European Health Futures Forum57th EOQ Congress, Estonia 18/19 June 2013David Somekh, Network Director, EHFF1	  
2	  What	  will	  her	  healthcare	  future	  be?	  
Health systems represent complex organisationsthat have more or less the same characteristics asbusiness organisations, al...
4	  Adapted	  from	  Kees	  van	  der	  Heijden	  Scenarios:	  the	  art	  of	  strategic	  conversaBon:	  2004	  
Source: Hans Kluge. Director Division of Health Systems and PH, WHO Europe 5	  
 	  6	  
7	  
Comment: note the ‘solutions’ in the previoustwo slides. The whole presentation is aconvincing over view of current threat...
‘The Singularity is Near: When Humans TranscendBiology’ Raymond Kurzweil (2005)*On the one hand we have the public health ...
Smart	  Living	  •  Smart	  clothes	  –  Sense	  body	  funcBons	  •  Smart	  bathroom	  –  Evaluate	  body	  fluids	  •  S...
GeneBcs	  •  HapMap	  ê	  £/€/$	  of	  human	  geneBc	  variaBon	  (disease	  diagnosis)	  •  “Gene	  Chip”–	  mul$ple	  ...
The	  Nanomedical	  Universe	  •  Nanomedicine	  •  Nanobots	  •  NanoroboBc	  therapy	  •  Nubots	  •  Nanosensors	  •  B...
The problem with the ‘future is techno.’ approachsuch as Mike Jackson’s presentation on his siteShapingtomorrow, which ski...
There are two elephants in fact crowding the room:human nature (a real problem when we come tothe value systems employed b...
15	  The future of European healthcare – a possible scenario
To summarise:‘Sickness care’ in its present form is notoriously wasteful andsignificant savings are likely to be achieved ...
17	  
18	  
Health effects of the financial crisis: omensof a Greek tragedyIn a review of public health capacity in the EU, ProfBrand ...
20	  
21	  There	  is	  indisputable	  evidence	  that	  European	  healthcare	  systems	  	  are	  simply	  not	  sustainable	 ...
22	  	  Even	  though	  the	  model	  of	  healthcare	  delivery	  we	  are	  using	  is	  	  currently	  by	  and	  large...
23	  Complexity	  science	  teaches	  us	  that	  condiBons	  of	  turbulence,	  of	  high	  levels	  of	  interacBon	  be...
An	  interes$ng	  idea	  Several	  years	  ago	  	  (at	  the	  end	  of	  2006	  to	  be	  precise)	  a	  group	  of	  us...
In addition to our existing expert knowledge, we started tolook at futures methods, such as scenario planning, horizonscan...
ESQH was set up as a European NGO in1998. It is registered as a charity in Irelandand the idea was to create a society ofn...
Networks	  of	  networks	  SocieBes	  Offices	  EU	  agencies	  and	  Associates	  27	  
In summary, there are several reasons that ESQHis well placed to provide a springboard for a newEuropean NGO which concent...
What are the USPs that EHFF offers, that meritparticipating in its development?•  Supporting disruptive innovation with a ...
30	  Consistency of EHFF principles with Foresightconcept
Brief	  summary	  of	  what	  EHFF	  will	  aIempt	  to	  do	  	  Create	  an	  open	  interac$ve	  forum,	  whose	  membe...
Global	  to	  local.	  Lessons	  from	  global	  ac$on	  networks	  (GANs)	  Steve Waddell* is fascinated with networks. H...
A	  new	  context	  –	  the	  new	  paradigm	  for	  how	  the	  world	  works	  •  from addressing issues in parts to who...
The	  three	  ini$al	  work	  streams	  (project	  categories)	  •  A	  Europe-­‐wide	  innovaBon	  laboratory	  for	  imp...
MagriIe:	  the	  schoolmaster	  (1954)	  	  In	  a	  leser	  to	  a	  friend	  Magrise	  says:	  “	  I	  had	  a	  magnific...
Thank	  you	  for	  your	  Bme.	  	  Now,	  how	  might	  we	  work	  together?	  	  	  	  	  EHFF became a legal entity i...
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Addressign the Need for a Paradigm Shift in Healthcare

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Addressign the Need for a Paradigm Shift in Healthcare

  1. 1. European Health Futures Forum57th EOQ Congress, Estonia 18/19 June 2013David Somekh, Network Director, EHFF1  
  2. 2. 2  What  will  her  healthcare  future  be?  
  3. 3. Health systems represent complex organisationsthat have more or less the same characteristics asbusiness organisations, although they are unusualin being usually very manpower intensive and quitecomplicated. Some of them are extremely, if notunmanageably, large e.g. the NHS in the UK.Given the modern day application of complexityideas in the turbulent modern social and businessenvironment, how is current strategic thinkingabout European health configured?3  
  4. 4. 4  Adapted  from  Kees  van  der  Heijden  Scenarios:  the  art  of  strategic  conversaBon:  2004  
  5. 5. Source: Hans Kluge. Director Division of Health Systems and PH, WHO Europe 5  
  6. 6.    6  
  7. 7. 7  
  8. 8. Comment: note the ‘solutions’ in the previoustwo slides. The whole presentation is aconvincing over view of current threats to EUhealth systems.What is not convincing however is the proposalto do what EU health systems have signallyfailed to over the last 20 years (make significantinroads into the estimated annual 25% wastageof resources across the board). Systems are tobe ‘strengthened’, not changed. The proposal issimply not credible, particularly in the context ofa hyper-connected rapidly changing externalenvironment.8  
  9. 9. ‘The Singularity is Near: When Humans TranscendBiology’ Raymond Kurzweil (2005)*On the one hand we have the public health dataand predictions from WHO-Europe, on the otherhand we have the largely US-based predictions ofrapid technological growth and its impact on healthsystems*Kurzweil argues that the inevitability of a technological singularity is implied by a long-term pattern of accelerating change that generalises Moore’s Law to technologiespredating the integrated circuit, and which, he argues, will continue to other technologiesnot yet invented. According to him, artificial intelligence should be able to pass the TuringTest (a test for the presence of intelligence in putatively-minded entities) by 2029, and thetechnological singularity should occur by 2045.9  
  10. 10. Smart  Living  •  Smart  clothes  –  Sense  body  funcBons  •  Smart  bathroom  –  Evaluate  body  fluids  •  Smart  kitchen  –  Prepare  body  nutrients  •  Smart  house  –  Elderly  can  live  at  home  
  11. 11. GeneBcs  •  HapMap  ê  £/€/$  of  human  geneBc  variaBon  (disease  diagnosis)  •  “Gene  Chip”–  mul$ple  gene  examinaBon  •  Personal  genome  sequencing                  direct-­‐to-­‐consumer  (DTC)  •  IdenBfied  origins  and  causal  rela$onships  of  complex  diseases  •  “Epigene$c"  factors  linked  to  diseases,  heritability  across  generaBons    •  Stem  cell  transplants  •  Human  reproducBve  cloning    
  12. 12. The  Nanomedical  Universe  •  Nanomedicine  •  Nanobots  •  NanoroboBc  therapy  •  Nubots  •  Nanosensors  •  Bionanobots  •  Nanotechnology  
  13. 13. The problem with the ‘future is techno.’ approachsuch as Mike Jackson’s presentation on his siteShapingtomorrow, which skillfully scans potentialtechnological advances and their impact, becauseof the audience it was aimed at it doesn’t tackle the‘elephant in the room’ issue that unlike airlines orproduction lines, present day health is manpowerintensive and complex and especially vulnerable tothe vagaries of the human psyche.The same argument applies to Luis Cordeiro’spresentation of a future world of enhanced human/human-robot synthesis, in his role as futurist andambassador of the Singularity University, CA13  
  14. 14. There are two elephants in fact crowding the room:human nature (a real problem when we come tothe value systems employed by the techno-enthusiasts who promote the advent of AI as thesolution to our problems) and the sheer size andcomplexity of current health systems. Their abidingcharacteristic is the second elephant: that if youconcentrate your resources on improving oneelement in the system, the effects are almostalways neutralised by compensating movementselsewhere in the system.  14  
  15. 15. 15  The future of European healthcare – a possible scenario
  16. 16. To summarise:‘Sickness care’ in its present form is notoriously wasteful andsignificant savings are likely to be achieved only by substantialchange in the form of care delivery. There are many barriers, bothinstitutional and political which hamper this transformationIncreasing life expectancy results in an increased burden ofpotential healthcare costs which ironically may be exacerbated byincreasing expectations from the public for care, potential costs of newtechnology (it could go either way), the effects of greater healthinequalities and of other factors such as migration, climate change etc.In the present setting, financial forecasts suggest that theenvelope for healthcare spending has limited capacity forexpansion. Equally there is gross underinvestment in prevention andhealth education.Chronic mismanagement of workforce planning makes it likely thatserious shortfalls will impact on quality of care16  
  17. 17. 17  
  18. 18. 18  
  19. 19. Health effects of the financial crisis: omensof a Greek tragedyIn a review of public health capacity in the EU, ProfBrand from Maastricht recently gave the exampleof the impact of the demands of the Troika on thehealth of the Greek population, as will be seen inthe next slide. However, he was also making acrucial point about the availability of what is called‘cockpit data’. The effects during 2007-9 were onlyavailable in 2011.I have my own example of the same phenomenonbased on the local effects of the Spanish crisis….19  
  20. 20. 20  
  21. 21. 21  There  is  indisputable  evidence  that  European  healthcare  systems    are  simply  not  sustainable  –  even  in  the  medium  term  future,    but    percep$on  of  threat  cannot  in  itself  bring  about  societal  change.      If  the  possibility  of  a  potenBal  collapse  of  the  system  can’t  be  contemplated,  people  will  behave  as  if  it  isn’t  there.  Just  like    they  did  in  the  banking  crisis.    Analysis  over  a  number  of  years  of  the  barriers  to  fundamental    change  in  health  delivery  systems  leads  to  the  inevitable    conclusion    that  there  is,  on  the  part  of  most  stakeholders    huge  vested  interest  in  maintaining  the  status  quo    
  22. 22. 22    Even  though  the  model  of  healthcare  delivery  we  are  using  is    currently  by  and  large  a  nineteenth  century  one,  bringing  about    radical  change  is  seen  as  far  too  difficult  and  threatening  Its  like  a  raBonal,  progressive,  energy  policy:  the  means  are  there,  but  the  resistance  to  change,  from  so  many  sources,    is  just  too  great.  
