Countering the Tragedy of the Health Care Commons by Exnovation: Bringing Unexpected Problems and Solutions into View

Willemine Willems
Additional contact information
Willemine Willems: Athena Institute, Vrije Universiteit, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands

Sustainability, 2021, vol. 13, issue 23, 1-19

Abstract: In the health sciences and policy, it is common to view rising health care costs as a tragedy of the commons, i.e., a situation in which the unhampered use of a resource by rational individuals leads to its depletion. By monitoring a set of outcomes, not only the costs but also patient experience and population health, simultaneously, it is claimed that the “triple aim” approach changes what is rational for health care stakeholders and, thus, can counter the rapidly rising health care costs. This approach has an important limitation: it reduces the monitored innovations to merely their outcomes; yet, how health care professionals and patients give shape to care delivery remains invisible. To get a more in-depth understanding of the consequences of adopting such an approach, in this article I use the method of exnovation instead. Exnovation foregrounds the everyday accomplishments of health care practices to enable reflection and learning. I draw on an ethnographic study into an innovation in care delivery aimed at rendering it more sustainable: Primary Care Plus. I reflected with both professionals and patients on what happened during 40 Primary Care Plus consultations. By presenting and analyzing three of these consultations, I foreground what is rendered invisible with the triple aim: improvisations, surprises and habits unfolding in practice. With exnovation, health care innovations can provide fertile soil for creating new forms of sustainable care that can help prevent the impending exhaustion of health care systems.

Keywords: sustainable care; exnovation; tragedy of the commons; reflection; health care innovation; care delivery (search for similar items in EconPapers)
JEL-codes: O13 Q Q0 Q2 Q3 Q5 Q56 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://www.mdpi.com/2071-1050/13/23/13082/pdf (application/pdf)
https://www.mdpi.com/2071-1050/13/23/13082/ (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:gam:jsusta:v:13:y:2021:i:23:p:13082-:d:688322

Access Statistics for this article

Sustainability is currently edited by Ms. Alexandra Wu

More articles in Sustainability from MDPI
Bibliographic data for series maintained by MDPI Indexing Manager ().