IN THE BUBBLE JOHN THACKARA - witz cultural

118 Chapter 6
should function more like supporting hubs, say reformers, than gigantic
centers that deliver all services. A decentralized health system would connect,
but not direct, midwives, alternative home care, birthing centers, the
fitness industry, health clubs, health food stores, organic farmers and
growers, people who offer inspirational workshops, biofeedback, and massage.
‘‘In re-defining health,’’ says economist Hazel Henderson, ‘‘hospitals
are bound to be much smaller, serving just the most acute and intensive
cases. Even within the traditional matrix of medicine, healthcare will be
forced into a more clinic-based and neighbourhood-based approach.’’ Prenatal
care, family planning, STDs, immunization, nutrition, eldercare—the
medical parts of building a healthier community are all things that should
involve a lot of people at the local level, she says. 20
Health City
Amsterdam Medical Centre (AMC), one of Europe’s largest hospital complexes,
houses a vast array of activities having to do with patient care,
research, and teaching. The building itself is like a medium-sized airport,
only taller. Road, bus, and rail links intersect at this hub, and there are
shops, restaurants, a university, and even a post office to service the eleven
thousand staff members and eight thousand visitors who pass through each
day. A multitude of actors is involved; untold thousands of actions and
decisions interact with one another every hour of the day and night. Rather
like the five-person team that ‘‘runs’’ Schiphol Airport, a three-person
board ‘‘runs’’ the hospital: Its main task is to create a common platform,
as well as shared agendas, working methods, and approaches, so that staff,
partners, and suppliers can do their jobs. The institution strives to be as
unbureaucratic as possible simply in order to survive: openness, teamwork,
learning, continuous improvement, performance measurement, and accountability
are the only ways that such a complex system can keep
moving. 21
Apart from the existence of huge centers such as AMC, the problem
with decentralization is that it’s an organizational answer to a conservative
question—namely, how best to organize the existing biomedical enterprise.
This is a systems-centered, not a person-centered, approach. A more radical
approach would be to transform the logic of care into a patient-centered
one and enable what software designers would call the commons-based