It’s a well-used line we are used to seeing on TV and hearing in life. “We will just keep you in for another night to keep an eye on you”. This gives us a sense of comfort that we are being cared for and are safe.  There are, however, plenty of ways today for clinicians to perform observations without you needing to stay in hospital. Staying in hospital can be lonely, create additional worry for family and friends and sometimes create risk of becoming less well. It’s been such a long-held practise that these things are hard to shift even when the technology and infrastructure exist to enable a different way.

Think about banking, it wasn’t that long ago the thought of transacting all of your financial affairs online without seeing or talking with anyone would have seemed absurd. Yet this shift is now almost universal. Why has healthcare been so much slower to progress digitally? Is it because the stakes are higher? The system too fragmented? Incentives too perverse? or could it also be the way in which innovation has been driven?

The digital health ecosystem has many players attempting to create the golden ticket (how many wellness apps can a market truly bare?). Low adoption, little funding, questionable evidence base, participation falling away after a certain amount of time, all lead to many of these attempts ending in a graveyard of broken dreams – often by some very passionate yet perhaps misguided entrepreneurs.

The health system is complicated (says everyone about their own industry), however in health this is especially true with many powerful motives that can paralyse true reform, create barriers at the frontline and high information asymmetry leaves consumers with little control.

Those within the system are often the best placed to drive innovation, yet many of the ideas emanate from the periphery (and end up in said graveyard). Why isn’t there more innovation in healthcare from within? Is it related (as some sceptics would assert) that there is too much to lose from change? I personally don’t buy this. Having worked in health a long time, my experience is that all of those working in health want to achieve the quadruple aim of healthcare (enhancing patient experience, improving outcomes, reducing costs and improving work life of healthcare providers)

I do wonder if it’s about ‘how’ innovation has been approached. Often clinicians are brought in late – not really sure of the problem that is seeking to be solved. Sometimes they are only engaged in order to achieve some level of ‘clinical sign-off’ but the horse has already bolted on the design. In some instances, the consultants, facilitators or other strategy folk are using very abstract terms (jargon) and continually wanting more ‘outside the square’ thinking. This can often lose the audience who are then wondering if their time wouldn’t just be better spent with patients rather than on these nebulous sessions where they do not connect – other than to play a naysayer when the ridiculous arises.

Having innovation developed and adopted by those in health – requires those in health. Rather than the abstract brainstorming sessions, consider different methodologies such as that of Systematic Inventive Thinking (SIT)* which challenges the concept of outside the square and suggests that it is Inside the Box thinking* which will produce the most creative innovations. These techniques seek to break fixedness (cognitive bias that limits how you think about things). SIT creates closed world conditions to force you to find a creative solution by heavily limiting the space of possibilities. Think MacGyver (for those of us old enough to remember) – what couldn’t be solved by what he could put his hands on? This is the premise of SIT. Clinicians are masters of MacGyver work – when a person goes into distress, no matter where they are – a clinician will respond with what they have around them to help.

One of the thinking tools in SIT is subtraction, for example in a global pandemic people can’t get to a clinic or hospital for general health issues – subtracting this infrastructure creates the opportunity for replacement such as greater telehealth consults and more remote monitoring. This subtraction has created the change in funding and adoption that the system had been resisting for some time. Has this subtraction compromised or enhanced the quadruple aim of health? – this will take some time to determine (and influenced by other COVID associated factors), however are there other innovations in a similar vein which may result?

Greater clinician involvement in healthcare is being championed by the American Medical Association through their Physician Innovation Networks (PIN) where they match doctors and medical students to health technology companies and entrepreneurs and captures some best practices in engaging physicians **

This matching makes me think about the value in reverse mentoring concepts. The impact of the culture and nuances of healthcare needs to be well understood. It is often what is below the water line which needs to be considered, after all we are talking about people as our end product and not just transactions. Reverse mentoring could help designers and CX better understand the culture in health and equally help clinicians better understand innovation and new techniques for advancement.

There is no silver bullet for progress in healthcare – it certainly won’t be found in an app alone. There is a lot of opportunity and it will be interesting to see how many patients will be asked to stay longer for observation given the backlog of elective surgery to get through – perhaps instead offered homecare driven by telehealth and remote monitoring. What will this mean for further extensions of telehealth funding is anyone’s guess. Healthcare reform to support the right care in the right setting at the right time is the right future and how we get there requires the ecosystem to stay connected and consider different techniques for innovation and engagement.

 

*Jacob Goldenberg and Drew Boyd ‘Inside the Box’** https://hbr.org/2019/11/how-to-engage-physicians-in-innovative-health-care-efforts