Building a sustainable health system.

OBJECTIVES To conduct a basic sustainability analysis of health systems, and explore models for conceptualising and creating sustainable organizations, based upon the experiences of the environmental sciences and organisational theory. To explore the role of information technologies in assisting health organizations become sustainable enterprises. METHODS A review of recent literature into sustainable systems and an analysis and extension of the literature to the specific case of healthcare. RESULTS Many if not all health systems around the globe face dual challenges of increasing demands and diminishing resources, which are ultimately unsustainable. Four physical system conditions which are pre-requisites for sustainability of systems--that materials should not be extracted, accumulate or be depleted faster than they can be managed, and that systems should fundamentally meet human needs apply equally to healthcare. For healthcare, in addition to physical material and energy, resources include people, and data, information and knowledge. Further, healthcare is an open system that needs to be sufficiently adaptive to changes if it is to sustain. Information and communication technologies are crucial tools to enable any large and complex modern enterprise to model, measure and then manage business processes. Technologies like organisational simulation, the electronic health record, and decision support are essential tools for sustainable health services. Applied inappropriately however, IT can itself create unsustainable conditions, for example through the accumulation of legacy systems, a situation that adherence to technical standards should mitigate. CONCLUSIONS It is crucial that our nations undertake a formal sustainability analysis of their health systems, to identify where the most pressing challenges are. In concert, there needs to be a long term process of exploring innovative designs for health services that improve the sustainability of the system as a whole, and there needs to be a will to implement the health system policies, infrastructure and services to ensure that in 20 years time we do have a healthy health system.