“The art of simplicity is the puzzle of complexity” (Douglas Horton).
Today’s healthcare systems are universally complex and packed with challenges. In England, total health spending is expected to rise from today’s £124 billion to over £127 billion by 2020/21. While it feels the system does not necessarily work for all patients all of the time, it’s worth noting the NHS was asked several years ago to find £22 billion in savings by 2020, in order to keep up with rising demand and an ageing population. Add to this the increase in emergency admissions (14%) and diagnostic tests (19%), as well as a fall in the number of nurses and the picture begins to look like a Jackson Pollock painting — highly respected yet expensive and messy.
Untangling complexities is not simple, but nonetheless we must try. We know, at least, that removing friction could improve user experience, drive engagement and increase satisfaction. Unfortunately, healthcare systems are not currently built with this in mind. Just ask anyone who’s seeking the advice of a specialist, or who’s had their entire week disrupted by the diagnosis of a single symptom. So could we, by re-imagining healthcare, solve our budgetary problems and design a seamless healthcare system?
The solution may consist of two parts: on the one hand, technological progress and beautifully designed, easy-to-use healthcare products; on the other, the organisations themselves and the key role governments play. While it’s becoming increasingly clear that Brexit will not balance the NHS’s books, we can still review here what Westminster could do to help build the healthcare system of tomorrow.
In order to fundamentally improve healthcare, governments need to rethink the way they think about healthcare: How to provide it; where it’s given; and the core definition of “healthcare” itself.
Location location location
When we think about “healthcare”, we normally imagine the interaction between doctors and patient at the point of care. While interactions with health professionals are important, it can be said that 90% of healthcare happens in between these visits. This is when medications are taken (or not) and your health improves (or doesn’t). As such…
…Clinics and hospitals could be the wrong place to focus attention.
Consider the following story:
Michael (fictional name, real case) went to see his doctor because he was suffering from blepharitis, a chronic eye condition that often results in recurring sties. As he needed to see a specialist, he waited more than a month for his appointment. He got treated with a 3 month cycle of antibiotics for 90 days. The treatment didn’t help and his symptoms didn’t improve. Now he’s taking antibiotics, which is not ideal for his body, his eye is still inflamed and his next appointment is in 4 months time.
Currently, months between appointments — particularly with specialists — can leave patients stuck in cycles of unsuccessful treatments, still suffering symptoms. The situation can be worse in rural areas. Our homes are not suitable to monitor our recovery progress and allow for at-home intervention… yet. However, telemedicine companies, such as Babylon, which provide remote patient monitoring tools that connect physicians and patients with self-diagnosis and self-therapeutics tools, are changing this reality.
Home-as-point-of-care carries economic as well as operational benefit: Buildings are not elastic, there’s a huge fixed cost associated with clinics and hospitals. Managers have little to play with beyond “driving efficiencies” and keeping beds full. Understanding the issue of location broadens the scope for change. Homes as extensions of hospitals, thanks to tech, is a reality within reach. On the operational level, care at home is a burgeoning business with operators like Elder and Cera offering viable alternatives to traditional care homes. These are the flexible, adaptable, potentially game-changing models that are oiling the wheels of change.
What can the government do to move patients from hospital to homes? The short answer is investment, either directly with funding and tax policy or indirectly through partnerships. There’s a longer answer — and I’ll touch on it briefly — but first we need to look at incentive design.
Reinventing incentive design
Here’s a hunting joke:
How do you hunt elephants?
Mathematicians’ answer: go to Africa, throw out everything that isn’t an elephant, catch what you have left.
Statisticians’ answer: hunt the first animal you see N times and call it an elephant.
Consultants’ answer: we don’t hunt elephants, in fact we’ve never hunted anything, but you can hire us by the hour to tell you how.
Economists’ answer: we don’t hunt elephants either, but we firmly believe that if elephants are paid enough, they will hunt themselves.
Whatever you think of the joke, it does contain a grain of truth: Incentives do make the world go round and can explain behaviours. Equally, misalignment creates conflict.
A broad look at the NHS suggests there is a conflict between the patient’s want and the healthcare system’s ability to provide. One example is homes vs. hospitals: While patients want to be released to their homes, the system is not designed for them to be released for hospitals and be treated there. Another conflict is friction vs. ease-of-use: While patients want an easy-to-access-and-use system, The NHS is — out of necessity — not designed to make it easy for patients to see caregivers. The NHS, currently, is focussed on reducing costs and maximising efficiencies by reducing the number of unnecessary treatments per patient. The NHS it is also not designed to make it easier for patients to have lab checks unless they already show symptoms.
It may sounds obvious but it means there is little incentive or ability to identify diseases early on — otherwise known as preventive medicine or disease prevention. Today, most healthcare systems are geared to treat diseases more than maintaining health. This reactive approach is not only bad for patients but is also expensive. According to the CDC, “every dollar spent on childhood vaccines saves $10” and a National Coalition on Health Care expert panel reported that, “Containing and treating just one case of measles costs about $140,000.” (It is worth noting that not all forms of preventive care are equally cost effective).
So why are things the way they are? There is willingness: Healthcare professionals have been talking about this subject for years now. But the opportunities that lie ahead rely on a paradigm shift in mindset. Alongside a new culture of engagement between patients and practitioners, a shift at the operational level is also needed: successful hospital management will need to be incentivised not by the “sweating of assets”, but by the minimising of need. Behavioral change is hard. This shift will take many years, require heavy investments and involve significant risk in a notoriously risk-averse environment. This word…
‘Risk’ really deters governments. Startups, however, embrace risk.
Education, exposure, acceptance
“What we are today comes from our thoughts of yesterday, and our presents thoughts build our life of tomorrow: our life is the creation of our mind” — Buddha.
Healthcare contains many highly-skilled, awesomely-knowledgeable people. But, as with all fixed mindsets, they need convincing intuitively as well as intellectually. For tech, AI, machine learning, big data and IOT to really penetrate the monolith of UK healthcare, healthcare professionals will need to get it in their hands as well as their minds.
Education, in the broader sense of the word, could be the answer. Safe environments that can breed familiarity of new tech and practices — free of real risk — are needed. Risk is more unacceptable in healthcare than any other sector and by its nature, doctors will continue to be the gate-keepers of most aspects of healthcare, or subconsciously use it as an excuse not to open up to innovations…
…Exposure breeds, in this case, acceptance.
The more professionals embrace innovation now, the sooner constructive change can happen. Government, as custodian of the NHS, can encourage this at the highest levels, where acceptance needs to happen before it can be expected to be embraced at operational levels. Add to this an open dialogue with high growth small businesses, and the road will be open for startups’ contribution to flow through the system.
From complexity to simplicity
Healthcare is already drawing a lot of attention from venture capital. Big tech companies and startups are starting to play a central role in the future of healthcare. How readily the incumbent system can absorb its impacts will shape the future of healthcare in the UK and beyond.
Could the solution though be that simple? Instead of reshaping the landscape itself, should the government simply support and open it up to others? If it’s that simple, why is it so hard?
According to Albert Einstein, “any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius — and a lot of courage — to move in the opposite direction.” Perhaps you don’t need to be a genius. Smartness and boldness might be all that are needed. And they, as we know, are in abundant supply in the entrepreneur community.
Eyal Rabinovich joined the Octopus team in 2016, with a focus on mobile, digital marketing, big data and AI. In the context of the UK Government’s latest Industrial Strategy White Paper, we asked him to discuss further the future of healthcare.
For reference: UK Government’s latest Industrial Strategy White Paper