Designing the future of health
“If we are honest with ourselves and listen quietly we all harbor one fiercely held aspiration for our healthcare — that it keep us healthy.” Rebecca Onie
The time has come for radical change to take hold in health care. The next frontier for health innovation will be in focusing on the broader system, bringing disciplines together around the human side of health, and reconnecting with its bigger purpose — creating quality of life. Designing the future of health means shifting from “the age of the molecule to the age of the system.”
We all have a health story, or several stories, that have shaped our lives and the lives of our families. Like many others, my friends and family have faced cancer, chronic disease, depression and disability. When health effects those closest to you, the true story suddenly comes into sharp focus. Health is a deeply personal, social and human experience, more than it is a medical event. In the end it’s not about pills, hospitals or surgeries. Although those are often key parts of many health experiences, it’s often more about how we feel, think and behave, everyday. It’s those stories we don’t actually define as “health” that actually are, and those are the ones that dictate how we live with our health. Surrounded by expensive machines, pills and treatment protocols, the true purpose of what we’re all trying to do gets lost. In an effort to reduce health to simple, isolated physical problems that can be targeted and serviced we lose sight of the true causes, long term needs, and potential for wellbeing. Even in the most traumatic cases, the goal of the health system should always be to create the highest quality of life.
Reinventing health and shaping future outcomes in service of wellness means truly refocusing on the human experience, the attitudes and behaviors core to patients, families, communities and the medical professionals that serve them. We need to reorient the disparate parts of the system of health around it’s bigger purpose, enhancing quality of life, not just treating illness. The next frontier of health change is on connecting systems around this intent.
Having worked as an innovation consultant for many years, collaborating with stakeholders from across the health system, 5 principles continually re-emerge as essential to setting the groundwork for building a new integrated system for living well:
Embedding health into daily living
Shaping the care experience beyond the medical
Setting the context for wellbeing
Building a culture of collaboration, coaching and compassion
Turning data into personalized, proactive and precise action
These are in no ways exhaustive, but simply a starting point demonstrated by pioneers at the forefront of change.
Embedding “health” into daily living
“You matter because you are you, and you matter until the last moment of your life. We will do all we can to help you, not only to die peacefully, but to live until you die.” Cicely Saunders
Health is in the little moments and the big moments of life. It’s in the daily actions people take, and the decisions they make (or don’t). It’s part of the before, during or after of medical realities. Designing for how people eat, move, sleep and connect often becomes a critical aspect of managing a condition, recovering from treatment, or preventing disease in the first place. 60% of care happens outside of the clinical environment, and 90% of health is managed by the patient, on their own.
Effective therapy and treatment is much more than medicine, it needs to address daily living across wider factors. It needs to be integrated into daily actions, blending into and enabling behavior. Digital therapy is one approach to extending health beyond the clinical environment and supporting patients daily reality with a wider system of tools. It’s increasingly serving as a behavioral alternative and/or compliment to current treatment options. When Suzanne Clough saw that 2 yearly visits wasn’t enough to help patients shift daily habits, she created Welldoc. With Welldoc she found a way to support patients everyday, integrating clinical, behavioral and motivational interactions. Now when a patient is facing a diagnosis of Type 2 diabetes, their physician can write a prescription for Welldoc’s FDA approved Bluestar app. The app helps patients capture and share daily data about glucose, activity, nutrition, and get instant medical input. When they sit down with their doctor, they can then share health reports based on progress over time. Bringing together coaching, social support, medication, and lifestyle changes into a comprehensive, easy to use, seamless system is becoming an achievable near future. As these tools become more sophisticated, people will be better equipt to act as “CEO’s of their own health” making smarter investments in the future, tackling health across their lifestyle, not just by adhering to a generic protocol or medication regime.
Shifting from designing for health moments, to designing for life moments, is present in the big as well as the small, from the daily choices to the pivotal events. Nothing demonstrates the reality of these complex relationships better than when addressing issues related to aging and end of life. While both aging and end of life are often treated as medical events, they are life events, with changes that ripple across multiple aspects of living and are deeply personal and social in nature. Most medical cost is incurred at the end of life, when desperate attempts to cure, save and fix the unfixable accumulate. When Cicely Saunders invented Hospice, it was to combat a very narrow view of death, one that focused too myopically on battling medical issues. She designed an entirely new model that took into consideration all the aspects that influenced how people were living through dying, and how mental, physical and environmental needs were met to create the best possible experience in their last moments. Her concept of “total pain” acknowledged that suffering was more than physical, and often extended beyond just the patient. She changed the staffing, the environment, and the methods of care delivery. The model was calming, often delivered at home or in a home like environment, reducing stress and even addressing spiritual needs.
