Building Networks to Make Health Work, or the Big Public Hospital part 4

January 13, 2007 at 5:44 am (Michael's Posts)

One of the college professors I consider a guru (in the Indian sense of someone who is a “root teacher,” a foundational source of knowledge) is a proponent of what I call network theory.  In this idea, states and governments are subordinate to networks, be they business,  non-governmental organizations, etc.  This is due to the flexibility and border-spanning nature of networks and their ability to ignore the restrictions of states and other more “concrete” institutions.  In the comparison of what kind of power is the best and who “wins the day,” this professor comes out on the side of networks over states as the primary actors.  There is definitely truth in this if we look at interpersonal organizations like terrorist networks and corporations whose power conduits carry farther and faster than anything our state can muster.  Their power comes from who knows who and what that relationship yields in terms of help for accomplishing the goals of the group.

So.  How does this relate to health?  Well, I have been thinking about the program that I am working on at the Public Hospital.  One of my objectives in joining the program was to see how something like this could grow from the ground up in a public healthcare situation.  In thinking back on it, I was frustrated because so little of what I have participated in has been the construction of a framework or the creation of any kind of structure.  “What is this?” I asked myself.  Whence came my program?

Personal connections.  The MD who thought of this basically picked up the phone and worked his connections and I happened to show up and provide volunteer manpower to get the actual screenings going.  There was no need to build structures because they were pre-existing in his professional and personal connections with his colleagues in and near his department.  And if there was something missing, he could probe connections within the first degree of separation from his colleagues and come up with good solutions.  It’s all who you know.

If global health is going to make changes for the better, we need a network of people who are connected in some way to the conduits that carry ideas and money and power and as they get connected to them, make further connections to spread knowledge and access to power nodes.  We need to make lists of people who are doing things like consulting and law and get in touch with them when we need to know what the statutes say about a certain thing or what the best way to organize an office is.  Doctors have long been isolated from the other parts of the structures that provide healthcare.  This is changing.  We must be aware of the change towards greater interconnection and push it forward, no matter what our profession, if we are to truly bring about our goals of better health for all.


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