Key Challenges facing European Healthcare
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Alexandre Lourenço's keynote on "Key Challenges facing European Healthcare" at the Health Management Institute of Ireland (HMI) Annual Conference in Dublin (2-Nov-2022).
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Key Challenges facing European Healthcare
- 1. Alexandre Lourenço Hospital Administrator & Adjunt Assistant Professor Coimbra University Hospital & Nova National School of Public Health Key Challenges facing European Healthcare
- 7. We ended up with XXI century technologies embedded in 1950 organisations © 2020 ALEXANDRE LOURENÇO CONFIDENTIAL AND PROPRIETARY
- 12. Healthcare system panorama LEGACY PROVIDERS © 2022 ALEXANDRE LOURENÇO CONFIDENTIAL AND PROPRIETARY
- 14. Improve operational decision-making Digital transformation patient flow This webinar is co-funded by the EU4Health Programme of the European Union. Views and opinions are of the speakers only.
- 15. Improve operational decision-making Digital transformation patient flow staffing This webinar is c-funded by the EU4Health Programme of the European Union. Views and opinions are of the speakers only.
- 16. Improve operational decision-making Digital transformation patient flow staffing scheduling
- 17. Improve operational decision-making Digital transformation patient flow staffing scheduling supply chain management
- 18. Health system panorama LEGACY PROVIDERS PHARMA/ MEDICAL DEVICES NEW DIGITAL PROVIDERS INDIVIDUAL HEALTH PROVIDERS © 2022 ALEXANDRE LOURENÇO CONFIDENTIAL AND PROPRIETARY
- 19. clients are dehumanized objects bureaucracy “the doctor knows best” professionalism “the patient knows best” patient-centered care © 2022 ALEXANDRE LOURENÇO CONFIDENTIAL AND PROPRIETARY
- 20. What happened during the pandemic? © 2022 ALEXANDRE LOURENÇO CONFIDENTIAL AND PROPRIETARY
- 22. Ignore the need for transformation or lead the transformation © 2022 ALEXANDRE LOURENÇO CONFIDENTIAL AND PROPRIETARY
- 24. The care configuration grid © 2022 ALEXANDRE LOURENÇO CONFIDENTIAL AND PROPRIETARY
- 25. Uber lessons for healthcare © 2022 ALEXANDRE LOURENÇO CONFIDENTIAL AND PROPRIETARY LEADERS HAVE THREE CHOICES: 1. ignore innovators and hope for the best 2. call for increasing regulation to make it harder for innovators to enter the market 3. compete on quality and efficiency, disruptive though that might be Detsky, A.S., and A.M. Garber (2016) N Engl J Med 374: 806-.
- 28. Thank you! Alexandre Lourenço URL: www.alexandrelourenco.eu Email: alexandre.lourenco@ensp.unl.pt
Editor's Notes
- Speaker title
- Let me start to go back to the origin of healthcare providers and how they evolved. Back then and until the post-second world war, the well-off were treated at home, and the poor needed to be hospitalized.
- The modern hospital results from the differentiation and technological development of the second half of the 20th century. Over the last 70 years, these new cathedrals have given a new focus to our lives: we are born, live, and die in the hospital. The hospital changed and prolonged our lives.
- At the same time, the hospital services are more differentiated, medical professionals get more specialized, medicines and treatment are more precise,
- a new paradox emerges. The dichotomy of high differentiation and increased disintegration, particularly for patients with multimorbidity and aged.
- Contrary to other industries, healthcare resists to organizational changes and continues to be primarily organized as it was more than half a century ago, and it struggles to adapt and evolve to overcome those challenges.
- We can even say that we ended up with XXI century technologies embedded in 1950 organizations. We talk about bigdata and AI, but we don’t even know how to use much simpler technologies or achieve interoperability. We don’t know how to crawl, and we ask our organizations to run the marathon.
- Where we face the risk that incumbents, do not allow other business models and models of care to evolve.
- Actually the system is more and more detached from individual and population needs. Ignoring that today’s needs are quite different from those observed in the recent past. Population aging and multimorbidity, the increase in citizens’ expectations, fiscal constraints in a context of low economic growth, the emergence and re-emergence of infectious diseases, or even the digital society, pose new and essential challenges to a structurally inflexible and rigid health system. A system that has proven incapable of promoting health and preventing disease, eliminating variability and inequity in access, and providing integrated care focused on people’s needs. A system like this bridge in Choluteca, Honduras, could not adjust to the river course/ population needs.
- A system based on inputs: Number of doctors, Number of beds, Number of nurses, Number of MRIs, Number of respirators. A system of volume: number of surgeries, number of medical appointments,
- A system that looses receptivity and walks towards oblivion
- The health system is typically dominated by: healthcare traditional providers: healthcare professionals that are organized in hospitals, primary care centers, clinics, etc
- Did you realize that the dawson report that establishes the idea of levels of care was published more 100 years ago?
