Natural ecosystems: A primer for health and other socio-technical systems design
Increasingly, healthcare (and other social) systems are perceived as service ecosystems consisting of interconnected and collaborating stakeholders – patients, practitioners, payers, care providers, industry and government bodies. Before designing or planning a technology, product or service intervention, an innovator or planner will typically map the different stakeholders to determine if the innovation has the potential to satisfy, and align with, their diverse set of goals and needs.
However, the ecosystems metaphor or perspective can be used for much more than stakeholder mapping and needs assessment alone. It can help us to get much deeper and closer to the heart of complex health problems, provide new understanding of their dynamic nature and most importantly, help us to design and intervene with better solutions. It also reveals new opportunities for changing status quo practices and for transforming health ecosystems altogether, rather than merely improving them incrementally. To know how to do so, we must literally go back to nature and first understand more deeply the concept and functioning of natural ecosystems.
Natural ecosystems: Components and dynamic properties
Over a century old, ecosystem thinking is a central concept in the science of ecology – the study of relationships between organisms and their natural environment. In any particular ecosystem, for example a river ecosystem, multiple interactions of species and the environment occur at eight hierarchical levels:
1. CELL FUNCTIONING AND INTERACTIONS OF AN INDIVIDUAL SPECIES - The particular combination of genetic, protein and cellular interactions and mechanisms that distinguish one species (e.g., an Atlantic salmon)
2. INDIVIDUAL SPECIES - An individual organism of one species interacting with the environment (e.g., an adult ocean-swimming Atlantic salmon using its magneto-reception sensing capabilities to locate the correct river mouth and return to its breeding ground).
3. WITHIN A POPULATION - Between co-operating (e.g., salmon helping each other navigate and find paths upstream), and sometimes competing (e.g., brown river trout limiting their own breeding to adjust their population to available river space) organisms of the same species.
4. BETWEEN POPULATIONS - Between two species, whether again in the form of competition where separate species compete for resources (e.g., between salmon and trout competing for invertebrates or for space); predation where one species preys on the other (e.g., grizzly bear eats salmon, or osprey catches trout); or mutualism where two species exist in a symbiotic relationship in which each benefits by interacting with or supporting the other (e.g., pollinator and plant, two fish species responding collectively to environmental disturbance).
5. IN A FUNCTIONAL GROUP – Between an individual species and other species in a functional group performing separate yet complementary activities in certain environmental conditions and locations. A functional group is a collection of species with similar co-occurring functional attributes and activities that make similar responses to external factors and/or have shared effects on ecosystem processes (e.g., groups of invertebrate species at the bottom of river beds - the “benthic zone” - performing synergistic nutrient cycling tasks; e.g., groups of birds species functioning together on different parts of a tree).
6. IN A COMMUNITY - Between multiple different species in a specific location or habitat (e.g., all the interactions between salmon, bears, trout, beaver, osprey birds, mayfly, moss plants, etc.)
7. IN AN ENTIRE ECOSYSTEM - Between all communities in multiple habitats and the non-biological (abiotic) components of the environment (the water in the river itself, air, rainfall, earth and light).
8. BETWEEN ADJACENT ECOSYSTEMS – The total interactions between communities and environment in two or more adjacent ecosystems (e.g., the interactions between communities in river and adjacent woodland ecosystems, or between river and ocean ecosystems).
All eight levels of interaction dynamically bound a particular ecosystem. At any given time, different species of organism will exhibit varying levels of ecological fitness. One species may be performing well, adapting its resources to changes in the environment and in response to adaptations made by other species. Other species may be performing less well and may be declining in numbers on a sustained basis. They may drop in population if another species that provides it with resources diminishes or disappears. A species may also decline if a predatory species increases in number or due to temporary, or long-term, environmental crises or perturbations. Not all organisms within a species perform optimally, have equal capabilities or exhibit the same behaviours. There is diversity within any single species. For example, Atlantic salmon can be divided into local, reproductively discrete populations associated with individual river ecosystems or tributaries within ecosystems.
