Addressign the Need for a Paradigm Shift in Healthcare

European Health Futures Forum

57th EOQ Congress, Estonia 18/19 June 2013

David Somekh, Network Director, EHFF

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What  will  her  healthcare  future  be?  

Health systems represent complex organisations that have more or less the same characteristics as business organisations, although they are unusual in being usually very manpower intensive and quite complicated. Some of them are extremely, if not unmanageably, large e.g. the NHS in the UK. Given the modern day application of complexity ideas in the turbulent modern social and business environment, how is current strategic thinking about European health configured?

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Adapted  from  Kees  van  der  Heijden  Scenarios:  the  art  of  strategic  conversaBon:  2004  

Source: Hans Kluge. Director Division of Health Systems and PH, WHO Europe 5  

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Comment: note the ‘solutions’ in the previous two slides. The whole presentation is a convincing over view of current threats to EU health systems. What is not convincing however is the proposal to do what EU health systems have signally failed to over the last 20 years (make significant inroads into the estimated annual 25% wastage of resources across the board). Systems are to be ‘strengthened’, not changed. The proposal is simply not credible, particularly in the context of a hyper-connected rapidly changing external environment.

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‘The Singularity is Near: When Humans Transcend Biology’ Raymond Kurzweil (2005)* On the one hand we have the public health data and predictions from WHO-Europe, on the other hand we have the largely US-based predictions of rapid technological growth and its impact on health systems *Kurzweil argues that the inevitability of a technological singularity is implied by a long-term pattern of accelerating change that generalises Moore’s Law to technologies predating the integrated circuit, and which, he argues, will continue to other technologies not yet invented. According to him, artificial intelligence should be able to pass the Turing Test (a test for the presence of intelligence in putatively-minded entities) by 2029, and the technological singularity should occur by 2045.

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Smart  Living  

•  Smart  clothes  –  Sense  body  funcBons  

•  Smart  bathroom  –  Evaluate  body  fluids  

•  Smart  kitchen  –  Prepare  body  nutrients  

•  Smart  house  –  Elderly  can  live  at  home  

GeneBcs  

•  HapMap  ê  £/€/$  of  human  geneBc  variaBon  (disease  diagnosis)  

•  “Gene  Chip”–  mul$ple  gene  examinaBon  

•  Personal  genome  sequencing                  direct-­‐to-­‐consumer  (DTC)  

•  IdenBfied  origins  and  causal  rela$onships  of  complex  diseases  

•  “Epigene$c"  factors  linked  to  diseases,  heritability  across  generaBons    

•  Stem  cell  transplants  

•  Human  reproducBve  cloning    

The  Nanomedical  Universe  

•  Nanomedicine  

•  Nanobots  

•  NanoroboBc  therapy  

•  Nubots  

•  Nanosensors  

•  Bionanobots  

•  Nanotechnology  

The problem with the ‘future is techno.’ approach such as Mike Jackson’s presentation on his site Shapingtomorrow, which skillfully scans potential technological advances and their impact, because of the audience it was aimed at it doesn’t tackle the ‘elephant in the room’ issue that unlike airlines or production lines, present day health is manpower intensive and complex and especially vulnerable to the vagaries of the human psyche. The same argument applies to Luis Cordeiro’s presentation of a future world of enhanced human/human-robot synthesis, in his role as futurist and ambassador of the Singularity University, CA

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There are two elephants in fact crowding the room: human nature (a real problem when we come to the value systems employed by the techno-enthusiasts who promote the advent of AI as the solution to our problems) and the sheer size and complexity of current health systems. Their abiding characteristic is the second elephant: that if you concentrate your resources on improving one element in the system, the effects are almost always neutralised by compensating movements elsewhere in the system.  

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The future of European healthcare – a possible scenario

To summarise: ‘Sickness care’ in its present form is notoriously wasteful and significant savings are likely to be achieved only by substantial change in the form of care delivery. There are many barriers, both institutional and political which hamper this transformation Increasing life expectancy results in an increased burden of potential healthcare costs which ironically may be exacerbated by increasing expectations from the public for care, potential costs of new technology (it could go either way), the effects of greater health inequalities and of other factors such as migration, climate change etc. In the present setting, financial forecasts suggest that the envelope for healthcare spending has limited capacity for expansion. Equally there is gross underinvestment in prevention and health education. Chronic mismanagement of workforce planning makes it likely that serious shortfalls will impact on quality of care

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Health effects of the financial crisis: omens of a Greek tragedy

In a review of public health capacity in the EU, Prof Brand from Maastricht recently gave the example of the impact of the demands of the Troika on the health of the Greek population, as will be seen in the next slide. However, he was also making a crucial point about the availability of what is called ‘cockpit data’. The effects during 2007-9 were only available in 2011. I have my own example of the same phenomenon based on the local effects of the Spanish crisis….

