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European Health Futures Forum
57th EOQ Congress, Estonia 18/19 June 2013
David Somekh, Network Director, EHFF
1	
  
2	
  
What	
  will	
  her	
  healthcare	
  future	
  be?	
  
Health systems represent complex organisations
that have more or less the same characteristics as
business organisations, although they are unusual
in being usually very manpower intensive and quite
complicated. Some of them are extremely, if not
unmanageably, large e.g. the NHS in the UK.
Given the modern day application of complexity
ideas in the turbulent modern social and business
environment, how is current strategic thinking
about European health configured?
3	
  
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 previous
two slides. The whole presentation is a
convincing over view of current threats to EU
health systems.
What is not convincing however is the proposal
to do what EU health systems have signally
failed to over the last 20 years (make significant
inroads into the estimated annual 25% wastage
of resources across the board). Systems are to
be ‘strengthened’, not changed. The proposal is
simply not credible, particularly in the context of
a hyper-connected rapidly changing external
environment.
8	
  
‘The Singularity is Near: When Humans Transcend
Biology’ Raymond Kurzweil (2005)*
On the one hand we have the public health data
and predictions from WHO-Europe, on the other
hand we have the largely US-based predictions of
rapid technological growth and its impact on health
systems
*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 technologies
predating the integrated circuit, and which, he argues, will continue to other technologies
not yet invented. According to him, artificial intelligence should be able to pass the Turing
Test (a test for the presence of intelligence in putatively-minded entities) by 2029, and the
technological singularity should occur by 2045.
9	
  
Smart	
  Living	
  
•  Smart	
  clothes	
  
–  Sense	
  body	
  funcBons	
  
•  Smart	
  bathroom	
  
–  Evaluate	
  body	
  fluids	
  
•  Smart	
  kitchen	
  
–  Prepare	
  body	
  nutrients	
  
•  Smart	
  house	
  
–  Elderly	
  can	
  live	
  at	
  home	
  
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	
  
	
  
The	
  Nanomedical	
  Universe	
  
•  Nanomedicine	
  
•  Nanobots	
  
•  NanoroboBc	
  therapy	
  
•  Nubots	
  
•  Nanosensors	
  
•  Bionanobots	
  
•  Nanotechnology	
  
The problem with the ‘future is techno.’ approach
such as Mike Jackson’s presentation on his site
Shapingtomorrow, which skillfully scans potential
technological advances and their impact, because
of the audience it was aimed at it doesn’t tackle the
‘elephant in the room’ issue that unlike airlines or
production lines, present day health is manpower
intensive and complex and especially vulnerable to
the vagaries of the human psyche.
The same argument applies to Luis Cordeiro’s
presentation of a future world of enhanced human/
human-robot synthesis, in his role as futurist and
ambassador of the Singularity University, CA
13	
  
There are two elephants in fact crowding the room:
human nature (a real problem when we come to
the value systems employed by the techno-
enthusiasts who promote the advent of AI as the
solution to our problems) and the sheer size and
complexity of current health systems. Their abiding
characteristic is the second elephant: that if you
concentrate your resources on improving one
element in the system, the effects are almost
always neutralised by compensating movements
elsewhere in the system.
	
  
14	
  
15	
  
The future of European healthcare – a possible scenario
To summarise:
‘Sickness care’ in its present form is notoriously wasteful and
significant savings are likely to be achieved only by substantial
change in the form of care delivery. There are many barriers, both
institutional and political which hamper this transformation
Increasing life expectancy results in an increased burden of
potential healthcare costs which ironically may be exacerbated by
increasing expectations from the public for care, potential costs of new
technology (it could go either way), the effects of greater health
inequalities and of other factors such as migration, climate change etc.
In the present setting, financial forecasts suggest that the
envelope for healthcare spending has limited capacity for
expansion. Equally there is gross underinvestment in prevention and
health education.
Chronic mismanagement of workforce planning makes it likely that
serious shortfalls will impact on quality of care
16	
  
17	
  
18	
  
Health effects of the financial crisis: omens
of a Greek tragedy
In a review of public health capacity in the EU, Prof
Brand from Maastricht recently gave the example
of the impact of the demands of the Troika on the
health of the Greek population, as will be seen in
the next slide. However, he was also making a
crucial point about the availability of what is called
‘cockpit data’. The effects during 2007-9 were only
available in 2011.
I have my own example of the same phenomenon
based on the local effects of the Spanish crisis….
19	
  
20	
  
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	
  
	
  
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	
  
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.	
  
