12 agosto, 2020
When we are in the midst of a storm, it is hard to see the light behind the clouds. As we live through a health crisis that has shut down the entire world, we search for a way forward by asking deep questions. Who are we? What is valuable in life? Where do we go from here? These questions help us make sense of the world. By exploring them, we restore a sense of order in uncertain times.
Covid-19 will have a lasting impact on our lives. Not least on our health and our perception of people who work in healthcare. It might not always be obvious, but unforeseen events of this magnitude have a way of changing how we see things. It reminds us of life's fragility and impermanence. Shocks make us aware that few things last forever, whether it is world views or the systems that uphold societal structures.
The importance of coexistence
We have learned that coexistence is vital for our wellbeing and that one man's actions have vast implications for the collective response in times of a crisis. We have experienced how complex systems are interconnected and how their wholes and parts depend on each other. We have sensed that our existence is symbiotic and that individual needs and those of nature itself are deeply intertwined. Maybe for the first time, we have realised that nothing—no one—exists in isolation. That being human is fundamentally about transcending a purpose beyond self-interest.
The changing landscape of our healthcare systems
The pandemic has challenged our healthcare systems to the extreme. Overnight, traditional touchpoints of interaction have radically changed. Hospitals have established new facilities and completely overhauled their workflows. They have bypassed the chain of command in established hierarchies and retrained staff to meet the demands of the moment. At the same time, general practitioners have stepped up and reinvented how they diagnose and treat patients during a pandemic. Similarly, all other stakeholders within the healthcare landscape have experienced this "lifequake" at scale—a fundamental shift in how and where they can interact to provide optimal care.
The biggest game-changer in health is the shift in Point of Care (PoC) from analogue to digital and from in-system to out-of-system. This transformation will articulate an undeniable demand: That a human being facing health challenges should always be the centre of all interactions, and that all stakeholders should collaborate based on a shared interest to produce positive health outcomes for that person. The collective response to the Covid-19 experience will send a ripple effect through the entire health landscape amplifying this demand for change that was already well on its way. As the landscape is changing, organisations and individuals alike are forced to ask a fundamental question: Are we doing the right thing?
What if public health budgets solely prioritise treatment over prevention? It may flatten the curve momentarily for high-prioritised focus areas like cancer. Still, it will not reduce the prevalence of non-communicable diseases on the long-term. What if first-line physicians only receive reimbursement based on a fee-for-service model? It may incentivise them to consult more patients. Still, it will undermine their ability to build a deep understanding of each patient's situation and needs over time. What if pharmaceutical companies narrowly focus their portfolio on low-volume, high-margin products? It may, on the short-term, satisfy shareholders and maintain a double-digit growth rate. Still, it will push the pricing through the roof and erode the health system's long-term capacity to pay for the medicine. These examples serve to illustrate that there are imbalances in the current health landscape that triggers systemic wrongdoing.
Short-term over long-term value. Quantity over quality. Self-interest over a shared interest. Coexistence is key to the systemic redesign of the healthcare system and restoration of the balance. We are at an inflexion point in history where all stakeholders have a unique opportunity to renew their modus operandi and where everyone should join efforts to promote a transparent, shared and genuinely human-centred agenda.
Reimagining the healthcare strategy
The bright light behind the clouds will shine on healthcare providers that are capable of reimagining their strategy for how to best engage with the surrounding world. It will require a rethinking of the roles and responsibilities that they are willing to take upon themselves and the meaningful coalitions they are ready to enter. It will trigger a much-needed shift in their mindset from unilateral to multilateral, establishing a resilient loop between push and pull engagement. On a more tactical level, it will lead to a complete redesign of how the stakeholder directly or indirectly contributes to the long-term improvement of points of care. In that sense, digital technology and digitally based ecosystems will become a super-enabler of coexistence.
The impact of covid-19
How people have experienced the impact of Covid-19 varies profoundly. Some are busier than ever or spot opportunities and launch new businesses. Others see their livelihood vanish or go through the experience of losing loved ones. Each one of us has different perceptions of this reality, and it influences how we deal with the current crisis.
A natural human response to unknown danger is to go directly into problem-solving mode and start putting out fires. We should, however, be mindful that this instinct can make us down prioritise the time needed to learn and internalise what we go through. Are we confronted with an isolated problem that needs to be solved or an entirely new condition that needs to be absorbed? According to Nobel Laureate Daniel Kahneman and his System 1 and System 2 theory, these are two fundamentally different ways of functioning. The first is fast, automatic and error-prone. The latter is slow, effortful and more reliable. We must make use of both approaches to create a new and better world.
As we question our ability to do the right thing, we must go above and beyond incremental efforts. It is not adequate to make small and fast adjustments to our business models or to merely push existing business transactions through a new digital channel. It raises a much more important question about the way we approach our coexistence.
Some work the system to get as much out of it as possible for themselves. Some work in the system without questioning their contribution and responsibility. Some work together with others on the system to change it for the better.
Where to play next?
We need to ask ourselves who we want to be going forward. Where to play next? It highlights that we, as individual stakeholders and collectively as a coherent landscape of health, must choose whom we want to be, what we stand for and why we have skin in the game.
As digital ecosystems mature and big tech companies aggressively enter the health space, our perceptions of how we best care for people will change. As will health services, reimbursement models, consumer attitudes and governmental regulations. Ambitions to monetise health data by cutting out the middleman and establish a data-for-services relation directly with end-users will enable a more proactive and holistic approach to health. But there is also an imminent danger that we move towards a scenario were a few dominant gatekeepers monopolise access to health data and undermine the long-term collaborative effort to coexist.
Digital has the potential to provide better and more affordable healthcare for more people. It will most certainly become a super-enabler of coexistence. It can help us decide where to play next and how we can all win together. But it does not free us from raising ethical questions of its compelling use. Only this way can we ensure that all stakeholders work together on the system to secure a sustainable improvement of what matters most to us in life: our health and relationships.