A system under pressure

Within weeks, health care systems across the globe have been stretched to the limit. In China and Italy we witness the sad consequences when such systems fail: doctors no longer have the means to treat all the patients in their care. I fear the worst for the US, where hospitals are facing shortages of almost everything. Triage is the term used to prioritize patients on the basis of their chance of survival. In this war-like situation the extra weight resorting to triage puts on medical staff is unimaginable. We can only pray for them and hope that they will be able to continue their life saving work.

Here, in the Netherlands, the situation is not so different. The whole country is witnessing a race against the clock to build up additional Intensive Care capacity.

The Domino effect

According to systems theory, a system is a cohesive conglomeration of interrelated and interdependent parts. We generally do not look at our society as a system. It takes a crisis like today’s COVID-19 to become aware that almost every aspect of our living is dependent on systems running smoothly.

In fact, this is the very reason that I am writing this blog at this time. It is only when systems start to malfunction and stop working that we become aware of them and realize their importance.

Today, we are extremely concerned about our health care system. The media feed us with detailed information of small parts in this large system that have become critical or have stopped working. We are now quickly learning about parts and interdependencies we could never have imagined. Let me give an example: Corona testing is not only about a kit test that has to be made available in sufficient quantities. It is also about personal protection materials like gloves, face masks, gowns. It is about simple things like cotton swabs, test tubes and pipet tips. It is about testing equipment and skilled technicians. It is about data infrastructure, data analysts and modelers. The shortages incurred today also reveal the weak spots the underlying supply chain. Only now we realize the vulnerability of this system.

The interdependencies we observe lead to a Domino effect: If one stone tumbles, the next will and the next and so on. If we run out of cotton swabs, we cannot sample, if we cannot sample we do not know who has been infected, if we cannot identify the infected, we cannot contain the spreading of the virus.

It is sad to say, but what we are witnessing today with Corona (or do our utmost to prevent) is the failure of our health care system. System failure can only be repaired by either relieving the pressure on the system or by changing the system itself.

System change

Social distancing, stopping public gatherings and minimizing transport are examples of measures rely on to relieve the pressure on the health care system. In fact this represents a system change on its own: our system of human interactions.

In my presentations on system change I make the following two statements:

  • System change is a no-choice option.
  • System change requires all actors involved to change.

It is clear that almost all governments faced with the Corona crisis reached a conclusion in line with my first statement: “We we cannot continue the way we are used to, we have no choice but to change this system of human interactions.” The same holds for my second statement. We can only control the consequences of the COVID-19 pandemic if everyone acts according to the strict guidelines.

The consequences are dire: the socio-economic impact will be huge and millions of people will lose their jobs. It will take years to repair the damage and recover.

We simply cannot afford to have a second pandemic in 2-5 years from now. In my next blog, I will discuss what options we have to prevent another pandemic from happening again.