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	
  
In addition to our existing expert knowledge, we started to
look at futures methods, such as scenario planning, horizon
scanning and wild cards and weak signals methodology, to
see to what extent these techniques had successfully been
applied 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 achieved
thus far within the health policy field in Europe to establish
quite a different enterprise…
25	
  
ESQH was set up as a European NGO in
1998. It is registered as a charity in Ireland
and the idea was to create a society of
national healthcare quality societies, to
represent the grass-roots staff across
Europe 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	
  
Networks	
  of	
  networks	
  
SocieBes	
  
Offices	
  
EU	
  agencies	
  and	
  Associates	
  
27	
  
In summary, there are several reasons that ESQH
is well placed to provide a springboard for a new
European NGO which concentrates on health
futures. Among these are:
It has a well established network involving 20 countries and
contacts within several stakeholder groups in each
Experienced at becoming involved with policy issues at a
significant level, starting from scratch and building a brand
Run as a lightweight, flexible but effective organisation that
is more or less virtual but has appropriate governance
Will build on ESQH’s work but will create its own brand and
intends to operate faster, smarter and more effectively
28	
  
What are the USPs that EHFF offers, that merit
participating in its development?
•  Supporting disruptive innovation with a cross-sectoral
focus using a network structure
•  Offering an approach to health scenarios which fosters
on-going multi-stakeholder dialogue
•  Aiming to collect data that identifies potential threats to
health systems in a more realistic timescale
•  Operating in a 21st century organisational mode, with an
effective but fluid, inclusive and open-source orientation
•  Cognisant of current policy but side-stepping political
pressures and the constraints of traditional institutions
29	
  
30	
  
Consistency of EHFF principles with Foresight
concept
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	
  
Global	
  to	
  local.	
  Lessons	
  from	
  global	
  ac$on	
  networks	
  
(GANs)	
  
Steve Waddell* is fascinated with networks. He says GANs tend to
have most of 7 characteristics: they are multi-level, ‘diversity-
embracing boundary spanners’, inter-organisational networks,
systemic change agents, entrepreneurial action learners, voluntary
leaders and global public good producers. EHFF could aspire to
most of these, eventually, on a smaller scale than global, but notice
how much growth of networks figures in the three work streams
discussed below. Steve also stresses that GANs cannot simply float
in the clouds as it were; their interest needs to be in ‘where the
rubber hits the road’ and on the ground action, because that’s one
important area where their influence can be assessed.
32	
  
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 order
to address the issues
•  from assuming the environment to nurturing it
•  from linear approaches to change to complex systems
strategies
•  from negotiating our way to solutions to envisioning futures
•  from a conformance focus to a collective values focus
Considering that we developed our concept piecemeal over time
and intuitively, not having read Waddell’s work, the closeness of fit
is pretty spooky!
33	
  
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	
  
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	
  
Thank	
  you	
  for	
  your	
  Bme.	
  
	
  
Now,	
  how	
  might	
  we	
  work	
  together?	
  
	
  
	
  
	
  
	
  EHFF became a legal entity in March 2013, after two years
of planning. The prototype portal address is www.ehff.eu
36	
  

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Future of European Healthcare - Disruptive Innovation from Outside