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There  is  indisputable  evidence  that  European  healthcare  systems    are  simply  not  sustainable  –  even  in  the  medium  term  future,    but    percep$on  of  threat  cannot  in  itself  bring  about  societal  

change.      If  the  possibility  of  a  potenBal  collapse  of  the  system  can’t  be  contemplated,  people  will  behave  as  if  it  isn’t  there.  Just  like    they  did  in  the  banking  crisis.    Analysis  over  a  number  of  years  of  the  barriers  to  fundamental    change  in  health  delivery  systems  leads  to  the  inevitable    conclusion    that  there  is,  on  the  part  of  most  stakeholders    huge  vested  interest  in  maintaining  the  status  quo    

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 Even  though  the  model  of  healthcare  delivery  we  are  using  is    currently  by  and  large  a  nineteenth  century  one,  bringing  about    radical  change  is  seen  as  far  too  difficult  and  threatening  

Its  like  a  raBonal,  progressive,  energy  policy:  the  means  are  there,  but  the  resistance  to  change,  from  so  many  sources,    is  just  too  great.  

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Complexity  science  teaches  us  that  condiBons  of  turbulence,  of  high  levels  of  interacBon  between  diverse  actors  fosters  the  emergence  of  new  configuraBons.  Conversely,  excessively  rigid  and  unchanging  systems  are  unlikely  to  generate  sustainable  new  forms.  StarBng  from  the  applicaBon  of  the  principle  to  financial  systems,  this  Harvard  Business  School  team  argue  that  the  only  way  to  generate  real  change  in  such  circumstances  for  healthcare  is  from  the  outside.  

DisrupBve  innovaBon  implies  demonstraBng  the  effecBveness  of  innovaBve    transformaBonal  change  by  implemenBng  it  outside  the  city  walls,  and  creaBng  a  criBcal  mass  for  the  alternaBve  paradigm  which  will  gradually  erode  the  status  quo.  

An  interes$ng  idea  

Several  years  ago    (at  the  end  of  2006  to  be  precise)  a  group  of  us  found  ourselves  in  a  very  unusual  situaBon  .....we  were  drinking  in  the  bar  of  a  hotel  in  a  European  capital  city,  late  at  night.    We  had  by  then  spent  many  years  working  on  improving  healthcare  quality,    but  recognised  that  the  results  of  the  labours,  not  just  our  own,  but  those  of  other  prac$$oners  in  the  field,  represented  a  very  poor  return  on  investment.    We  concluded  that  what  was  required  was  a  radical  transformaBon  in  the  way  that  healthcare  was  delivered;  an  ac$ve  collabora$on  between  representa$ves  from  Industry,  Educa$on  and  Healthcare,  crossing  tradi$onal  boundaries.    

This  we  called  our      BIG  IDEA.  However,  it  took  several  years  to  find  a  means  to  put  the  idea  into  pracBce…  

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In addition to our existing expert knowledge, we started to look at futures methods, such as scenario planning, horizon scanning and wild cards and weak signals methodology, to see to what extent these techniques had successfully been applied in the health field. We discovered William Gibson (author of ‘Neuromancer’)… “The  Future  is  already  here  –  it  is  just  not  evenly  distributed”   We decided to use what small inroads we had achieved thus far within the health policy field in Europe to establish quite a different enterprise…

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ESQH was set up as a European NGO in 1998. It is registered as a charity in Ireland and the idea was to create a society of national healthcare quality societies, to represent the grass-roots staff across Europe and whose mission statement was:

•  to  promote  communicaBon  between  the  stakeholders  in  European  health  quality  

•  to  champion  quality  in  healthcare  in  Europe  •  to  sBmulate  innovaBon  in  healthcare  quality  in  Europe  

Both  the  founders  of  EHFF  have  formerly  served  as  Presidents  of  ESQH  (and  collaborated  with  EOQ!)  

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Networks  of  networks  

SocieBes  

Offices  

EU  agencies  and  Associates  

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In summary, there are several reasons that ESQH is well placed to provide a springboard for a new European NGO which concentrates on health futures. Among these are: It has a well established network involving 20 countries and contacts within several stakeholder groups in each Experienced at becoming involved with policy issues at a significant level, starting from scratch and building a brand Run as a lightweight, flexible but effective organisation that is more or less virtual but has appropriate governance Will build on ESQH’s work but will create its own brand and intends to operate faster, smarter and more effectively

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What are the USPs that EHFF offers, that merit participating in its development?

