What now? — Health management post covid 19
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Alexandre Lourenço's keynote on "WHAT NOW? Health management after COVID-19", at the SDA Bocconi #MIHMEP graduation ceremony, 25 February 2022, Milan, Italy.
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What now? — Health management post covid 19
- 1. alexandrelourenco.eu WHAT NOW? Health management post COVID-19
- 9. … emerged paradox of disintegration. © 2022 ALEXANDRE LOURENÇO CONFIDENTIAL AND PROPRIETARY
- 14. What happened during the pandemic? © 2022 ALEXANDRE LOURENÇO CONFIDENTIAL AND PROPRIETARY
- 15. clients are dehumanized objects bureaucracy “the doctor knows best” professionalism “the patient knows best” patient-centered care
- 17. Ignore the need for transformation or lead the transformation © 2022 ALEXANDRE LOURENÇO CONFIDENTIAL AND PROPRIETARY
- 19. Health system panorama LEGACY PROVIDERS PHARMA/ MEDICAL DEVICES NEW DIGITAL PROVIDERS INDIVIDUAL HEALTH PROVIDERS © 2022 ALEXANDRE LOURENÇO CONFIDENTIAL AND PROPRIETARY
- 20. 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-.
- 21. Anyway, the future does not necessarily arrive in a straight line. Grazie mille www.alexandrelourenco.eu
Editor's Notes
- Buon pomeriggio. Good afternoon. I will be talking about healthcare, particularly healthcare management. As a hospital administrator struggling to be an academic, a particularly relevant topic. Today, covid-19 is an excuse to talk about healthcare and our role in changing it. Not that I’m minimizing the relevance of the last two years. Last year, my hospital had more then six hundred covid-19 patients hospitalized during several days. We faced singular moments in our lifetimes. Too many persons died by covid-19 and non-covid-19 diseases, and many families lost their dear ones. Too many healthcare professionals suffer and are scarred for life.
- As Italians, 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.
- If anyone knows this topo, please raise your hand. Not the two in the right — that is my sister and me. Tough audience. As you can see, different generations have different knowledge. I am- we are . from ages that have never known the devastating effect of infectious diseases. We are products and consequences of a modern society and healthcare system. We know Topo Gigio but never experienced the true power of infectious diseases That way, the covid-19 pandemic was singular. Not that it was unpredictable. It was foreseen, and different scenarios were built. We have never experienced something like it.
- We do not need to go back in time to face infectious diseases. Triumph of Death (Brugel the Elder)
- It would be enough to have been born in other latitudes or longitudes to feel its impact on the vulnerable human condition. Looking at why people die tells how they live. Compare the leading causes of death between high-income with low-income countries, where the leading causes are neonatal conditions, lower respiratory diseases, etc. In common, only ischaemic heart disease and stroke. The ones that even richer countries are not able to solve. — non communicable diseases.
- Let's 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.
- 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 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.
- 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.
- A system that looses receptivity and walks towards oblivion
- 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 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.
- 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 lead health systems to change configuration and perform complex functions, like people centered.
- 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 an alternative player. 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. a new world is around the corner