A systems-of-systems perspective on healthcare: Insights from two multi-method exploratory cases of leading UK and US hospitals

Several developed nations around the world are grappling with high healthcare expenditures and unsatisfactory outcomes. High level country benchmarks show that there is wide variation in health outcomes for countries with similar levels of income and education, and the US healthcare system in particular is often singled out as the least effective system amongst developed countries. A common US and UK characteristic is that the highest source of healthcare expenditures are hospital services and infrastructure. Consequently, the strategies and operations developed and implemented by hospitals have a significant effect on access, quality, and cost of care. This paper's intended contribution is twofold. Firstly, to provide a system's perspective of healthcare beyond traditional high level country benchmarking exercises, and conduct two exploratory cases of leading hospital enterprises, one from the US and another from the UK, so as to further our understanding of hospitals' inherent system complexity, which has remained buried within traditional high level comparative country statistics. Secondly, to address a recent call from the systems engineering community to adopt a multidisciplinary research approach that combines both qualitative and quantitative methods with the goal of further supporting the systems-of-systems (SoS) practice.