•  Supporting disruptive innovation with a cross-sectoral focus using a network structure •  Offering an approach to health scenarios which fosters

on-going multi-stakeholder dialogue •  Aiming to collect data that identifies potential threats to

health systems in a more realistic timescale •  Operating in a 21st century organisational mode, with an

effective but fluid, inclusive and open-source orientation •  Cognisant of current policy but side-stepping political

pressures and the constraints of traditional institutions

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Consistency of EHFF principles with Foresight concept

Brief  summary  of  what  EHFF  will  aIempt  to  do  

 Create  an  open  interac$ve  forum,  whose  members  will  seek  out,    process  and  exchange  knowledge  and  informa$on  in  real  $me  that      may  either  influence  the  future  of  health  and  healthcare  in  Europe    and/or  provide  a  beIer  understanding  of  future  possibili$es  and  risks    in  this  area.  We  aim  to  facilitate  beIer  ques$ons,  not  offer  solu$ons.      The  business  model  involves  establishing  a  diversely  populated  not  for    profit  legal  enBty  and  incrementally  building  web  presence,  funding    streams,  eclecBc  network  of  expert  associates  linked  to  current    network,  involvement  in  relevant  European  acBviBes,  iniBaBng  own  projects,  on-­‐going    horizon  scanning  and  promoBon  of  values.      

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Global  to  local.  Lessons  from  global  ac$on  networks  (GANs)  

Steve Waddell* is fascinated with networks. He says GANs tend to have most of 7 characteristics: they are multi-level, ‘diversity- embracing boundary spanners’, inter-organisational networks, systemic change agents, entrepreneurial action learners, voluntary leaders and global public good producers. EHFF could aspire to most of these, eventually, on a smaller scale than global, but notice how much growth of networks figures in the three work streams discussed below. Steve also stresses that GANs cannot simply float in the clouds as it were; their interest needs to be in ‘where the rubber hits the road’ and on the ground action, because that’s one important area where their influence can be assessed.

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A  new  context  –  the  new  paradigm  for  how  the  world  works  

•  from addressing issues in parts to whole systems thinking •  from inter-national structures to multi-stakeholder ones in order

to address the issues •  from assuming the environment to nurturing it •  from linear approaches to change to complex systems

strategies •  from negotiating our way to solutions to envisioning futures •  from a conformance focus to a collective values focus

Considering that we developed our concept piecemeal over time and intuitively, not having read Waddell’s work, the closeness of fit is pretty spooky!

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The  three  ini$al  work  streams  (project  categories)  •  A  Europe-­‐wide  innovaBon  laboratory  for  improving  health:  its  

first  projects  would  be            a)  involvement  in  EC  projects  on  paBent  self-­‐management              b)  the  young  health  innovators  project:  EVY  (a  network  project)            c)  a  community  of  pracBce  for  those  at  the  leading  edge  of                      health  professional  educaBon              d)  seeking  partnerships  with  business  and  educaBon  to  create  Health                        based  Knowledge  and  InnovaBon  Centres  (KICs)  as  promoted  by  EITT    •  The  first  ever  Europe  wide  scenarios  exercise  for  health  that  

includes  all  the  stakeholders  •  Linked  to  web-­‐portal,  begin  a  scanning  exercise  on  emerging  

health  trends  using  sophisBcated  techniques  imported  from  other  fields  

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MagriIe:  the  schoolmaster  (1954)    In  a  leser  to  a  friend  Magrise  says:  “  I  had  a  magnificent  idea  without  realizing  this,  nor  did  you,  when  I  pointed  out  to  you  a  year  or  two  ago,  that  the  moon  in  certain  posiBons  was  exactly  above  a  chimney-­‐stack  or  a  tree.  At  the  Bme,  we  thought  this  'droll',  'amusing'  but  of  lisle  interest.  Thanks  to  the  new  pictures:  The  girls  of  the  sky,  The  evening  gown,  The  schoolmaster  and  The  masterpiece,  we  can  now  display  genius,  if  we  realize  that  the  'droll'  idea  is  in  fact  magnificent...  genius  is  not  about  having  magnificent  ideas,  but  about  recognizing  them.”        

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Thank  you  for  your  Bme.    Now,  how  might  we  work  together?          EHFF became a legal entity in March 2013, after two years of planning. The prototype portal address is www.ehff.eu

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