Supporting meaningful health impact needs to shape experiences around the complexity of people’s daily reality. It’s about seeing the person (not a condition), meeting them where they are, and making living well easy, accessible and achievable. Platforms and systems that are taking this holistic view of the person, understanding how multiple dimensions of health blend into daily life, are the precursors to designing comprehensive health solutions that will drive true health outcomes in the future.
Shaping the experience beyond the medical
“Elements of subjective wellbeing such as hope, trust (in medical staff) and agency for example all play a crucial role in shaping health outcomes” Neil Thin
A commitment to quality, efficiency and scientific measurements has often meant dismissing the softer elements of a health experience. Several studies have shown that how care is accessed, the service experience, the qualities of the physician, and ultimately how the patient felt, have an effect on the outcome. For instance, patients who feel in control, who trust the provider and feel cared for are more likely to be successful. When faced with the most dramatic and traumatic health issues, discussing the experience around it can sound frivolous. It’s not a matter of window dressing or décor, but fundamentally how all the non-medical aspects of care are shaped. It can include everything from how the clinician speaks with the patient, how the patient is brought into the office in the first place, how they interact with the next steps in care post visit. These should all be carefully considered and designed, not left as an afterthought or byproduct.
By far one of the most critical aspects of the care experience is the provider patient relationship. An empathetic, responsive care provider that listens well can be the difference in efficacy. Trust is the critical ingredient. For too long provider-patient relationships have been skewed toward information asymmetry and paternalistic behavior. The reality is patients are coming in much more informed. They are experts in themselves. Bringing more transparency into the dialog is one step forward in rebuilding trust. A new initiative, called Open notes, is challenging old dynamics. It’s aim is to have shared notes between patient and doctor that they both collaboratively see, develop and own. It creates a sense of shared control, and collaboration. In the moment of consult, both patient and provider need to have the best tools and data on hand to fuel better connection, dialog, and be in the right environment to shift the dynamics of the interaction.
It’s not just designing the moment of consultation, but the relationship over time. Prevention, chronic disease and complex co-morbidities require a service beyond acute interventions and occasional conversations to an on going accessible relationship, more like a coach. New models like One Medical, Iora Health and Sherpaa are fundamentally rebuilding and realigning the doctor patient relationship, built around continuous dialog. These could indicate a future for primary care, one defined by easy access, data collected over time and coaching support from a trusted resource that sees the bigger picture of an individuals care needs.
These new platforms are helping to reshape all aspects of the patient experience. By focusing on building relationships for the long term, creating easier access to services, allowing for better dialog in the moment, complimenting clinical expertise with patient goals, and focusing together on how to best invest effort in health change (across multiple dimensions of health and wellbeing), they are better setting both providers and patients up for success.
Setting the context for wellbeing
“nature alone cures” Florence Nightingale
It’s been widely acknowledged that zip code often determines health far more than genetic code. Shaping the context for wellness can be one of the greatest drivers of a health. Workplaces, communities and cities determine how healthy people are. It’s the combination of wider social, economic, environmental factors that truly influence health and wellbeing. Reshaping these underlying determinants can go a long way in impacting a communities wellness as a whole. Education and information, and even treatment, doesn’t necessarily create change if the system doesn’t support it. Countries, cities and organizations of all sizes are increasingly recognizing their role in this, and being measured on their ability to support and design for health. The question of “health” is not the domain of doctors and hospitals, it’s policy makers, government officials, civil engineers and hr managers that play a role in advocating for quality of living. Economically it’s in their best interest. When one dollar invested in community prevention is proven to result in a return of over five, the value of this long term, integrated view, is well worth it.
The truth is, when the underlying cause of a health issue stems from context, there’s often little a physician can do. When asthma is linked to poor housing, or stress is being driven by lack of employment, there is no “treating” surface symptoms through traditional medical interventions. Healthleads is filling this critical gap in care, taking into account the broader reasons behind sickness. They have been recognized for creating a means for prescribing the social services, housing, education, that are necessary for long-term health. Working in the clinic and hospital, trained college volunteers (often future medical professionals) are staffed to help to “fill” prescriptions for the patient, connecting them to critical resources. Rather than avoid the true issue at hand and simply send patients on their way, Doctors are free to dig into the true issues and help patients solve the critical factors that are the true cause of their sickness. This dramatically shifts the view of treating symptoms, to having the right kinds of tough conversations and systems in place to truly focus on generating health.
Creating the right context for health means shaping workplaces, communities and cities around wellbeing and reignite public health as a broader mission that engages wider dialog across industries and domains.
Building a culture of collaborative care
“It’s everyone’s job to turn time into resources and possibility for our patients.” Possible’s For Impact Culture Code
Changing the health system cannot happen without the participation and redesign of the experience on both sides of the conversation. Creating great working experiences for those on the front lines, the medical professionals and caregivers, is necessary for them to succeed. How doctors are trained in the first place, the cultures they work within, and the tools that support their daily practice are all in conflict with supporting their success in a dramatically shifted health care environment. The education and established roles within the medical profession need to shift to be in line with broader system change.
There is still a tradition of training medical professionals in acquiring knowledge, yet “knowing” being the key capability is becoming not only not as valuable, but also nearly impossible. The pace of change means information is shifting all the time, and with 13 organ systems with 60,000 ways they can go wrong, and 4,000 procedures and 6,000 medicines to treat conditions, one person won’t be able to learn it all, and apply it in an instance. It’s not a matter of smart experts or skilled craftsmen anymore. While those roles have their place, the most critical role is missing, the leader invested in broader health and quality of life. The ability to bridge disciplines, synthesize data across sources, and support people in a very human way in optimizing their health will become new skills that aren’t currently taught or acknowledged. The leader of a medical team in the future is likely more interdisciplinary, public good focused, empathetic, and skilled in coaching/consulting. They would be a highly skilled practitioner who can help line up resources to best invest in health success of the individual and community.
Certain systems are uniquely ahead of others in terms of what is valued, prioritized and taught as part of the growth of future medical professionals. Dr’s in Cuba are trained with a community focus, and an emphasis on delivering health that is a public good. Most of their learning happens within their community, with a sensitivity and connection to the underlying determinants of health, helping people upstream and leaning on a variety of treatments to help optimize the health of their patients. Pills and medical interventions are not the first port of call. ELAM has been a model for how to train professionals across the developing world, as well as been a reference for medical training more widely. The whole person is acknowledged, addressed and treatment is holistic, across multiple factors, not just one symptom. Mind, body, lifestyle, family and community are all part of the equation. Public health is a core part of the curriculum, assessing housing, economic, and social conditions. Prevention and upstream work is emphasized, along with a new type of conversation to engage patients in.
Enlightened organizations are also shaping a new internal culture for how they deliver, identifying and supporting a new set of staff values. Possible, in Nepal, is not only building a new model from scratch, but shaping a core set of values from the ground up as they go. This drives all of their hiring, and is baked into their interactions with the community they operate in. They have 10 principles that including “realizing great design creates dignity” and being “transparent until it hurts.” Their people are committed to a much bigger purpose beyond their own self interest or financial rewards. They intentionally hire “givers” — those focused on broader success of their team. Collaboration is critical, because great care isn’t just the domain of a solitary practitioner, it’s truly a team effort. Care and collaboration isn’t limited to medical professionals. Harnessing the contributions of families, friends and communities can extend support into the places it’s needed most. Peer networks and informal caregiving often makes up the bulk of the true health support network. New roles and new contexts for care are creating ways for increasing access to support, coaching and advice, closer to the patient and closer to the community.
We should be educating future leaders in care, not just experts in medicine. The new capability of the future health system depends on shifting the culture of delivery to support coaching, collaboration and innovation. The leaders in care tomorrow will demonstrate the daily art of compassion, act as “givers,” shifting health beyond a system stifled by self interest. This should unlock new ways of working as a team “in service of,” with the only true measure of success being the change in patients and communities.
