Across Vendors
2.4.1 Determining if a health service system satisfy the characteristics of an ecosystem With our knowledge in the „source and target‟ domains relationships in understanding
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29 2.4 Characteristics of ecosystem processes
Ecosystem is a biological environment in which dynamic interactions happen between plants, animals, and microorganisms and their environment working together interdependently as a functional unit. Ecosystems, being open systems, are constantly changing due to internal or external influences, thereby causing imbalance (Donavan, 2010). Two key elements of a biological ecosystem is (i) the interaction between the different respective elements of the physical environment, and (ii) the relationship between the different elements of the environment. Also, ecosystem can be seen as having a dynamic and complex dimension, with ecological interactions within elements via free flow of energy and matter among them.
Each member within the ecosystem are related and will interact with each other, performing their specific roles to ensure all mutual benefits to every single living thing the system and to enable the proper function of the process, equilibrium has to be maintained. In other words, ecosystem processes worked together to ensure that the particular ecosystem is able to operate and perform its function effectively. The „cooperative‟ nature of ecosystem can evolve in an endless reciprocal cycle through the process of co-evolution (Bateson, 1983), where each element of the ecosystem is of relevance to the other members, and as such, variations in one element will result in evolutionary responses of others (Corallo, 2007).
2.4.1 Determining if a health service system satisfy the characteristics of an ecosystem With our knowledge in the „source and target‟ domains relationships in understanding conceptual metaphor, we can investigate if the health service system can be metaphorically represented with the concept of ecosystem. Based on the understanding of ecosystem and the characteristics within the ecosystem processes, three main characteristics (i) the interdependency (cooperative) nature, (ii) the co-evolution process, (iii) the openness and dynamism with free flow of energy or matter present in ecosystems are an important characteristics which can be observed in ecosystems. In fact, many business systems and
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30 structures employ the concepts of ecosystems‟ unique characteristics. For the case of a health service system, the three characteristics have to be observed for the ecosystem metaphor to stand.
(i) Interdependency (Cooperation) nature of the system
Interaction is exceptionally critical in the case of an ecosystem, where the idea of „shared fate‟ is of utmost importance. This interdependency is the foundation to a stable, productive and creative system (Iansiti and Levien, 2004). Each element in the ecosystem will contribute essential inputs which are vital for the survival of the other elements. In the case of a health service system to tackle elderly care, relationships are built between various elements essential for the functioning of the system. These elements include the users who are empowered to monitor their health and provide critical health information to the system, the medical providers such as the family doctors and hospitals which provide medical services and advices to the users, the technology service providers which collect information and digest them into useful figures, which are then disseminated to the other members of the system for appropriate actions. Also, the element which regulates the health service system (such as the 50 Fortune companies which initiated Dossia) plays one of the most crucial roles that enable the operation and innovation in the system, known as the keystone element. In the case of Singapore‟s aging population issue, the governing agency takes on the role of the keystone player in the health service system. Each element depends on one another‟s proper actions such that they, too can function, which then also facilitates the effective running of the health service system.
(ii) Co-volution
Closely related to the interdependency and the cooperative nature between elements in the ecosystem, co-volution emphasizes the close relation between all elements in the ecosystem.
In a health service system, since one action of an element will affect the other, adaptation
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example, changes in demographics will influence the services provided by medical providers, thereby generating response actions within the system. Also, differences in lifestyle, habits, cultures and policies will also trigger co-volution to happen to sustain the system. This also answers the high possibility of changes in lifestyles that can occur to elderly and their caregivers due to elderly or chronic health problems.(iii) Openness and dynamism of system
A biological ecosystem, being an open system, will encounter entries and exits of elements from time to time, resulting in the free dynamic flow of matter or energy within it. Just like the nature‟s system, a health service system is also open to providing assistance to health solutions according to needs, and will experience increase of decrease in number of users and allow entry of enhanced services with the adherence of regulations. Hence, a dynamic system is formed with constant changes in services, objectives and regulations due to changing environment and needs. This openness in system once again plays an important role in sustaining an effective healthcare network when needs and demands of users change. The mappings between these 3 main features can be seen as follows:
Source: ECOSYSTEM Target: HEALTH SERVICE SYSTEM
Interdependency between elements in the ecosystem.
Interdependency between
each participant in the healthcare system.
Evolution of living things with constant changes to fulfil changing demands and needs.
Presence of water transformed in various forms
Presence of medical data and information of various forms.
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potential and capability of evolution, thereby improving the operations of the systems. Finally, the openness of both systems allows for entrance and exit of different players in the systems.Figure 5: Conceptual blending between health service system and ecosystem Input 1:
Ecosystem
- Interdependency between elements in ecosystem - Evolution of living things due
to changes in environment - Open system with entrances
and exits of members in
- Co-volution of services due to changing needs for
- Interdependent relationship between stakeholders.
- Room for improvement for changing needs of elderly care.
- Open system for entrance and exits of stakeholders.
- Allows flow of medical information and data.
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33 The electronic health records system that can be established to counter issues of aging population is the result of the blend and encompasses these three specific characteristics in the generic space as shown in Figure 5, which are crucial for the functioning of a system to cater to successful aging.
The three main characteristics in the generic space are focused on features of co-operation and possibility for more collaboration, which adheres to the spirit of public health service.
With the satisfaction of the three main characteristics of biological ecosystem, it can be concluded that a health service system to successful aging can be metaphorically explained by the behavior of a biological ecosystem, forming linkages and evolutions which mimic the nature.