Decomposition versus the Grassroots attitude to healthcare problems

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An intimate glance at the administrative prerogative

The most characteristic trait of human nature is its problem-solving capability. Because, day in and day out, a person strives to survive. Along the way also must put effort into making life simpler, healthier, more convenient, and prosperous.

The mission is to pursue it singly, nonetheless, as a matter of necessity. The human not too uncommonly would seek collective efforts of other-selves; because by nature, humans are social beings. In the process of problem-solving, there exists a much inherent challenge when it arrives at a collective crisis unraveling; that is the cycle of coordination, synchronization, and simplification of the process.

Masterminds of the domain of a given issue have often been victorious in many ways. They have enforced protocols, strategies, and procedures to enhance the fluidity and simplicity of operating forenamed problem-solving instruments. They have smoothly combined efforts between individual contributors. And Within the historical trend and context of delivering efficient synchrony, coordination, and simplification, the style of choice has shifted as it has predominantly been unity and consolidation prelude.

The ordain of leadership

In a typical appoint, pact compel leadership, and sometimes a leader must make decisive choices. On behalf of any team, leaders chronologically have utilized an adequate understanding of elements of the society parallel to the actual problem. Then comes the next challenge; that is understanding those components.

Unfortunately, the larger the community, the more difficult it is the acquaintance with every aspect of that environment. The best example refers to the use of ordinance within the context of large business forces, associations, and government administration.

Maintainance of the organizational process

To maintain the corporate process, the system, by default, utilized consolidative effort partaking via organizational hierarchy, which inclines to constrain every member under the network by the one set of ordinances produced by a few at the top of the administrative chain of command. The use of a consolidative undertaking is easy to manage, does not require robust education of the constituents. Perhaps it is less costly in the short run; still,  less flexible and expects strict obedience of its subordinates.

On the other end of the spectrum, the power of collaborative efforts sums up where all partakers of the given solution independently function towards the same goal. Latter is in discrepancy to the pendant nature of consolidation; anyhow, it requires honoring the autonomy of its elements within the grassroots. It compels comprehensive education and maintenance of decentralized operations with independent hierarchical oversight. But, unlike uniting, it is deemed extraordinarily flexible and motivating to its players. 

Simplicity is the virtue

There comes another impediment, as amidst problem-solving to curb over-simplicity, and mistakenly confused between simplicity and making shortcut; or for any distinct reason.

In other words- while trying to simplify the assignment, resultantly, we end up over-simplify the act of problem-solving itself. The latest is not only counterproductive but also has the potential to yield unfavorable aftermaths. For instance, it is not extraordinary for administrations around the world to duplicate solutions for identical problems of another system or country.

To make the most usage of the adapted protocols, the inheriting administration must analyze and make minor adjustments to ensure its adaptability to the new hosting system.

In technical terms, it is nothing but ‘reverse engineering’ for problem-solving efforts in another domain. In the real world, such an outline exists for every industry and purpose; and generally impacted by economic and political factors. 

The Variance of approach to problems in an individual setting 

It is not an overlooked fact that everyone banking on the point of time and place and environment embraces from the spectrum of selections to tackle the same dilemma.

The decision of strategy inevitably influenced by any given individual’s attitude depending on their role within the system, where each element holds the potential to change the policy and tactical approach to that specific challenge.

The consolidation

Concerning the consolidation- the dominant influence of the majority frequently overridden through the attitudes, hence decisions of few at the top of the hierarchical ladder. And- with collaboration, the view of every member and element of the system are recognized, honored, and considered influential.

For instance- today’s Medical practice through top-down reversely engineered solutions has evolved into a byproduct of unyielding applied science-based solutions. That is in contrast to the discipline of humanity that inherently engulfs the best of all scientific and technological innovations within the confines of its core individual human values

Treating the patient as a person is the driver of medical science and not correcting a set of test results and protocols.

Related Article: Medical Societies and their Flop of a Century-Old Quest

Centralized Administration

Administrations utilizing centralized and organizational consolidation structure, by nature, tend to adapt the problem-solving mechanism that entails reverse engineering phenomenon. This is commonly referred to as; Top-down strategy. Also known as autocratic leadership, the top-down is the process of upper management, reaching independent decisions that may or may not improve system efficiency.

Policies can affect all employees or only one division. Pros of the Top-Down approach are those decisions made by the executive team, design, and rolled out fast; still, the choice is predictable. The Cons of Top-Down includes the dissatisfaction of Members and constituents. The program implementation is error-prone and may not meet the needs of its subordinates.

Top-Down strategy

In technical terms, the Top-down approach begins with a large image of a problem. It continues to break down from there into smaller components. Also known as a stepwise method or” decomposition” that virtually involves the crumbling of a system into its elemental state. The strategy merely gains insight into the compositional subsystems in a reverse engineering fashion.

