An Analysis of Bangladeshi Healthcare Systems Using a Systems Approach

According to Scott and Davis (2003), organizations are a combination of interrelated instruments working together to attain a specific goal. Therefore, in order to understand the organization better, it is important to understand those interrelated parts, their function, and also their responsibilities. Carrol and Tosi (1977) identified complex organization as open systems interacting with outside environment. They defined system as a “set of interrelated components surrounded by a boundary which absorb inputs from other systems and transforms them into outputs that serve a function in other systems.

Complex organizations are open systems, interacting with an outside environment and adjusting to it. A business organization must react to changes in the environment from which it takes its inputs or resources (e.g., suppliers of raw materials) and to changes in the environment in which it delivers outputs or goods and services (i.e., to clients or customers).” Their definition outlines the key features of the organization: various components, a boundary, a transformation of inputs into outputs, interrelatedness of different parts of the organization, and their adaptation.

A system approach is different than traditional approach in many ways. The traditional approach just let us to look at the center of concentration whereas system approach allows us to “look at the whole picture, understand the broader context, appreciating interaction among levels, and taking an interdisciplinary approach” (Leischow and Milestein, 2006). Scott and Davis (2003) divided system in to two groups: close and open system. Close system has a defined boundary which makes it different from the open system, where boundary is usually porous.

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In an open system, organization can be influenced by outside environment, but in vice versa, organization itself cannot control the influencer. In a healthcare setting, this influence can come from government, political demand, or even from the emergence of a new epidemic. Besides, healthcare sector is capable of importing energy from outside of its boundary. Considering these aspects, healthcare can be labeled as an open system.

This paper is an attempt to analyze Bangladeshi health sector in system theory perspective. Bangladesh is a developing country located in South Asia which has quite different types of health sector than any developing country. The health sector is mostly dependent on government for policy implementation and financial requirements. However, over the years government put a little money from the yearly budget for health sector which makes it more difficult for healthcare to function properly (Islam and Biswas, 2014). They identified several core challenges that health system is Bangladesh are facing including limited public facilities, limited access, lack of essential commodities, significantly low level of workforce in healthcare, misuse of resources, insufficient financial resources, political instability, information barriers etc among others.

In this paper, I argue that, putting Bangladeshi healthcare in open system perspective will help us to understand this problem even better, identify where the problems lied and where to improve, and how improving different parts will help us to improve the total health system. Besides, to solve the health problems or to get the optimal output from the health sector, employing a systems approach could be a solution. However, this requires new tools which is different from the traditional one. And it uncommon for a single part of the organization to provide all the required tools. A system approach will help to collaborate different discipline together and come with their own different expertise. Such collaboration will help to create a new theoretical framework, new methodologies, and new measurement techniques to tackle the new health issues. (Fowler et al., 2009).

It is important for the policy makers to understand the parts of the system, inter relationship among different parts, and how the whole system operates. This paper concentrates to explain the healthcare of Bangladesh in system theory perspective. Like other countries, the health sector is an open system in Bangladesh where it interacts with the environment, influences by that, and adopt in accordance with the environmental demand. Though it is not possible to understand everything about a system but knowing about the key parts and discipline provides enough information about the whole. The first aim of this paper is to develop a theoretical framework of the healthcare system based on open system theory. Second aim will be analyzing how different parts of this system are inter-related with each other and their function.

Chuang and Inder (2009) identified emergency and hierarchy, and control and communication as the foundation of system theory. According to Bailey (2006), the hierarchy structure of an organization can explain the general model of a complex system. On the other hand, a system like healthcare is a combination of interrelated parts “that kept in a state of dynamic equilibrium by feedback loops of information and control” (Ackoff 1971). Thinking the overall healthcare system in system theory perspective will allow to put healthcare in a framework, which will allow us to see the system from a different perspective. It will help us to view the whole healthcare in different parts and to find the inter relationship among them. Petula (2005) argued hierarchy and effective communication in a system approach can influence quality care and health promotion.

Depicting the healthcare in system theory approach can help to identify where system is under performing, where need assistance, what are the risks system will have, and what is the predicted outcome. Like Burton and Obel 2004, Carzo and Yanouzas 1967 and others, I like to see Bangladeshi health sector from an applied perspective. This perspective will help me “to determine the work flow, control systems, information processing, planning mechanism, knowledge transfer, and their interrelations. (Scott and Davis, 2003).

Reid et al. (2005) identified four level model of the healthcare system: individual patient, the care team, which includes all professionals including doctors, nurses, family members etc., the organization, includes hospitals, clinic, nursing home etc. and political and economic environment. Kaplan et al. (2013) brought system approach to health where they mentioned culture, workflow, and technology as three critical component of patient care program.

According to them employing system will promote better health at lower cost and will make resources available when necessary. Petula (2005) identifies various application of system theory in healthcare system and found its usefulness in different dimension. According to him, system approach improve communication efficiency, establish trust, support collaborative efforts, help focus on process rather than stuff, strengthen hierarchical relationship, encourage creativity among others in a healthcare setting.

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