Natural ecosystems persist over long periods of time, but that doesn’t always mean they are sustainable or functioning well. At any given time they may be degrading or even on the verge of failure. Nevertheless, most ecologists agree that the higher the diversity of organism populations within an ecosystem (and arguably within populations too), the more the interactions and the higher the rate of adaptation, then the greater is the ecosystem’s resilience to internal and external events, changes and shocks.
The natural ecosystem perspective applied
Natural ecosystems evolve through dynamic interactions and relationships of organisms with each other, and with their environment (see model below). They function through repeated acts of resource sharing, use and adaptation. In this way, an ecosystem, its constituent species and the environment co-evolve through ongoing acts of resource co-creation. They each adapt with, and because of, the other’s actions and resources in a mutual process of generative emergence.
It is this conception of natural ecosystems as service systems of resource co-creation that provides a fuller and more practical perspective for understanding, innovating, organising, creating and transforming health ecosystems. Just like natural ecosystems, health ecosystems or more correctly, service ecosystems, consist of a diversity of actors (patients, clinicians, payers, providers, organisations etc.) interacting directly and indirectly through acts of resource and information sharing, integration, collaboration, co-creation and adaptation.
Interaction and components of natural ecosystems
Whilst sharing common dynamic properties, it is important to acknowledge two important differences (amongst others) between health service and natural ecosystems. These are:
1 Designed vs. Organic – Health, and indeed all, social ecosystems are made and imagined by humans in their initial design, frequent planned interventions and ongoing adaptations. They can be created, transformed and even eliminated. They can be reimagined and remade. They evolve in response to new and changing values, purposes, goals and contexts (e.g., new diseases) and in a collective effort to resolve important societal and health outcomes. They are changed through both bottom-up and top-down design and interventions. Natural ecosystems, by contrast, emerge, function and disappear organically without planned intervention (except by humans). They are completely bottom-up in their origin and evolution.
2 Replicable Adaptation vs. Evolutionary Adaptation– In health service ecosystems, adaptations in the form of innovation and best practices can be replicated and diffused within and across multiple health and other social ecosystems. They may also be copied from other social ecosystems. Many technologies now used ubiquitously in healthcare were first deployed outside of healthcare, which is often slow to adopt new technologies. Only when PCs and laptops became widespread in the home and texting became second nature to clinicians and patients in their personal lives, did these technologies become adopted in health ecosystems. In natural ecosystems, adaptations evolve very slowly through genetic modification and reproduction, rarely noticeable to the human eye.
Despite these differences, by applying ecosystems thinking, health innovators and designers are able to:
1. Identify the functional components of health service ecosystems, and determine thedynamics of interaction, resource sharing and co-creation that occur within them. This allows us to better frame and scope problem enquiries.
2. Define a hierarchy of co-creation practices in health service ecosystems and use this to determine the most relevant design and innovation approach when planning interventions
3. Apply ecological methodologies to understand and quantify patterns of diversityand variation within health service ecosystems, and reveal hidden opportunitiesfor innovation
4. Identify the causal factors that give rise to complex health problems
5. Frame and design health service ecosystem innovation, adaptations or interventions that address these complex health problems
6. Improve our ability to predict the impact of innovations, solutions and adaptations before introducing them into health service ecosystems
7. Build advanced ecosystem design thinking, innovation and strategy capabilities and processes to do all the above, and finally
8. Develop ecosystem-aligned organisations and acquire the leadership principles and skills needed to sustain ecosystem problem solving, adaptation, value creation and wellbeing
Transforming Value in Health: An Ecosystem Design Perspective
The above is a draft extract from my forthcoming publication: Transforming Value in Health: An Ecosystem Design Perspective. In it, I introduce a service ecosystem model and a practical framework for designing value and innovating outcomes in health ecosystems (healthcare, public health, wellness, social care).
To receive a copy when released, connect with me, register on the UMIO website or sign up to the UMIO community.