In a top-down approach, a synopsis of the system is formulated, specifying, but not detailing any first-level subsystems. Each subsystem is then cultivated in yet greater detail, sometimes in many additional subsystem levels, until the entire specification reduced to base elements.

A top-down criterion often restricted with the aid of “black boxes,” which renders it susceptible to manipulation. Black boxes have the propensity of downfall to elucidate elementary mechanisms and not detailed to sufficiently validate a prototype. Comparing the decomposition model in policies and the technical sphere, any observer must easily comprehend as to why historically some of the large-scale solutions in healthcare have flunked.

Bottom-Up attitude


A bottom-up attitude is the piecing together of networks to give rise to more sophisticated schemes, thus compelling the subsystems of the first system of the new system.

Bottom-up policy and procedure is a type of processing based on the direct participation of elemental constituents within the immediate environment through perception.

Architects of the Bottom-up model proceed with the execution of strategy with the target communities. Because the target groups are the original implementers of any policy. Moreover, bottom-uppers argue that if local implementers are not authorized discretion in the enactment process relating their particular circumstances, then the system will likely cease to function. Accordingly, goals, strategies, and actions must deploy with specific notoriety to the culture the policy will influence. Thus, evaluation based upon the street-level administrator would be the best practice. Such Grassroots efforts are necessary to maintain the effectiveness of any undertaking.

Now, let’s imagine what would yield if we scale the Variance of approach to the immense large setting, such as society or country.

In a collaborative bottom-up morality, that originates within the grassroots of a society stimulates precision of solution, hence the satisfaction of citizens and the equitable outcome.

The consolidated top-down strategy, even though successful, may only be reasonably achieved at a smaller scale. Parallel, the error, and failure will exponentially increase with the increasing size of the community as well as the expansion of the project scope.

Role of administration in boosting societies 

There are a variety of administrations with various constitutional framework. Their fundamentals can confirm the spectrum of the decentralized sovereign republic to a fully Authoritative system of governing; and some pattern of social democracy in between. Whenever someone uses the phrase-” By the people for the people,” It merely implies a governing scheme that holds the primary responsibility of surveillance of individual local small sovereign governing bodies that retain the responsibility of creating and managing their solutions based on their perspective perception.

Social Democracy

Some societies wield the Social Democratic approach as the political, social, and economic philosophy that favors economic and social interventions. It tends to facilitate the top-down approach to problems of its dependents. Given the framework of a liberal democratic state and a capitalist-oriented ordinance.

In the overdue scenario, the emphasis is on the majority vote through a populous referendum, and less about the grassroots interest. The problem with top-down morality is its propensity to become reproduced conveniently. It benefits from the efforts of others and tertiary resources. Yet it is capable of modification at the grassroots (reverse engineering), which is extremely difficult to validate to precision.

Top-down is convenient, cheap, and authoritative. The problem with bottom-up is that it requires personal independent thinking. Nevertheless, it is reliable and autonomous. 


So why governments and corporations like top-down?!

The answer rests within the intention! 

Top-down is central, easy to control, and authoritative govern. It is efficient, fast, and probably most effective in the context of smaller, passive, and those of lower overall schooling.

The bottom-up, decentralized system is liberating to the elements, therefore less attractive to the populous and the authoritarian administration. It merely takes full control of micromanagement out of the leadership agenda.

How does it apply to healthcare? 

Just like described earlier, the answer is within the choice between individual vs. entities. Corporate medicine is the exemplar of a sound system of top-down strategies; only applied to the medical field. It is easy, cheaper, and, most of all, susceptible to manipulation by the hands of the executive chain of power.

For an entity striving to maximize the revenue stream, the stepwise approach well aligned with its strategic mission; however, it comes at the expense of its actual tactical expedition.

The decomposition or top-down solutions aims to incorporate social and popular values. In contrast, the bottom-up scheme respects the Values of the individual persons, society. That is why the population health model deems desirable for most entities. But the bottom-up approach is always definitive due to its respect for individual reign. 

Medical Societies and their Flop of a Century-Old Quest

The argument against the grassroots approach is its cost. In fact, in the short run, it indeed may be somewhat costly but, still, fiscally efficient and practically error-proof in the long term.

Smaller the size of the community where the problem is dealt with; the more successful is the solutions. That can only be attained in the grassroots through a bottom-up approach. Contrariwise, we would be coercing local citizens to submit to a one-size-fits-all solution formulated by others across the globe at the expense of distinctive liberties.

Adam Tabriz, MD Dr. Adam Tabriz is an Executive level physician, writer, personalized healthcare system advocate, and entrepreneur with 15+ years of success performing surgery, treating patients, and creating innovative solutions for independent healthcare providers. He provides critically needed remote care access to underserved populations in the Healthcare Beyond Borders initiative. His mission is to create a highly effective business model that alleviates the economic and legislative burden of independent practitioners, empowers patients, and creates ease of access to medical services for everyone. He believes in Achieving performance excellence by leveraging medical expertise and modern-day technology.

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