21st century healthcare organisations

The VitalSign Series: Why have an English doctor from the United Kingdom and a Canadian technologist from Australia come together to write a blog series? Because healthcare and technology are equally complex, and it’s challenging enough to stay at the forefront of one industry in this rapidly evolving digital era — let alone two. In the VitalSign series, Ben Bridgewater, MD (the English doctor) and David Pare (the Canadian technologist) join forces to present a point of view on health systems in the 21st century and demonstrate the extent of what is possible. This is the third blog in the series.

As we move further into the 21st century, technology will continue to shape society, and organisations will need to keep up to deliver external expectations. This applies as much to healthcare organisations as it does to other industries, and the evidence from outside healthcare is that those organisations that fail to keep up will rapidly become obsolete. One of the primary challenges 21st century healthcare organisations face is to re-consider their services from the citizen’s perspective, just as digital banking, retail and transport have done.

Historically, patient-facing services have been left in silos and defined by the ‘sector’ and ‘specialty’ that healthcare has decided patients should fit into. This made sense in the old world, but things are changing.

As an example, let’s take a woman who wishes to have a baby. In the United Kingdom, from the perspective of healthcare providers, pre-conception services will not be considered, unless there are infertility issues. Once pregnant, the woman will usually be looked after by gynaecology for the first 6 months or so of pregnancy, and then obstetric services will take over through to birth, using a mix of hospital and community-based services.

This may make sense from a healthcare providers’ perspective, but does it make sense from the citizen’s perspective? (Here we use citizen deliberately because most pregnant women are not patients.) Surely this is one continuous journey from a wish to conceive to, it is hoped, a successful delivery and then through to post-delivery care. In the digital era, citizens will start to expect an end-to-end, supported experience from the health system, enabled by integrated and effective digital technologies to optimise all stages of the experience for the mother-to-be and her partner, family and friends.

Taking an outside-in approach

In Reimagining healthcare for the 21st century, organisations must start to adopt this outside-in approach, which will inevitably lead to changes in operational models, such as moving to integrated accountable care systems. This will not be easy, since it disrupts existing fiefdoms, payment models and ways of working.

Where this approach is just not possible for commercial or political reasons, managing handovers to minimise citizens’ inconvenience, decrease risk and drive overall efficiency is highly desirable from a societal perspective. If only to minimise the escalating costs of care and their implications on the wider economy, this needs to be on the agenda of healthcare regulators and politicians.

Mapping this different perspective onto the Leading Edge Forum 21st Century Organisation Model is useful for framing these thoughts. We have already seen the need for two of the key transformation requirements the Leading Edge Forum (LEF) describes: an “outside-in approach” and a “360o optimised portfolio of products and services”.

One business that is putting this approach into practice is Welio, an Australian start-up that developed a virtual consulting platform that allows patients to engage with their physicians using a Skype-like video technology. As most tele-consult activities are currently not reimbursed in Australia, the platform embeds an Uber-like payment feature that directly debits the amount for the consultation from the patient’s bank account to compensate the general practitioner. This is a great example of technology providing what consumers want, and organisations that get this right will be successful in the market place.

According to the LEF model, 21st century healthcare organisations also require “adaptive execution”.  We previously referred to the slow innovation cycle in medicine, with an average time from ideation to change in practice at a scale of 17 years, and suggested that healthcare needs a hybrid approach, combining the best of academia with modern approaches to product life-cycle management. This type of innovation should be deeply embedded within the 21st century healthcare organisation, and this will require changes in organisational models, supported by the necessary cultural evolution programmes to shift the status quo. The organisation will also need to ensure that it has people with the right capabilities for delivering these new approaches.

Addressing culture

Culture is key, and it is becoming increasingly clear that an optimal culture for delivering both safe and effective services as well as digital transformation can be defined and measured using domains such as leadership effectiveness, relationships, engagement, personal ownership, trust, living the organisation’s values and momentum. Measuring the “as-is culture” using appropriate tools and then closing the gap to the desired cultural state should be the priority for all healthcare organisations simply to deliver better care. This is equally important for driving digital transformation.

To thrive in this new world, culture must be digital, where everything is dominated by human interaction with technology. Only then will full benefits be realised for patients, organisations and their employees. This is a long way from the current state, where technology often feels like a burden rather than a primary driver of better outcomes.

So how do you drive towards a new culture? From our experience, both formal and informal processes need to be in place — including education, objective-setting, appraisal, personal development, and holding to account — to drive digital interaction. Digital interaction must cease to be an option for employees, which leaves the potential for a two-speed organisation, based on individual preferences and behaviours. The leadership must overtly live and display digital values and priorities. You cannot drive a compelling digital organisation if the chief executive has no coherent digital presence or brand and is not being seen to ‘walk the talk’.

The culture in a healthcare organisation is the responsibility of the board. And since every successful organisation in the 21st century will be digital, the board needs to be full of 21st century executives. There obviously must be blended expertise and experience across the various necessary domains (finance, governance, patient engagement, etc.), but this experience should ideally be a digital experience.

The board should also include clinicians, who are key to shaping and delivering care. And in a digital world, a 21st century healthcare organisation’s board needs a chief clinical information officer (CCIO) with a strong voice. If the organisation does not have such an individual, it needs to identify one with the right attitude and capabilities and train him or her accordingly, or recruit. The CCIO should be tasked with increasing digital capabilities across the clinical workforce, as well as developing an active digital talent management scheme, a task that will get easier as the younger generation of professionals who are ‘digitally native’ flow through the system. Some national agencies are now stepping up to support these challenges.

Similar to other industries, healthcare needs to embrace the 3 digital truths: the digital customer, disruptive platforms and exploiting platforms to benefit citizens. The 21st century healthcare organisation must use digital approaches to add value to itself, the citizens it cares for and to society. Choices will need to be made in the current financial climate, and evidence from other industries shows that clarity and prioritisation are the keys to success.

As care becomes more citizen-centric and extends beyond the walls of a hospital — for example, encompassing healthcare and wellness services — the 21st century healthcare organisation will need to use digital approaches to deliver an enhanced experience across traditional sectors. We believe that healthcare should learn from other industries and use customer relationship management approaches to give a 360o view of the ‘customer’, enable appropriate segmentation and deliver customer-intimate services to patients using omni-channel approaches. For example, smartphones with appropriate apps using social networks may be fantastic for the younger patient with chronic, enduring mental health issues, but the frail elderly often have much lower internet and social network use, so a more appropriate channel should be considered.

There is an urgent need for healthcare organisations to learn from those industries that have gone through digital transformation. The good news is that it is possible to drive that change and increasingly we know what we need to do to make these changes happen. The bad news is that there are real challenges, as change is needed in the culture of the organisation, embedded in every employee from top to bottom. The pace of technology change isn’t slowing down, and healthcare organisations must act now to leverage these developments to create better experiences and outcomes for citizens and staff.

Ben Bridgewater, M.D., was the director of global advisory for DXC’s Healthcare and Life Sciences Build organisation. He is an expert on health informatics, national clinical audit, clinical governance, healthcare transparency, patient-experience measurement and digital transformation in healthcare. He is now chief executive of Health Innovation Manchester.



David Pare is the chief technology officer for DXC Healthcare and Life Sciences in Australia and New Zealand. He is an innovative thinker with 20 years of experience in business and technology management consulting, helping organisations through their digital transformation.





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