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For thirty years, we’ve tried to achieve an efficient healthcare system through protocols, product thinking, and performance indicators. The result? High costs, burned-out professionals, and fragmented care. It’s time to acknowledge this approach was misguided.
Not out of nostalgia but for inspiration. Until the 1990s, community nurses, general practitioners, and social workers collaborated locally. About ten thousand community nurses actively kept people healthy. Prevention wasn’t a buzzword but a daily practice. Care was based on relationships, not transactions. And it worked. Until the system was ‘optimized’ with market economics and performance indicators.
In the ‘90s, major changes were implemented. Funding became contingent on eligibility assessments. Just like that, care was redefined as a product. Procedures were narrowly defined and billed by the minute. The bond between caregiver and client was subordinated to regulations and protocols. Community nursing had to be ‘quantifiable.’ The result? An explosive growth of the volume and cost of care, and an implosive decrease in effectiveness.
We did not choose our ecosystem metaphor arbitrarily. Care, like nature, is about balance, mutual reinforcement, and natural growth. About systems that sustain themselves because they work with rather than against natural patterns. We aim for a system that:
This transition is not a romantic ideal but a stark necessity. We have the required knowledge and technology, plus the proof that it works. What we need now is courage. To let go of approaches that don’t work. To choose trust over control. To provide world-class care in local community settings. In practice, this means:
When caregivers know their community, bonds of trust form. Where there is trust, self-reliance develops. And where there is self-reliance, the demand for care decreases. This isn’t a theoretical concept but an empirical fact.
familiar face instead of countless fleeting interactions. One professional who knows the patient, sees the big picture, and can adjust course when necessary. Personal continuity wasn’t a KPI; it was a feature of the design. It made complex care manageable and human. And it can do so again.
An ounce of prevention is worth a pound of cure – and considerably cheaper. Health education, early detection, and activating social networks weren’t incidental activities but core principles. Community nurses endeavored to make themselves redundant by empowering patients and their networks.
General practitioners, community nurses, and social workers formed a tight-knit team. With short lines of communication, frequent coordination, and a shared goal: keeping their community healthy. They knew, informed, and strengthened each other.
Professionals had autonomy. They were trusted for their craftsmanship. And their focus was on care, not administrative processes. This enabled care professionals to adapt and continuously mobilize the right mix of formal and informal care.
We obviously cannot (and have no desire to) return to the ’70s or ’80s. But going forward, we can integrate lessons from the past with our modern capabilities. By: