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Getting serious about making changes in health care?


Pressures in First World countries health care system are relentless and increasingly feel insurmountable. Layers of initiatives and services crisscross each other like the picture above. It kind of works but difficult to make change and God bid that it should all collapse one day. 

Solutions to-date at best provides temporary relief and at worst actually makes it worst. The mind-set of mainstream decision makers in health care to these intractable challenges is fundamentally to call for more resources (funding, staff, facilities and information), improves the effective and efficient of current services and when it does not work blames someone else. 

There are those who realise this hiatus cannot continue and are starting to do something different about this. Some are from the health care sector, but it is the nonhealth actors that are taking most of the lead supported by likeminded health leaders. While mainstream decision makers in health care continue to discount and put up barriers to these new entrants, it has not slowed down the exponential growth of these new entrants. This week’s announcement of the partnership of the UK based Babylon with the China based Tencent together with the current discussion between Wal-Mart and Humana in the USA are the latest data points providing a clear signal of the trajectory of change in health care. 

Why Most Proposals Won’t Work

These new entrants will not always get everything right and are likely to make some mistakes along the way. But they are more agile, open minded, understand the power of exponential technology, faster to give up what does not work, figure out and try what might work. 

Attempts by mainstream decision makers in the health care to-date have not provided durable answers yet more of same is still being proposed in most First World countries. They have not and will not work because: 

  • Linear and complicated solutions are proposed to solve complex problems. 
  • Solutions are often design to improve each of the fundamentals e.g. workforce, funding, facilities but not the relationship between them. Such silo approach is actually making the situation worst not better by reinforcing the importance of each fundamental but not the whole system. 
  • Solutions offered to date on improvements are design to make the current system more effective, efficient and productive when changes in context and environment requires disruptive not sustaining innovations. 
  • Talents, capabilities and structures needed for disruptive change is fundamentally different from those that are managing the existing system. 

Complex rather than complicated or linear

Linear and complicated solutions do not and will not work because complex challenges and problems have these characteristics: 

  1. there are many and increasing number of causes 
  2. the relationship between these causes and their effects are not well understood, difficult to explain and constantly changing the cause-
  3. effect relationship can only be seen after they have occurred and are difficult to predict 
  4. even when the cause-effect relationship becomes apparent after it happens, they do not necessarily repeat themselves 
  5. data at best provides insights into correlation but does not explain causal relationship (why it occurs) 

discovery approach with a portfolio of safe to fail initiatives is the right response to find solutions for complex challenges. Some of these initiatives will not work but learnings from it provide insights for initiatives that follow. If there are no failures then these portfolio of initiatives will not contribute to discover the way forward. There are no best or good practices to solve complex challenges. Yet how many times have we heard comments like “let’s not reinvent the wheel and adopt these best or good practices”. The value of the discovery approach is more in the learning and process rather than the milestone or results. 

Optimising relationships between fundamentals

How many “advisory groups” for workforce, eHealth, capital planning, funding have come and gone and the challenges not just remain but gets more pressing. That is because each of these is design to make recommendations to optimise each of these respective areas. Even when a whole system advisory group is set up, recommendations on these fundamentals are almost always cherry pick by decision makers when it comes to implementation. 

Current interventions are design to respond to “events” or “trends that emerge from a series of these events” but not the underlying weakness of the relationship between the fundamentals of the whole system. 

Complex social challenges need a system approach that optimises the relationships between all the fundamental parts rather than optimise each fundamental part. 

Disruptive not sustaining innovations needed 

Making improvements (effectiveness, efficiency and productivity) on somethings that works but was design for a different time, context and environment is flawed. These sustaining innovation improvements still must be pursued. But on its own it is not nearly enough and does not and will not improve access, affordability and equity of health outcomes that has emerged as a result changes in context and environment. 

The theory of disruptive innovation introduces new partners, new technologies, new networks, new operating and business models that is more relevant for today’s context and environment. These disruptive innovations properly executed will improve access, lower cost that can contribute to improving equity of health outcomes for those who currently are missing out. 

Different talents, capabilities and operating models 

Asking current leaders whose talents and capabilities are design to manage current system to disrupt themselves is like asking the turkey to vote for Christmas. Incumbent leaders need to keep doing sustaining innovations to create the head room for disruptive innovations. But they are not the ones (no fault of their own) that can deliver on the disruptive innovation agendas. 

Likewise, current organisation structure, incentives, rules and criteria of success, capabilities, skills and knowledge are all orientated towards managing status quo. 

Disruptive innovations require different talent, capabilities and operating models to execute a discovery approach on a portfolio of safe to fail initiatives that strengthens the relationships between all the fundamentals of the whole system. Therefore, a dual transformation approach that clearly separates the talents, capabilities and processes of sustaining from disruptive is needed. Can this be done within a single organisation? There is some emerging literature that suggests it is possible but current exemplars from what works in other sectors points to a need to be set up separate organisation lead by leaders with different set of talent and capabilities. 


Linking the four concepts 

These four concepts are interconnected. Complexity framework recognises that a discovery approach is the right response. The discovery approach is disruptive and requires a portfolio of safe to fail initiatives that strengthen the relationships between the multiple and varied fundamentals that make up the health eco-system. Different talent, capabilities and structures are needed to take a discovery approach to execute disruptive innovations.


Concluding remarks

As someone who could be serious about making changes to health care take some time to mull over this article and begin the journey to find out whether you are a sustaining or disruptive leader because you cannot be both. 

To help you with your discovery journey listen to these talks that explains the above concepts and more (like big data, etc) in greater details. 

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Chai 。仁材 Chuah 蔡
is the founder of Health System Transformation Limited. A New Zealand Company, he started after he finished up as the Director-General of Health
and Chief Executive of the New Zealand Ministry of Health on February 2018.

He is the first Asian to be appointed as Chief Executive in the New Zealand public service. His previous roles included the National Director
of the National Health Board, Chief Executive of a District Health Board, Chief Financial Officer, and Chief Operating Manager in public health institutions in New Zealand

His focus is currently writing, speaking, sharing, and advising on:
1. future of healthcare
2. leaders we need
3. better care for our seniors (elderly)

He currently also provides mentoring and coaching for up and coming leaders, especially in healthcare.

In his free time, he enjoys travelling with his wife, spending time with his adult children, and a brand new granddaughter. He also enjoys pottering around his garden and developing hs newfound hobby of drawing


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