The 20th century was the century of the bureaucracy.

The 21st century is the century of the system.

The horizontal arrangement of healthcare into primary, secondary and tertiary care is no longer useful or fiscally prudent. It creates an environment where the focus is on bureaucracy and empire building
(= the healthcare archipelago) at the cost of recognising the patient and healthcare professionals as decision-makers capable of assessing the most relevant quality of care for their needs. We must move from healthcare services in which institutions are the dominant type of organisation to one in which healthcare systems dominate.

A systems approach to healthcare recognises the vital importance of self-care and informal care. It provides a vehicle to better address the misdistribution of patients throughout primary, secondary and tertiary care. It can answer the currently unanswerable question of “How much money do we spend on our core business?” where the core business of healthcare consists of

  • presentations, such as chest pain,
  • conditions, such as depression and asthma,
  • populations, such as elderly people with frailty.

The healthcare leadership needs to:

  • Design and develop population based systems

  • Create clinical networks

  • Establish and build patient centered care pathways

  • Manage healthcare program and healthcare system budgets for optimal value

  • Understand and use process and outcome measures to best effect

  • Provide a strong foundation to support other quality improvement techniques

  • Make the most of knowledge and IT

  • Meet the challenges of 21st Century healthcare