Insights October 2016
Open Letters

Future of Healthcare 2036 – An Integration of Providers, Consumers and Technology

Kevin PD Smith

This letter is part of series of Open Letters from Canadian Leaders in Healthcare. To see the complete series please click here.

“The only thing that we can be sure of the future is that it will be absolutely fantastic.”
             Sir Arthur C. Clarke (1964)

Most of us are thankful for our modern health services and our health research, surely two of the greatest creations of the 2Oth Century.  However in these first decades of the 21st Century we also know that our funders are deeply concerned about the cost of sustaining healthcare, the lack of consistent outcomes and integration of services.   We see seismic shifts in other industries such as taxi services and desktop computing, with phones, tablets and apps creating new expectations and opportunities for consumers.  What will all this mean for healthcare in the next 20 years?   Is healthcare truly “different” as some suggest?  Well it is a dangerous thing to make predictions, as Arthur C. Clarke commented in 1964:

 “If by some miracle a prophet could describe the future exactly as it was going to take place, his predictions would sound so absurd and so farfetched that everybody would laugh…”

With that caution in mind, I will suggest that some remarkable changes have already begun in healthcare and our work over the next 20 years is to open up our system of care so that we can take full advantage of them. 

First, we as patients and families are redefining our relationship with the healthcare system by beginning to use health apps on our smartphones and demanding a more user friendly health system. We are challenging the fragmented system of today by asking for more personalized care.  Why not allow us to book appointments and see our results online?  And let’s be clear about something here, this is not a one way street of ‘I want’ - this is a good news story about our willingness to engage.  If the healthcare system works with us, we are offering our homes as a place for clinical care and our resources to take on more of the work of caring for ourselves and our family members.  However - be warned that all the talk of patient-centredness and integration mean nothing to us if patients can’t see and feel the difference. 

Second, the very fabric of the healthcare system is on the cusp of being changed by technology in remarkable ways.   Robots are now performing routine tasks in some hospitals.  Artificial Intelligence (AI) is beginning to outperform human beings in trials.  As the work of early adopter clinicians becomes augmented by these new machines they will become the instant rock stars of the medical world, able to swiftly analyze vast amounts of information from a population to make very specific and highly informed clinical decisions for an individual patient.    Perhaps this seems a little fanciful today but the process of change is already well underway.  Tech giants, such as Google and Apple, have entered the healthcare arena.  Earlier this year New Scientist Magazine reported that Google’s DeepMind AI system has been given access to data on 1.6 million patients in the UK.   The Japanese government has challenged technology companies to develop $1000 robots to assist healthcare workers in basic tasks such as lifting patients.  The future has arrived.  Combined with the power of consumers it is having an impact.

We must open up our healthcare system so that we can adapt to these changes and others.   To do this we need a third remarkable change, the willingness to let go of historic structures and practices so that we can embrace fundamentally new models of care fuelled by those we serve and the newest technologies.  A new kind of adaptability is needed and I will highlight three important goals:

  1. We need to allow front-line workers to design their own work in concert with those they serve.  It is front-line staff who touch the patient and they are typically less encumbered by organizational self-interest.  In our experience in the St. Joseph’s Health System (SJHS) front-line staff can solve service design issues that no amount of leadership team meetings can resolve.  So if in doubt give them some clear parameters and support, and then step back and let them innovate. It is very important to stay out of the “how”!
  2. We need funders to give healthcare provider organizations the latitude to adapt and reinvent care, and for providers to step up and do so.  Today funders typically tell healthcare providers what to deliver and how to deliver it.  Consequently innovation is almost impossible.  If funders step back and focus solely on results and outcomes, then providers have the opportunity to gain an advantage by finding better, faster and cheaper ways to deliver care, as well as the alliances to support this.  Some would say this is a radical direction.  I would suggest it is a timid first step.
  3. We need to rethink our approach to incentives.  Today we largely pay for tasks performed and so we incent the performance of those tasks.  We get mixed results.  Instead we need to embrace the learnings of social psychology on how to engage populations to produce population outcomes - and reward the same.  In short, we need the collective will to incent the system we truly dream of.

In many respects our concept of integration today needs to be replaced by the understanding that the relationships between consumers and healthcare providers are being “democratized” by technology.  This is a good thing.  It offers new solutions to old frustrations.   How successful will we be over the next 20 years?  Well, as with taxi services and desktop computing, much depends on our willingness to work with the consumers and technology that are changing our world. 

About the Author(s)

Kevin Smith is the President & CEO, St Joseph's Health System, the CEO, Niagara Health System, and an Associate Professor, Dept of Medicine, McMaster University


Duncan Sinclair wrote:

Posted 2016/04/10 at 12:20 PM EDT

Right on, Kevin! The goals are clear but what's missing are the ingredients to make change happen, incentives now missing in our top-down "system". We could do worse than look to the fast developing Accountable Care Organizations south of the border. Give my organization (a LHIN, hospital, primary care team, whatever), the responsibility and funding to optimize the health of the population I serve, scrutinize the results for sure, but otherwise get out of the way.


Ted Ball wrote:

Posted 2016/04/10 at 06:31 PM EDT

The unintended consequence of top-down, command-and-control, one-size-fits-all solutions is the dysfunctional dynamics that consume the attention and talent of our healthcare leaders for several years after each MOHLTC imposed structural alteration. We need high-level strategic outcomes from Queens Park and then enable our HSPs at the Sub-LHIN Level to self-organize.


Robert Pental wrote:

Posted 2016/07/10 at 06:21 PM EDT

As suggested by the author, the future of healthcare and how we presently distribute and implement healthcare, and what it will resemble in the future, is anyone's guess.

However, if there's one certainty we do know from our practice it is this, change is inevitable and necessary.
Accordingly, whether those changes result in a platform base approach or a continued pipeline system, or the more likely combination of both, our approach to the unknown will determine its characteristics.
In other words, the Zen we carry up the mountain will be the Zen we find.
To seed that climb and learn as we go three awareness points stand out to light our way.

One, healthcare as it is provided is not what it once was. We have made enormous strides in our ability to dispatch care and foster healing. Healthcare is no longer a reactive process but a proactive force. To put it simply, healthcare is now part of how we proceed not a response to what happens as we go. Moreover, this is why funders must not second guess or be hesitant in their support least they undermine a pillar to our future selves. I mean, it may be costly to support but it will be catastrophic if we don't.

Two, we have reached a period of life experience design in healthcare. In keeping, as we move forward it isn't about an interface we are making but a system to carry us forward. We need, at a minimum, to make flexibility, balance, value, collaboration, behavior, the process, and our survival the priority, not institutions.

Three, health care can no longer afford to be just about the little things. Not that they aren't still important. Rather, we must acknowledge in present day to day actions are the influences of a complex system. We must remind ourselves there is still a forest of ills before us though we go tree by tree. Funders, in turn, would do well to remember it may not be costs they are cutting funding service to service but an ability to be flexible on a larger scale.

In the end, what lays at the top of the mountain as was said before is anyone's guess. Nonetheless, there is no guessing that the best and surest way to discover it is in on our approach.


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