- PATIENT FLOW data-driven operational decision-support systems can provide valuable insights to aid in making these triage, admission, and discharge decisions. ER Triage, decision to admission, and bed preparation Machine learning and decision-support algorithms can also be used to predict the expected number of admissions, discharges, and transfers to and from the ward
- STAFFING - Digital technologies can also help with the supply side when it comes to better managing capacity. Take, for example, nurse staffing, which accounts for a significant proportion of hospitals’ costs. Instead of relying on phone calls, text messages, and spreadsheets to make ad-hoc staffing decisions that often change at the very last minute, charge nurses and hospital administrators can utilize analytics to improve this process. For example, algorithms can predict nurse absenteeism rates and the need for surge staffing to preemptively determine the right number of float nurses to call in. Research in emergency department operations shows that both can be modeled, even in environments where demand is highly uncertain.
- SCHEDULING While many hospitals have moved to electronically capturing and storing patient records, the scheduling of various resources is still largely a manual process. This applies to the scheduling of surgical procedures in operating rooms, scans in radiology suites, and many others. This is another area where digital technologies can bring substantial improvements — not only by better predicting resource needs and effortlessly incorporating last-minute changes and cancelations but also by optimizing schedules based on the latest research. machine-learning algorithms can be used to better predict the duration of each procedure such as the length of a surgery or an MRI.
- SUPPLY CHAIN MANAGEMENT Across many industries, digitally transforming the supply chain has been shown to reduce process costs by 50% and increase revenue by 20%; hospitals are no exception. By automating the process of collecting data, ordering, reconciling, and paying for medical, surgical, and pharmaceutical supplies, hospitals can reduce supply chain and inventory management-related costs. Radio-frequency identification (RFID) technologies and internet-connected trackers can be used to better track and locate supplies in real-time and allow a better usage of equipments and consumables.
- The health system is typically dominated by: healthcare traditional providers: hospitals, primary care centers, clinics, etc pharma and medical devices industry These two have been evolving in developing precision medicine and risk-sharing contracts. Hospitals also understand that they need to break their walls and increase proximity to patients and communities. Namely to solve problems in provider-patient transitions. A third party is emerging. Primarily as technological partners of legacy providers, pharma, and medical devices industry. New technological players are primarily influencing the previous two. We see its influence on Bigdata, remote monitoring, etc. If primarily they rely on conventional providers, they now venture themselves to solo initiatives: remote physical therapy, teleconsultations, etc., disrupting the way care is being provided. In my opinion, the most significant disruption will come from alternative players. The individual health providers. The primary technology companies are investing in health prevention. They have the capacity and resources to influence healthcare, as we didn’t see it yet. The ability to detect prediabetes, fever, arrhythmia, and provide meaningful advice. With telehealth quickly becoming more prevalent, clinicians’ roles may evolve in some unexpected ways. As more patients begin accessing care through video connections, it is not hard to imagine a pathway toward lower-cost care providers. The first wave could involve price shopping in a patient’s local community. That could be followed by price shopping in different communities or worldwide. And once we are conditioned to getting our care through a computer screen, could software-controlled, animated chatbots of some kind be that far off? Although the need for the health professions is not going away, it is likely to fundamentally change. While technical expertise may not distinguish care providers the way it once did, relationship expertise will become far more important. a new world is around the corner
- We know, that due to institutional forces and professionalism, and limited management, the healthcare system tend to status quo. Most industries have evolved from bureaucratic principles to market relations in the past decades, where the customer knows best in opposition to classic professionalism in which “the doctor knows best,” or bureaucracy, where clients are seen as dehumanized objects. During the covid-19 crisis, we have witnessed that professionals and managers worked together and redesigned care.
- The Pandemic did not eliminate any challenge, on the contrary, it created others. Perhaps, it allowed us to perceive that it is possible to change in an adverse context.
- We know that the same configuration of care will only permit the same functions to be provided. The pandemic contingency catalyzed care structural change and allowed healthcare to perform different functions.
- Are we using this experience to transform healthcare or choosing to ignore the need for change or prepare for transformation? Many still insist on the past solutions, promising more funding, hospitals, or doctors, without understanding that the current model is approaching obsolescence.
- It is at this point that managers need to lead health systems to change configuration and perform complex functions, like people centered.
- From the relation between the concern for the transaction and patient-centeredness, the grid shows five positions: X Laissez-faire provider Efficient provider Pioneer model of care The “good life” model of care Sustainable reconfigured model of care X Vertical movement requires transformational leadership. Horizontal movements require transactional leadership. Both the framework and the care configuration grid are novel contributions to the theoretical understanding of patient-centered care under organizational theory, providing guidance to policymakers and managers on positioning their organization. Moreover they enable the identification of the priority issues to address when implementing patient-centered care-
- I hope you know the meaning of the safety car — the pace car. It enters the when a major incident occurs. Everyone slows down and gets ready to restart the race. This is how I hope that we look at covid-19, a major incident that will allow us to rethink the healthcare system. After all the crisis we had in the first 20 years of this new century, we cannot afford to lose this one to not evolve the health system.