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Embracing Irreducible Complexity: The Health Alliance Approach


Don Matheson

Health Alliance, Lutwyche, QLD, AU
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In 2017, Metro North Hospital and Health Service and Brisbane North PHN created the Health Alliance to tackle complex healthcare problems that transcend the mandate of any one part of the sector, and that can't be fixed by existing approaches. One focus area for the Alliance is older people.


It’s widely acknowledged that the way healthcare is delivered to older people needs to change. However, it remains a significant challenge to pursue system-wide reform when service pathways, funding flows, stakeholder groups and data are not well connected and traditionally have not been managed as a holistic system. Patients themselves bear the consequences of this fragmentation.

Practice change

The Alliance creates a neutral space where stakeholders come together on equal footing to discuss shared problems and develop shared solutions. The Alliance process is facilitated through a small backbone team. Underpinning the work is a shift from siloed to collaborative approaches, a focus on populations rather than institutional service boundaries, more effective use of data, and shifting funding incentives from volumes to value.   

Theory of change

In working across the sector to develop a shared view of problems and outcomes, we can then move to an aligned approach address these problems.

Targeted population

People 75years+ and Indigenous people 50years+ in The Prince Charles Hospital catchment, and those involved in their care.


The Alliance is a three year commitment through to June 2020


The two organisations committing to this shared initiative and taking a population approach.

The sector moving to a shared understanding of problems and solutions, with high levels of participation and retention of stakeholders. 

High level conversations underway between the HHS, PHN, State and Commonwealth on changing funding arrangements.


The Alliance process is about changing the way the players in the system work, and embedding changes in the information and funding environment to sustain it.



The concept and process of the Alliance is transferable, however it needs to be built within local context and is dependent on having a group able to play the backbone role.


Agility, building on momentum, and engaging local consumer voices has enabled progression towards desired outcomes. What the Alliance is seeking to achieve is relatively new to the sector. An independent evaluation is underway, with formative findings used to inform the ongoing approach.


Creating a neutral ground is vital to ensure all voices have been heard. The Alliance has facilitated this process by actively and nimbly engaging with stakeholders, and supporting leaders to be open to change the way health care is delivered.


•              The backbone role is vital.

•              There is a tension between hierarchical nature of health organisations and the need to adopt an agile approach to exploit opportunities for change. An agile approach also is required for evaluation.

•              Change involves holding a dynamic tension with stakeholders to move from the status quo.

•              It’s important to capitalise on existing momentum and also produce quick wins, some of which can be delivered without new funding.

How to Cite: Matheson D. Embracing Irreducible Complexity: The Health Alliance Approach. International Journal of Integrated Care. 2021;20(S1):193. DOI:
Published on 26 Feb 2021.


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