briefly explain how (I think) healthcare works using the SCIM model, and together we’d focus on what breaks in our scenario.
- In 15 minutes, our network experts would look at it from the “network” point of view. I can imagine some things (each person has contact with others within the system), but not others. Together we can flesh it out, learn and contribute to the solutions, so do come!
- We can then make groups of 3-4 people for each area. Each area would pose a specific subchallenge, and each group would be expected to come up with workable ideas. (If there are many areas, a group might want to do more than one area if they work really fast.)
What are the areas? A hyper-complex system such as “health” can be split up in many different ways. The general focus is “we have people and buildings and knowledge, but supplies may be costly or unavailable”. We think the following might work as “sub-focus areas” for our creative thinking:
- Peer-to-peer diagnosis and treatment. (Even diagnosis of epidemics?)
- Low-cost pharmaceutical products: medicines, prosthetics, etc. (Include water filters, compost toilets, hand washing in case there’s a general break-down and not just health-care is affected?)
- Prevention through life-style changes: can we help each other live healthier lives and enjoy the process?
- Cooperative help when there’s need for transport (or this is part of #1).
Can you bring expertise to one or more of these areas? Can you suggest more areas? Do you have specific ideas we shouldn’t have to re-think?
Coming up with workable ideas would be done by looking at two aspects:
- What are the networks involved: what people are closest to the problem? who provides the services now? who could provide some alternatives?
- How would the sub-focus needs be "solved": reinforce the present system if possible, substitute some elements, do a full redesign of the provision system, change some protocols, etc. Here, creative thinking can be applied to the fullest. If you’re a permaculturist, please apply permacultural design principles such as “relative location for mutual service”, etc.