James M. Tien

Both during and after the recent reform efforts, healthcare delivery has been identified as the key to transforming the U.S. healthcare system. In light of this background, we borrow from systems engineering and business management to present the concept of service co-production as a new paradigm for healthcare delivery and, using the foresight afforded by this model, to systematically identify the barriers to healthcare delivery functioning as a service system. The service co-production model requires for patient, provider, insurer, administrator, and all the related healthcare individuals to collaborate at all stages – prevention, triage, diagnosis, treatment, and follow-up – of the healthcare delivery system in order to produce optimal health outcomes. Our analysis reveals that the barriers to co-production – the misalignment of financial and legal incentives, limited incorporation of collaborative point of care systems, and poor access to care – also serve as the source of many of the systemic failings of the U.S. healthcare system. The Patient Protection and Affordable Care Act takes steps to reduce these barriers, but leaves work to be done. Future research and policy reform is needed to enable effective and efficient co-production in the twenty-first century. With this review, we assess the state of service co-production in the U.S. healthcare system, and propose solutions for improvement.

Engineering has and will continue to have a critical impact on healthcare; the application of technology-based techniques to biological problems can be defined to be technobiology applications. This paper is primarily focused on applying the technobiology approach of systems engineering to the development of a healthcare service system that is both integrated and adaptive. In general, healthcare services are carried out with knowledge-intensive agents or components which work together as providers and consumers to create or co-produce value. Indeed, the engineering design of a healthcare system must recognize the fact that it is actually a complex integration of human-centered activities that is increasingly dependent on information technology and knowledge. Like any service system, healthcare can be considered to be a combination or recombination of three essential components - people (characterized by behaviors, values, knowledge, etc.), processes (characterized by collaboration, customization, etc.) and products (characterized by software, hardware, infrastructures, etc.). Thus, a healthcare system is an integrated and adaptive set of people, processes and products. It is, in essence, a system of systems which objectives are to enhance its efficiency (leading to greater interdependency) and effectiveness (leading to improved health). Integration occurs over the physical, temporal, organizational and functional dimensions, while adaptation occurs over the monitoring, feedback, cybernetic and learning dimensions. In sum, such service systems as healthcare are indeed complex, especially due to the uncertainties associated with the human-centered aspects of these systems. Moreover, the system complexities can only be dealt with methods that enhance system integration and adaptation.