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.

Exponential innovation, or getting ahead

Josep Maria Monguet

The sustainability of health services is associated with rational development. The key element is the generation of knowledge-intensive employment, which can only be the result of innovation.

In general terms, innovation in health must have an exponential dimension and be based on:

• The generation of intelligent demand by health professionals
• The participation of citizens and all social and economic agents
• The promotion of business models based on value for users

Innovation or decadence. There’s no middle ground

Josep Maria Monguet

Innovation is not a fad; it’s a structural phenomenon of the future, largely a product of the acceleration in the production of new knowledge. Innovation was always part of our world, but there are two new factors nowadays:

1. Accelerated innovation: more novelty in products and services are observed more frequently.
2. It's everyone's business: each one of us are protagonists of innovation.

Innovation 3.8 over 10: a clear "not passing"

Josep Mª Monguet

Self-deception is the path to regression. A few years ago (in 2006), I was invited to speak at the opening course conference for one of the entities of my university. I spoke about the deficit in innovation observed in Spain, sustained by multiple data. The rector, who spoke later, did his best to deny it using the sole argument that the universities had a large scientific production [1]. It became clear that he didn’t understand the difference between innovation and academic scientific production. Well, ten years later, our country is still the same if not worse. We can continue doing nothing about it, but we must understand that for building an innovative country, the islands of excellence are essential, but not enough.

To optimise the expense, the cost must be reduced

Josep Mª Monguet

It’s well known that the budget allocated to health services has endured brutal cumulative reductions over recent years. This is a detrimental fact, but one can not deny the merit of having suffered and then having survived the cut, the professionals - in the first instance and the users alike. It’s sad but praiseworthy.

The health budget is unlikely to improve in the short to medium term because the situation is what it is and by definition the public deficit has a ceiling. Lamenting that resources were not well managed during the "good times" doesn’t change anything. Although it seems a contradiction, the financial management cannot be improved if the health system and its users, collaboratively, are incapable of reducing the avoidable costs that weigh us down. Only thus we can free up resources and allocate them to make the system more efficient.

Keep calm and leave the mobile for a while

Josep Mª Monguet

The trade fairs tend to present the technological innovations somewhat passed by the commercial magic, which puts at risk the necessary objectivity to evaluate what they will actually contribute. This is aggravated if we consider that technology is nowadays advancing much faster than human capabilities. As technological innovation progresses exponentially, the adaptive and changing capacity of individuals and organizations is logarithmic.

In general, to take advantage of the new options that technology offers, you have to know where you want to go and what to do to get there; the problem is that we just grope. The good news, however, and the fair is a good exponent, is that so many of us are doing it that the possibilities for progress don’t stop multiplying. Remember Edison when he said he had discovered 10,000 ways of not making a light bulb.

Big Med or wholesale medicine

A few months ago, Josep Maria Monguet published a post on this blog about the low cost medicine in India, and along these lines I thought it would be interesting to comment on an article by Atul Gawande in the New Yorker with some comparative reflections between medicine and restaurant chains. "In medicine -says Gawande- try to provide a wide range of services to millions of people at reasonable costs and an acceptable level of quality, but the reality is different: the costs continue to rise, the service we offer is mediocre and the quality, uneven. Each doctor has his own way of doing things and the variations in the results, even within the same health centre, are inexplicable.

Dave Luz, regional manager at the Cheesecake Factory in the Boston area, explains to Gawande that his mother, with advanced Alzheimer's, fell down at home the other day and has been taken to the emergency room, where doctors visited her, did various tests and kept her under observation for the night. Luz received three types of explanations: from the emergency physicians, from the internist at the observation room and from a specialist, and these were not exactly coincident. He soon realized that there was no plan involved there. The next morning, a nurse told him that his mother was fine and that they would prepare her for discharge but because the nurse in charge was having her breakfast, they would have to wait, and that process, seemingly bureaucratic lasted until the afternoon because the doctor who had to make the discharge report could not be found. To cap it all, when it was time to dress his mother, the auxiliary disappeared and Luz had to fend for himself. With the discharge papers, he would schedule a control visit to collect the results of urine tests and one to see a neurologist. A couple of weeks later, the neurologist, after an examination that lasted a couple of minutes, called for new tests (by the way some matched those that had been made in the emergency services) and prescribed some medication that, once asked what they are for he admitted they‘re useless. Dave Luz says that this kind of disorganization among professionals and circuits, this lack of an overall plan, was to be found everywhere where he had to go to accompany his mother for receiving medical care.

Low cost medicine "made in India"

By Josep Mª Monguet

On 25th February, the first building of the Health City hospital complex which plans to grow up to 2,000 beds and be accredited by the JCI, offer all kinds of advanced tertiary health services and even open their own university, was inaugurated in the Cayman Islands. But what really draws the attention towards all of this is the origin of the initiative, which is none other than innovation in the health business model from India. Between 2001 and 2012, Narayana Health, a project led by Dr. Devi Shetty evolved from a 300-bed hospital in Bangalore to an aggregate of 6,000 beds in 17 hospitals, 80,000 patients and 3,500 interventions per month. And now they have switched their antipodes to enter the global market, offering, via a one and a half hour flight from the United States, open-heart surgery, prosthesis or neurosurgery, for obviously very competitive prices.