The health care system of the future is here now

Josep Mª Monguet
 

Who took the chestnuts out of the fire?

In difficult moments, everything is shown as it is and that is when authentic leadership can be identified. In this sense, a revelation of the recent stage, which we could already intuit, is that health care professionals have shown an exceptional capacity for response. It’s not a common occurrence in the public system. Despite the multiple deficiencies faced, they have assumed the difficult part of the situation and overcome it.

In an earlier time, also known as February 2020, our existence was statistically predictable, with relatively low odds of experiencing a crisis. Today, the proximity of a certain and little controlled danger brings us new sensations in which threats and opportunities are intermingled. It has become brutally clear that without health there is nothing, that we have a hard time learning and that there are things that are not done well.

I want to talk about two ideas that characterize aspects of this pandemic and that have the common axis of health care professionals.

• A collective intelligence test has been carried out in health care centres.
• A critical mass of people with innovation potential has emerged.

It’s about two expressions of the same phenomenon in which we live: the overcoming of the post-industrial era and the gradual change towards a more transparent and more conscious society. I will try to advance some reflections on the key to the future.

What is collective intelligence?

Collective intelligence (CI) is the manifestation of the value of the group when it acts efficiently unifying efforts to take initiative and solve problems. The CI cannot be improvised, for it to appear certain conditions must be met: knowing how to work as a team, one and the other must be listened to and respected, there must be credibility and mutual trust and one must have competencies. To make the group’s work even harder, we reduce the response time to a minimum; eliminate expectations of obtaining some type of extrinsic reward, and add the risk to one's health.

Facts. Many health care organizations, of different sizes, from a few dozen people to a few thousand, have revealed their level of collective intelligence. Teams of professionals have taken the initiative and merged to tackle new and unknown problems.

• An emergency has been assumed, abstracting from the bureaucracy and confronting it in more than one case.
• New knowledge about the disease and its treatment has been incorporated, in real-time and expressly, as has never been done before.

What is a person with innovative potential like?

A person with creative and innovative potential has several qualities:

• Is predisposed to constantly learn without complexes, assuming she does not know everything.
• Admits diversity as a consequence of the variability of cases that he has to solve in his work.
• Can empathize with people listening, for example, to their stories.
• Can multitask and distribute the time between production, research and management. That is, it combines effort-result thinking in the short, medium and long term.
• Knows how to act responsibly by making decisions with different degrees of freedom.
• Can manage stress in its different formats.
• It’s subject to transparent and permanent accountability.

You will agree that a health professional can easily identify with most of these attributes and is therefore predisposed to experimentation and change. From here to entrepreneurship and systematic innovation there is only one step.

Facts. In health care centres, in these months, a latent innovation potential has “imploded” as a result of the pressure. Hospitals have been transformed into ICUs overnight and primary care has massively managed the population at home and treating a disease for which there were no clinical guidelines. Why was it possible? It is because professionals have the key qualities necessary to innovate. We have several examples of this:

• Attention has become telematic, radically adapting to a new model.
• Teams have restructured their work in real-time.
• We have worked with engineers and designers solving new needs in record time.

The future of the healthcare sector

And this is where I wanted to go. What are we to keep from what is happening?

• What has changed? Management autonomy and bottom-up coordination have been required.
• What is a great asset? It’s the health care professionals, both collectively and individually.
• Can you keep the change? No reason justifies returning to the previous normality without taking advantage of what has happened.

In an objectively difficult situation - little time, ignorance, risk and limited resources - results have been achieved. With less pressure, in more familiar situations, with controlled risk and with a minimum of resources, it would be logical to trust that health care centres of diverse types are capable of organizing and coordinating themselves. Is it so irrational to let the organizations of the system solve everything on their initiative? It’s not easy, but this is, in Marxist language, a revolutionary moment.

The first contribution to some debates that don’t add value if they are raised in a reductionist way:

• Public and private. Service is neither better nor worse for being public or private. Equity and social justice are associated, without evidence, with public ownership of services. But the results seem to improve when there are public-private collaboration and non-profit activity.
• Technology and people. People are what counts, but technology increases its potential. The FAANGs (Facebook, Amazon, Apple, Netflix and Google) are neither alien who wants to control us, nor are they the ones who will solve our lives. But they have an extraordinary potential to be exploited.
• Privacy and collective. It’s a very serious mistake that all the data that people are generating is not being exploited, particularly in the health system. Surely, neither the Chinese model, which seems to obviate any personal right nor the European model, which puts individual rights ahead of any other, are sustainable solutions. Apart from this, there is the problem of managing and controlling the abundance of data collection sources.
• Health and social. After witnessing the sad disaster that has occurred in the residences of our grandparents, is there any doubt that social services have to be integrated into the health care system?
• Self-management and control. The principle of subsidiarity must be applied and all centres must be given maximum management autonomy. Is there still someone capable of defending that a healt care centre can manage tens of thousands of citizens with a new risk to their lives, but cannot manage the budget for training its personnel or the purchase of consumables without intermediaries?
• Conflicts of professional competences. The pandemic has moved some debates about the boundaries of professional skills into the zone of ridicule. Let's leave them there and focus our attention and energy on the challenges that we will be able to identify from now on and that we will have to solve together with interdisciplinary collaboration.

Before COVID - After COVID (BC-AC)

That health has collapsed the political agenda is clear, but what is relevant is that people have experienced that health is key and that the economy has unexpectedly become dependent on it. In a more advanced society, the errors, the duties concerning these errors and the deficiencies that have occurred would now be analyzed. And in an even more advanced society, the situation would be taking advantage of to deepen knowledge and consolidate changes.

The world is shutting down with regulations and administrative processes. A transformation has begun towards a social model based on trust in the individual, who acts freely with more awareness and subjected to levels of transparency that had never existed before, but that today technology allows us to design and implement.

The most important component of the transformation is people, and the health care system has them. Let's throw away the old chip (BC) and put the new one (AC), let's do pedagogy taking advantage of the social leadership that has been gained in the health field. Let us not allow the force that has overcome the inertia of the past to be diluted.

A window of opportunity has opened for a future that is now and here.