Doctor innovation: Shaking up the health system is an Economist Intelligence Unit report, commissioned by Philips, the second in a series of four to be published in 2009. The Economist Intelligence Unit bears sole responsibility for the content of this report. The findings and views expressed within do not necessarily reflect the views of Philips.
Asked to picture healthcare in the twenty-first century, readers might imagine scientists applying the latest breakthrough in biotechnology as a radical cure for disease. But equally, they might also think of lengthy waiting lists, shabby wards and lumberingly bureaucratic administrative systems.
This dichotomy is one of the biggest problems confronting policymakers and managers when they look at today's health sector. Advances in medical science and technology have not been matched by innovation in healthcare management and processes. It is a failure that costs taxpayers and patients dearly. "Twenty-first century medical technology is delivered with 19th century organidational structures," notes Professor Elizabeth Teisberg of the University of Virginia's Darden School of Business. "The most powerful innovation in the coming decade will be structural and organisational—new ways of working, new team approaches to delivering the full cycle of care."
The problem is not a lack of ideas, as cutting-edge medical research continues apace. Nor is it unwillingness to put money into healthcare, which consumes vast budgets. Rather, the difficulties lie in the diverse blockages to new ideas finding their way into widespread and transformative change. But new approaches exist which demonstrate how healthcare systems could be improved.
The Economist Intelligence Unit conducted interviews with a range of healthcare professionals and leading experts, along with extensive desk research, to uncover several examples (profiled here as in-depth case studies) which illustrate how organisational and structural changes can deliver clear benefits. The research suggests that policymakers and healthcare professionals should focus on five main areas of system innovation:
Share information, especially on the outcome of treatments, to improve quality. Modern healthcare systems are typically characterised by a lack of transparent, comparative data about the costs and effectiveness of medical interventions. At a very basic level, knowing what actually works best in given situations is central to outcomes-based medicine. But only recently, driven by cost at least as much as by purely clinical considerations, has such data begun to be collected. In places where this has been carried out, the results are often striking. One such example can be found in Minnesota, where a non-profit organisation has been gathering and sharing data from participating local healthcare providers, leading to striking improvements. For example, since 2006 the rate of childhood immunisation has leapt from 52% to 78%. Still, although numerous similar initiatives are under way around the world, the healthcare sector is only beginning to scratch the surface of what is possible.
Bring outside entrepreneurship to healthcare. The inherent conservatism of health managers—understandable, when mistakes pose such a risk to human safety—too often allows incumbents to resist innovation that might leave them at a competitive disadvantage. This does not stop innovation, but makes it more likely to come from incremental change by existing bodies than through revolutionary change from outside. But it does not always have to be this way. When the UK's National Health Service (NHS) would not begin screening for abdominal aortic aneurysms, which kill one in 50 British men, a group of doctors formed New Medical Limited in 2002 to provide a private service. They have since examined 15,000 people, one in 20 of whom had the condition; one in 200 required, and received, urgent attention. Facilitating other, similar breakthroughs requires reforms that reduce the ability of incumbents to block or deter market entrants. Entrepreneurial ideas must be judged on their medical potential, not on the threat they pose to existing providers.
Deliver integrated care based on medical conditions rather than provider expertise. "Patient-centric" healthcare has been a buzzword in the industry for some time. However, it is impossible to be patient-centric when healthcare systems are so fragmented and incentive structures do not sufficiently reward innovation. In particular, the pay-for-service model puts too high a value on aspects of treatment at the expense of the overall care of a patient. But there are examples of genuine progress towards redesigning healthcare around the needs of the patient. The West German Headache Centre, for example, provides consultations with various types of specialists, all of whom work within the same facility and collaborate on diagnosis and treatment recommendations. Of those who have gone through its programme, the proportion missing more than six days of work in six months has fallen by around 80%, resulting in lower costs to the healthcare system.
Treat patients as a source of innovation. Large organisations find it inherently difficult to remain innovative. So it is in healthcare, where many countries operate monolithic systems. However, although many businesses have realised that their customers can be a powerful source of new ideas and innovations, healthcare providers seem almost instinctively to resist such an approach. Many initially saw the spread of medical information on the Internet as a nuisance or even a risk, although most have since come to see it as a way of enriching doctor-patient conversations. Data from the Pew Research Centre shows that of those Americans with Internet access, 83% use it to look for health information. These "e-patients" increasingly use social networking platforms to teach each other about conditions and treatments. In turn, this will again change the doctor-patient relationship, and could even create the basis for a more market-driven system where customers are able to make informed choices about varying providers.
Use these ideas together. The ideas and approaches reviewed in this study are not mutually exclusive. Together, they become even more powerful. India's Aravind Eye Care System provides a compelling story of innovation in medicine, employing all of the advice listed above. It is entrepreneurial in its outlook; it measures and reports outcomes data; and it is also highly integrated. Finally, it learns from its customers: certain innovations—such as the establishment of permanent village clinics—took place after market surveys of patient needs and service uptake.
These various examples point to innovations that get at the root of the obstacles to further improvement of healthcare. Such ideas are not simple market prescriptions for what ails healthcare, however much they may borrow from other sectors. They are about thinking differently in order to do things differently. Such ideas are worthwhile not because they may or may not be based on a market-led approach, but because they provide better healthcare.
