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Gordon Moore
Professor of Population Medicine
 Harvard University  Medical School

'We must tap into the largest unused source of manpower: the patients themselves.'


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Meeting the challenges of affordable quality healthcare

Health care systems throughout the world are about to be hit by a tsunami.  Dramatically escalating GP demand is driven by the growth of life-style-related chronic illness, the surge of baby-boomers, a primary-care doctor shortage in some countries, and, in America, the surge of unmet needs now paid for by Obamacare. Either the current system will seize up, or new ways of caring for patients must be found.

Traditional responses unsustainable
Typically, healthcare systems respond to increased demand by adding manpower: usually nurses and other health workers. Increasing manpower reduces the potential for economies of scale in which increased volume reduces costs. Even worse, with additional workers added to a healthcare practice, efficiency actually decreases as downtime, communication costs, turnover, coverage, duplication and re-work increases. 

Healthcare systems must find a way to reduce the costs as they struggle to meet this surge of demand.  The old manpower-based responses, which at first seem attractive solutions, are unsustainable in the long run.

4 musts
What are the answers? 
  • First, we must tap into the largest unused source of manpower: the patients themselves.  Anyone who cares for patients with diabetes, smoking, or high blood pressure knows that the best plans of GPs often are not carried out despite many repeated visits to the doctor or nurse. 
  • Second, to activate patients, care support for them must be truly patient-centred.  Patients need help to gain confidence necessary to take control of their own therapeutic pathways. Such a system of support requires “having your doctor in your pocket”, which should be entertaining, engaging, educational, available 24/7, continuously helpful, personalized, and safe.
  • Third,having your doctor in your pocket,” can only be achieved if IT is used in new and innovative ways.  The most cost-effective avenue by which we can move patients with chronic illnesses to become more actively involved in their own care is through the Internet, where dramatic shifts in user interfaces, devices, and process interactions are taking place almost daily. By transferring expert knowledge to patients and thereby creating a truly patient-centred system, caring for ones’ own illness will be no more difficult than using a cash machine or mastering a smart phone.  
  • Finally, if the Internet can facilitate the transfer of knowledge from the medical system to the patient, then also it can facilitate the transfer of expert health knowledge to lower the cost of all clinical personnel from doctors to nurses to health coaches.  If guidelines, such as those produced by NICE in the UK, are built into the process of care that health professionals use, we would have developed a system that significantly extends the capacity of health professionals while maintaining the safety and quality aspects of care that increasingly people expect and demand.  An apt analogy is the way that today’s cockpit technology enables all pilots to be as good as the best.  Through the use of technology, we can do the same in medical care.
The past is no indication of the future
Today, healthcare is largely using IT to reproduce what doctors have done in the past. The electronic record is little different to paper records.  In the evolution of any new technology, its application development goes through this stage. However, we must put IT to use in doing new things, in innovation that reduces our dependence on expensive manpower and in producing more value for less money.

Making such a transition will not be easy or inexpensive.  But the costs of remaining the same and trying to meet escalating healthcare demands by adding more costly inputs are higher and more threatening in the long run.  We should be investing in the future, not tinkering with the present.  
 
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