New systems-thinking approach could help improve health of the U.S. population

The United States spends more on health care than any other country in the world, yet the life expectancy of its citizens is significantly shorter when compared to other high-income countries. Now, researchers at the University of Missouri School of Medicine are suggesting that an innovative systems-thinking approach to population health could improve the country's current health disadvantage.

"Our country's inability to define, monitor and improve on preventable deaths has complicated our progress in managing the health of our communities and population," said Julie Kapp, Ph.D., associate professor in the Department of Health Management and Informatics at the MU School of Medicine and lead author of the study. "This goes beyond collective impact. A national systems-thinking approach could be a step in the right direction toward improving the health and health care of the U.S. population."

A national systems-thinking approach considers how components within a larger structure operate and interact, and how to optimize the design, implementation and evaluation of that system. This approach can be applied to various health concerns, including obesity, infant mortality and disparities to elder care, so long as the ultimate goal is improving quality and quantity of life. Kapp used the Malcolm Baldridge Framework for Performance Excellence as a model of which to apply systems thinking to population health improvement.

"We consider U.S. population health a supra-system, which means it contains many subsystems at federal, state and local levels," Kapp said. "This approach requires all health and health care organizations to share metrics."

Kapp said this approach could be implemented by creating an evidence-based national reporting dashboard and offering incentives to health care organizations that agree to use a shared measuring system. She also recommended that community-based nonprofit organizations be required to use shared outcomes-focused metrics when applying for federal funds and accreditation.

"To improve the effectiveness of how community-based organizations address health and health-related issues, we must change their funding requirements," Kapp said. "Changing their funding requirements on a broad scale requires change at the federal level. Therefore, a systems approach is required."

Kapp's recommendations are conceptual and are intended to provide a theoretical framework for implementing a systems-thinking approach to U.S. population health. Applying the Baldrige framework in this way would be innovative, Kapp said, but she also acknowledged that implementing a systems approach in the U.S. would probably take many years to accomplish.

"However, given our country's current health outcomes compared to other peer countries, and our failure to make progress on improving the proportion of citizens dying from preventable deaths after 100 years of awareness, we cannot afford to not consider an aligned and integrated systems thinking perspective for improving U.S. population health," Kapp said.