  23. 23. 23  Complexity  science  teaches  us  that  condiBons  of  turbulence,  of  high  levels  of  interacBon  between  diverse  actors  fosters  the  emergence  of  new  configuraBons.  Conversely,  excessively  rigid  and  unchanging  systems  are  unlikely  to  generate  sustainable  new  forms.  StarBng  from  the  applicaBon  of  the  principle  to  financial  systems,  this  Harvard  Business  School  team  argue  that  the  only  way  to  generate  real  change  in  such  circumstances  for  healthcare  is  from  the  outside.  DisrupBve  innovaBon  implies  demonstraBng  the  effecBveness  of  innovaBve    transformaBonal  change  by  implemenBng  it  outside  the  city  walls,  and  creaBng  a  criBcal  mass  for  the  alternaBve  paradigm  which  will  gradually  erode  the  status  quo.  
  24. 24. An  interes$ng  idea  Several  years  ago    (at  the  end  of  2006  to  be  precise)  a  group  of  us  found  ourselves  in  a  very  unusual  situaBon  .....we  were  drinking  in  the  bar  of  a  hotel  in  a  European  capital  city,  late  at  night.    We  had  by  then  spent  many  years  working  on  improving  healthcare  quality,    but  recognised  that  the  results  of  the  labours,  not  just  our  own,  but  those  of  other  prac$$oners  in  the  field,  represented  a  very  poor  return  on  investment.    We  concluded  that  what  was  required  was  a  radical  transformaBon  in  the  way  that  healthcare  was  delivered;  an  ac$ve  collabora$on  between  representa$ves  from  Industry,  Educa$on  and  Healthcare,  crossing  tradi$onal  boundaries.    This  we  called  our      BIG  IDEA.  However,  it  took  several  years  to  find  a  means  to  put  the  idea  into  pracBce…  24  
  25. 25. In addition to our existing expert knowledge, we started tolook at futures methods, such as scenario planning, horizonscanning and wild cards and weak signals methodology, tosee to what extent these techniques had successfully beenapplied in the health field.We discovered William Gibson (author of ‘Neuromancer’)…“The  Future  is  already  here  –  it  is  just  not  evenly  distributed”  We decided to use what small inroads we had achievedthus far within the health policy field in Europe to establishquite a different enterprise…25  
  26. 26. ESQH was set up as a European NGO in1998. It is registered as a charity in Irelandand the idea was to create a society ofnational healthcare quality societies, torepresent the grass-roots staff acrossEurope and whose mission statement was:•  to  promote  communicaBon  between  the  stakeholders  in  European  health  quality  •  to  champion  quality  in  healthcare  in  Europe  •  to  sBmulate  innovaBon  in  healthcare  quality  in  Europe  Both  the  founders  of  EHFF  have  formerly  served  as  Presidents  of  ESQH  (and  collaborated  with  EOQ!)  26  
  27. 27. Networks  of  networks  SocieBes  Offices  EU  agencies  and  Associates  27  
  28. 28. In summary, there are several reasons that ESQHis well placed to provide a springboard for a newEuropean NGO which concentrates on healthfutures. Among these are:It has a well established network involving 20 countries andcontacts within several stakeholder groups in eachExperienced at becoming involved with policy issues at asignificant level, starting from scratch and building a brandRun as a lightweight, flexible but effective organisation thatis more or less virtual but has appropriate governanceWill build on ESQH’s work but will create its own brand andintends to operate faster, smarter and more effectively28  
  29. 29. What are the USPs that EHFF offers, that meritparticipating in its development?•  Supporting disruptive innovation with a cross-sectoralfocus using a network structure•  Offering an approach to health scenarios which fosterson-going multi-stakeholder dialogue•  Aiming to collect data that identifies potential threats tohealth systems in a more realistic timescale•  Operating in a 21st century organisational mode, with aneffective but fluid, inclusive and open-source orientation•  Cognisant of current policy but side-stepping politicalpressures and the constraints of traditional institutions29  
