Like other sectors, health care also requires innovation. Current models are based on a reactive and transactional approach to how health care is delivered. As patients, we wait for symptoms to present themselves before making any improvements to our health. In a similar way, health care providers often wait for regulatory changes before making adjustments to the systems that deliver the needed care. What is common to both is all the waiting.
Time for Change
I attended a presentation a few years back on the topic of Health Systems Innovation at McMaster University (Hamilton, Ontario), where the discussion focused on the future of health care, what it might look like, and how it can change from a reactive model to one that is proactive, participatory and where risk is shared.
The speakers where:
Dr. Des Gorman (Faculty of Medical and Health Sciences, University of Auckland), and
Mrs. Danielle Freschette (Executive Director, Health Systems Innovation and External Relations, Royal college of Physicians and Surgeons of Canada)
Here is my brief summary of the presentations and ensuing discussions. What I found most interesting is that many of the issues presented are also found in other sectors. Health care is not the only industry that suffers from being too reactive.
We have the wrong model
Reactive
Transactional
Funding the wrong things
Regulation that constrains innovation
Health care is moving towards
Participatory health care
Self-management
Focus on outcomes
Co-development
Mutualised risk
Process agnostic
Insights
Within 5-7 years whatever new system you put in place becomes corrupt. People figure out how to game it. We need to design systems that are intended to be gamed but where everyone wins.
People want to pay for outcomes not activity (i.e. transactions). Yet, there is little motivation to do anything other than continue to transact.
Evidence based medicine was introduced to reduce variation and improve outcomes but is no longer innovating.
We should have a strong skepticism around data and its use. Data only tells "half" the story.
Health care is not ready for industry 4.0. We are not teaching people how to adapt. In many cases providers do not have the capacity to change.
In Canada (specifically Ontario) there are too many pilot programs. Not enough have reached the point of viability and able to scale.
Innovation is currently driven by technicians and technology. Technology should not be the driving factor; patient outcomes should be instead.
For health care to be proactive it needs to be based on outcomes and competency
We need greater participation from all areas of health care if we are to come up with better approaches. There is no lack of desire to do this but a lack of effective ways to engage everyone.
We need to create the conditions that encourage innovation not stifle it.
My thoughts
Health care systems are based on a model that is not sustainable and it has been this way for some time. There are many factors that contribute to this and there is a multitude of options for how to improve. However, what is not clear, is how these innovations are funded, introduced, and scale to achieve the intended benefits. Some of these can be done incrementally. but others may require changes to current systems to enable these innovations.
What is clear, is that more engagement is necessary from all who provide health care and those that benefit from it. Perhaps, this is where innovation is most needed. A participatory approach based on mutualised risk that focuses on patient outcomes might just be the kind of innovation we need to become more proactive with our health care. This approach may also be helpful in other industries that are highly regulated, where risks need to be managed, and that suffer from being too reactive.
Amendment
In the years since I wrote this the Healthcare system in Ontario has started to transition towards a teams-based approach to improve overall coordination and improve support for proactive health care strategies.
Having recently undergone surgery to remove a gall bladder I have now experienced first hand the level of care which was excellent. After the surgery I was sent home as part of a virtual nurse program. During this program which lasted two weeks, I took my vitals each day which where uploaded using a tablet and then interacted with nurses and physicians through video sessions. Throughout this entire process I was treated with respect, dignity and with great care.
More work is still needed to address systemic issues across the healthcare systems along with new realities of sustainability and burn-out. However, several of the shortcomings I wrote about have now been addressed at least within the primary care system which I am very grateful.