Twins in trouble (II): Systems thinking in healthcare and education

Abstract In an attempt to create new perspectives on the issues facing the US education and healthcare systems, we describe – in tandem – the root causes of system-wide dysfunction in both. A unifying concept is the lack of systems thinking. We assess: Timeline of causality; The substrate; The culture; Outcome measures; Micro-economic disconnection; Unending demand for resources; Incentives and accountability; and Organizational structure. Recommendations include: (1) do what is needed, not what is initially considered possible; (2) implement radical transformation, not incremental adjustment; (3) the Federal government must stand in loco parentis; (4) create a Champion-with-power; (5) develop a process for dialogue between practitioners and experts in education, healthcare and management, particularly systems thinking; (6) engage, educate and learn from the public early in the process; (7) create national databases; (8) reform the legal tort system in order to allow the blossoming of learning cultures.

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