  • 1. European Health Futures Forum 57th EOQ Congress, Estonia 18/19 June 2013 David Somekh, Network Director, EHFF 1  
  • 2. 2   What  will  her  healthcare  future  be?  
  • 3. Health systems represent complex organisations that have more or less the same characteristics as business organisations, although they are unusual in being usually very manpower intensive and quite complicated. Some of them are extremely, if not unmanageably, large e.g. the NHS in the UK. Given the modern day application of complexity ideas in the turbulent modern social and business environment, how is current strategic thinking about European health configured? 3  
  • 4. 4   Adapted  from  Kees  van  der  Heijden   Scenarios:  the  art  of  strategic  conversaBon:  2004  
  • 5. Source: Hans Kluge. Director Division of Health Systems and PH, WHO Europe 5  
  • 8. Comment: note the ‘solutions’ in the previous two slides. The whole presentation is a convincing over view of current threats to EU health systems. What is not convincing however is the proposal to do what EU health systems have signally failed to over the last 20 years (make significant inroads into the estimated annual 25% wastage of resources across the board). Systems are to be ‘strengthened’, not changed. The proposal is simply not credible, particularly in the context of a hyper-connected rapidly changing external environment. 8  
  • 9. ‘The Singularity is Near: When Humans Transcend Biology’ Raymond Kurzweil (2005)* On the one hand we have the public health data and predictions from WHO-Europe, on the other hand we have the largely US-based predictions of rapid technological growth and its impact on health systems *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 technologies predating the integrated circuit, and which, he argues, will continue to other technologies not yet invented. According to him, artificial intelligence should be able to pass the Turing Test (a test for the presence of intelligence in putatively-minded entities) by 2029, and the technological singularity should occur by 2045. 9  
  • 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. 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. The  Nanomedical  Universe   •  Nanomedicine   •  Nanobots   •  NanoroboBc  therapy   •  Nubots   •  Nanosensors   •  Bionanobots   •  Nanotechnology  
  • 13. The problem with the ‘future is techno.’ approach such as Mike Jackson’s presentation on his site Shapingtomorrow, which skillfully scans potential technological advances and their impact, because of the audience it was aimed at it doesn’t tackle the ‘elephant in the room’ issue that unlike airlines or production lines, present day health is manpower intensive and complex and especially vulnerable to the vagaries of the human psyche. The same argument applies to Luis Cordeiro’s presentation of a future world of enhanced human/ human-robot synthesis, in his role as futurist and ambassador of the Singularity University, CA 13  
  • 14. There are two elephants in fact crowding the room: human nature (a real problem when we come to the value systems employed by the techno- enthusiasts who promote the advent of AI as the solution to our problems) and the sheer size and complexity of current health systems. Their abiding characteristic is the second elephant: that if you concentrate your resources on improving one element in the system, the effects are almost always neutralised by compensating movements elsewhere in the system.   14  
  • 15. 15   The future of European healthcare – a possible scenario
  • 16. To summarise: ‘Sickness care’ in its present form is notoriously wasteful and significant savings are likely to be achieved only by substantial change in the form of care delivery. There are many barriers, both institutional and political which hamper this transformation Increasing life expectancy results in an increased burden of potential healthcare costs which ironically may be exacerbated by increasing expectations from the public for care, potential costs of new technology (it could go either way), the effects of greater health inequalities and of other factors such as migration, climate change etc. In the present setting, financial forecasts suggest that the envelope for healthcare spending has limited capacity for expansion. Equally there is gross underinvestment in prevention and health education. Chronic mismanagement of workforce planning makes it likely that serious shortfalls will impact on quality of care 16  
  • 17. 17  
  • 18. 18  
  • 19. Health effects of the financial crisis: omens of a Greek tragedy In a review of public health capacity in the EU, Prof Brand from Maastricht recently gave the example of the impact of the demands of the Troika on the health of the Greek population, as will be seen in the next slide. However, he was also making a crucial point about the availability of what is called ‘cockpit data’. The effects during 2007-9 were only available in 2011. I have my own example of the same phenomenon based on the local effects of the Spanish crisis…. 19  
  • 20. 20  
  • 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     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   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. 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. In addition to our existing expert knowledge, we started to look at futures methods, such as scenario planning, horizon scanning and wild cards and weak signals methodology, to see to what extent these techniques had successfully been applied 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 achieved thus far within the health policy field in Europe to establish quite a different enterprise… 25  
  • 26. ESQH was set up as a European NGO in 1998. It is registered as a charity in Ireland and the idea was to create a society of national healthcare quality societies, to represent the grass-roots staff across Europe 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. Networks  of  networks   SocieBes   Offices   EU  agencies  and  Associates   27  
  • 28. In summary, there are several reasons that ESQH is well placed to provide a springboard for a new European NGO which concentrates on health futures. Among these are: It has a well established network involving 20 countries and contacts within several stakeholder groups in each Experienced at becoming involved with policy issues at a significant level, starting from scratch and building a brand Run as a lightweight, flexible but effective organisation that is more or less virtual but has appropriate governance Will build on ESQH’s work but will create its own brand and intends to operate faster, smarter and more effectively 28  
  • 29. What are the USPs that EHFF offers, that merit participating in its development? •  Supporting disruptive innovation with a cross-sectoral focus using a network structure •  Offering an approach to health scenarios which fosters on-going multi-stakeholder dialogue •  Aiming to collect data that identifies potential threats to health systems in a more realistic timescale •  Operating in a 21st century organisational mode, with an effective but fluid, inclusive and open-source orientation •  Cognisant of current policy but side-stepping political pressures and the constraints of traditional institutions 29  
  • 30. 30   Consistency of EHFF principles with Foresight concept
  • 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. Global  to  local.  Lessons  from  global  ac$on  networks   (GANs)   Steve Waddell* is fascinated with networks. He says GANs tend to have most of 7 characteristics: they are multi-level, ‘diversity- embracing boundary spanners’, inter-organisational networks, systemic change agents, entrepreneurial action learners, voluntary leaders and global public good producers. EHFF could aspire to most of these, eventually, on a smaller scale than global, but notice how much growth of networks figures in the three work streams discussed below. Steve also stresses that GANs cannot simply float in the clouds as it were; their interest needs to be in ‘where the rubber hits the road’ and on the ground action, because that’s one important area where their influence can be assessed. 32  
  • 33. A  new  context  –  the  new  paradigm  for  how  the  world  works   •  from addressing issues in parts to whole systems thinking •  from inter-national structures to multi-stakeholder ones in order to address the issues •  from assuming the environment to nurturing it •  from linear approaches to change to complex systems strategies •  from negotiating our way to solutions to envisioning futures •  from a conformance focus to a collective values focus Considering that we developed our concept piecemeal over time and intuitively, not having read Waddell’s work, the closeness of fit is pretty spooky! 33  
  • 34. The  three  ini$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. 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. Thank  you  for  your  Bme.     Now,  how  might  we  work  together?          EHFF became a legal entity in March 2013, after two years of planning. The prototype portal address is www.ehff.eu 36