  30. 30. 30  Consistency of EHFF principles with Foresightconcept
  31. 31. Brief  summary  of  what  EHFF  will  aIempt  to  do    Create  an  open  interac$ve  forum,  whose  members  will  seek  out,    process  and  exchange  knowledge  and  informa$on  in  real  $me  that      may  either  influence  the  future  of  health  and  healthcare  in  Europe    and/or  provide  a  beIer  understanding  of  future  possibili$es  and  risks    in  this  area.  We  aim  to  facilitate  beIer  ques$ons,  not  offer  solu$ons.      The  business  model  involves  establishing  a  diversely  populated  not  for    profit  legal  enBty  and  incrementally  building  web  presence,  funding    streams,  eclecBc  network  of  expert  associates  linked  to  current    network,  involvement  in  relevant  European  acBviBes,  iniBaBng  own  projects,  on-­‐going    horizon  scanning  and  promoBon  of  values.      31  
  32. 32. Global  to  local.  Lessons  from  global  ac$on  networks  (GANs)  Steve Waddell* is fascinated with networks. He says GANs tend tohave most of 7 characteristics: they are multi-level, ‘diversity-embracing boundary spanners’, inter-organisational networks,systemic change agents, entrepreneurial action learners, voluntaryleaders and global public good producers. EHFF could aspire tomost of these, eventually, on a smaller scale than global, but noticehow much growth of networks figures in the three work streamsdiscussed below. Steve also stresses that GANs cannot simply floatin the clouds as it were; their interest needs to be in ‘where therubber hits the road’ and on the ground action, because that’s oneimportant area where their influence can be assessed.32  
  33. 33. A  new  context  –  the  new  paradigm  for  how  the  world  works  •  from addressing issues in parts to whole systems thinking•  from inter-national structures to multi-stakeholder ones in orderto address the issues•  from assuming the environment to nurturing it•  from linear approaches to change to complex systemsstrategies•  from negotiating our way to solutions to envisioning futures•  from a conformance focus to a collective values focusConsidering that we developed our concept piecemeal over timeand intuitively, not having read Waddell’s work, the closeness of fitis pretty spooky!33  
  34. 34. The  three  ini$al  work  streams  (project  categories)  •  A  Europe-­‐wide  innovaBon  laboratory  for  improving  health:  its  first  projects  would  be            a)  involvement  in  EC  projects  on  paBent  self-­‐management              b)  the  young  health  innovators  project:  EVY  (a  network  project)            c)  a  community  of  pracBce  for  those  at  the  leading  edge  of                      health  professional  educaBon              d)  seeking  partnerships  with  business  and  educaBon  to  create  Health                        based  Knowledge  and  InnovaBon  Centres  (KICs)  as  promoted  by  EITT    •  The  first  ever  Europe  wide  scenarios  exercise  for  health  that  includes  all  the  stakeholders  •  Linked  to  web-­‐portal,  begin  a  scanning  exercise  on  emerging  health  trends  using  sophisBcated  techniques  imported  from  other  fields  34  
  35. 35. MagriIe:  the  schoolmaster  (1954)    In  a  leser  to  a  friend  Magrise  says:  “  I  had  a  magnificent  idea  without  realizing  this,  nor  did  you,  when  I  pointed  out  to  you  a  year  or  two  ago,  that  the  moon  in  certain  posiBons  was  exactly  above  a  chimney-­‐stack  or  a  tree.  At  the  Bme,  we  thought  this  droll,  amusing  but  of  lisle  interest.  Thanks  to  the  new  pictures:  The  girls  of  the  sky,  The  evening  gown,  The  schoolmaster  and  The  masterpiece,  we  can  now  display  genius,  if  we  realize  that  the  droll  idea  is  in  fact  magnificent...  genius  is  not  about  having  magnificent  ideas,  but  about  recognizing  them.”        35  
  36. 36. Thank  you  for  your  Bme.    Now,  how  might  we  work  together?          EHFF became a legal entity in March 2013, after two yearsof planning. The prototype portal address is www.ehff.eu36  

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