Health and well-being of people are determined by many factors – genes, culture, living conditions and social determinants. Social determinants influence and are influenced by economic, environmental and political determinants. Health professionals and academics have known this for a long time. There has always been call for politicians, policy makers, funders, providers and health professionals to look at the broader determinants of well-being. After some initial progress especially in public health recent progress however has been ad hoc and slow.
Most First world countries health system now faces unprecedented pressure. In the last few years there is growing concern that this pressure is reaching a tipping point. The convergence of these five main factors could tip these health systems over the edge:
The impact of the above five factors is fuelling current level of frustration and dissatisfaction of users, carers and providers of current health services as they watch the growing chasm in access, affordability and comprehensiveness of health services.
Reforms and improvements to-date have focus mainly on the “supply” side of the equation such as better horizontal and vertical integration of services, reducing harm and improving quality of services, better and more workforce, facilities and information, structural and organisation changes, more and different ways of funding, incentives, performance measures and accountability.
While some initiatives have focus on appropriate changes in demand, these have tended to initiated from the lens of professionals and providers rather than from the users. The asymmetry of information in favour of the professionals and providers coupled with a more compliant behaviour of the older generation has made some progress in influencing demand behaviours such as smoking cessation. However, there is increasing signs that the impact of the current approach to change demand behaviours is waning. Lessons need to be learnt from non health industries that are more up to-date with influencing consumer behaviours.
Future healthcare in a 10 to 20 years horizon will have these themes:
In the last 12 months more data points are emerging that is signalling the momentum for change is reaching the hockey stick point of the exponential curve. This includes:
Creating a future healthcare system requires an approach that starts by imaging the future and work backwards in terms of what needs to be done. Imagine what future health care will be like in 2030 (12 years away) work backwards and imagine what it will look like in 2025 and 2020. Come up with an agile plan of what needs to be done in 5 years, 1 year, 1 month and 1 week. Mistakes, pauses, u-turns and de-tours are to be expected but each of these provides insights towards progress. A link on an example of a future back approach can be seen on this link – https://www.thegeniusworks.com/2018/06/journey-from-the-future-back-jump-to-the-future- then-work-backwards-to-today-to-shape-it-to-your-advantage/
Current health organisations that will emerge in this future health system would have adopted an implementation that retain and strengthen the relevant core services AND create new services and products. Different thought leaders have written on this theme for example ADAPTIVE SPACE by Michael J. Arena and DUAL TRANSFORM ATION by Scott D. Anthony, Clark G. Gilbert and Mark W. Johnson. Successful implementation of such approach will require different mind-set and capabilities.
The transition from where most current health systems are today to where they will be in the future will be difficult, challenging and disruptive. The inevitable collision between the slow decision–making process and reluctance to embrace change by some incumbents on the one hand and the arrivals of new entrants partnering with reformist health partners is underway.
There are two broad scenarios of what is going to happen with First world health systems:
The door to be part of the second scenario is open. Accepting this invitation will require an open mind-set, willingness to be part of a team and partnering with new and different type of partners.
This journey starts with accepting that what has been done and most of what currently is being plan (more and different ways of funding, more staff, more facilities, organisation & structural changes, better integration, better quality and safety) is NOT going to be enough!
There are enough recent literature and publications on how and what needs to be done to transition. These are just tools that need courageous professionals with new mind-sets, talents, capabilities to implement change and a culture of taking responsibility rather than blaming others for these challenges.
Imagine in 10 to 20–year time what will the population look like, how will people live their lives and when they encounter well-being and health services how will they experience it? Imagine what is possible at home, in the community, in primary care and hospitals? One thing is certain it will not look like today! So those making decisions today for significant capital investments in fixed physical facilities like rest homes, high street primary care facilities and large hospitals facilities – hope your design are not hard wired and can be easily be re-configured for different uses.
Future healthcare system must address the issues of access, affordability, comprehensiveness and relevance for the users. It must start by imaging what that future looks like and make decision today for a dual transformation to move to that future.
The final word goes to Jeff Bezos, CEO of Amazon reported comments on the Amazon Berkshire JP Morgan Chase ventured headed up by Atul Gawande – “we said at the outset that the degree of difficulty is high and success is going to require an expert’s knowledge, a beginner’s mind and a long term orientation”.
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