Personalized, proactive and precise action
“if people can really begin to understand their bodies, that can help them change their lives.” Elizabeth Holmes
Health is intensely personal. It’s connected across interactions, evolving over time, and influenced dramatically by context. Yet, often it’s still treated by the medical community with a wide degree of imprecision and generalities. Better blending technology into the health experience should ultimately lead to early detection, improved diagnosis, and personalized treatment. It will help augment the doctor, up-skill the patient, and accelerate future discoveries.
The practice of medicine today is wildly imprecise and highly variable. Currently, 10 different Clinician’s will diagnose 10 different conditions (and then asked a year later, change their opinion). The science of medicine is shockingly unscientific. Even when there is proven evidence behind a practice, it doesn’t mean physicians will apply it. Technology has the potential to reinvent healthcare, changing the way it’s accessed, applied, and delivered. A new wave of data has the potential to create more insight to base action on, and will move more rapidly to sophisticated and targeted treatments. Clinician’s are doing as much googling these days as patients are and tools like AgileMD and Epocrates can increasingly put the right data at their fingertips in the moment.
Simply removing the old administrative burden and paper based systems of hospitals and clinics has already raised quality levels and improved outcomes. The lives of more than 750 patients have been saved at two hospitals after nurses started using iPods instead of paper charts to record patients’ vital signs. Eliminating the faxes and written letters that still dominate referrals, stacks of paper during rounds and linking up the mountains of technology in the hospital room, is long overdue. Soon-Shiong, MD billionaire, sees the potential for this massive change on the horizon, and is investing in the edges of connected and precise care. His “Manhattan Project” is an open and interoperable software platform, connecting every device in a hospital, 6,000 different devices, along with different types of clinical and financial software, to the cloud. His approach would bring new intelligence and pattern recognition to the trail and error taking place in the medical environment. Suddenly the patient room, ward, and data across hospitals would be connected.
While digital is slowly beginning to dominate, and more data is getting captured and connected, there’s still a long way to go in turning it into insightful, and truly personal, action. An individual’s health story is a long-term journey of experimentation to best optimize their ability and potential for living well. With new tools, and more sophisticated data, there should be more ability for connecting intent, effort and impact that is truly unique to the individual to achieve impact. The value will be in new combinations of data in order to unlock early and accurate diagnosis, upstream prevention and tailor on going management to the person. Wearable sensors (such as Fitbit), coupled with genomic data (from companies like 23andme), behavioral mapping (driven by organizations like Ginger.io), and finally understanding the daily impacts of treatment on community based condition groups (fueled by pioneers like Patientslikeme), is the critical combination of elements to unlock a whole new health care potential. It should empower physicians in the moment, help them see population data over time, and most importantly, change people’s awareness and engagement with the nuances of their own health.
Connected devices that share data, work in tandem, and blend into people’s lives seamlessly, will enable patients to self diagnose and self manage, and allow clinicians to enhance their practice. This underlying enabler will superpower a system where the future of care is tailored to the individual, helping people enhance their potential, prevent sickness, and diagnose issues before it’s too late.
Health care’s ‘Blockbuster video moment’
“the secret of change is to focus your energy, not on fighting the old, but in building the new.” Socrates
The health domain is on the cusp of dramatic change, and reaching the tipping point. It’s full of unrecognized and unrealized possibility, capabilities not yet harnessed to pursue the next frontiers. The most exciting solutions are emerging on the edges. Those most passionate to drive change are often leading it from the ground up. Patients and doctors who have seen the problems first hand are creating their own solutions today. The old story of healthcare was of a broken system filled with barriers. Today it’s one of possibility, filled with entrepreneurs, innovation platforms, collaboratives, data consortiums and change makers, all investing in the future. Startup Health has spotlighted more than 7,500 start-ups around the globe, creating the foundations for the health system of tomorrow. They are pushing the edges of each of the systems they operate in, learning from one another, and becoming more global in nature.
Armed with new tools, smarter data and a broader mind set shift slowly taking hold across the practice of medicine, the time is ripe for change. Predictions of a future where doctors collaborate with patients, communities are designed to support health, prevention and wellness are prioritized, diagnosis and treatment is personalized based on a synthesis of data around genes, lifestyle, population outcomes, and real time vitals, are achievable today. It’s a vision we can all see on the horizon, many agree on it’s promise and potential. Now it’s time to make it happen.
