The  Future  of  Surgery  |  The  Emerging  View    Insights  from  Mul0ple  Expert  Discussions  10  March  2016   The  world’s  leading  open  foresight  program  

Context  Discussions  on  the  Future  of  Health  in  2015  were  followed  by  a  deeper  explora0on  of  the  Future  of  Surgery  including  an  event  in  March  2016.    

It  is  the  emerging  view  to  be  shared,  challenged,  built  upon  and  enhanced.    

Ini0al  View  Feb  2016  

Global  Feedback  Mar  2016  

Synthesis  Apr  2016  

The  Future  of  Surgery  |  The  Emerging  View    This  document  provides  an  overview  of  what  we  heard  from  many  expert  voices  around  the  world  –  on  the  future  of  surgery,  how  it  is  changing,    what  is  driving  this  change  and  how  it  may  evolve  over  the  next  decade.  

Six  Key  Themes  Across  the  mul0ple  discussions,  issues  related  to  surgery  

seem  to  be  touching  upon  and  connec0ng  with  six  underlying,    and  interwoven,  themes  with  different  emphasis  in  different  countries.  

The  Impact  of  Digital  

Technology  Enabled  Change  

The  Wider  Team  

Funding  Constraints  

Agreed  Procedures  

Global  Solu0ons  

THE  IMPACT  OF  DIGITAL  

Data’s  Impact  on  Health  BeUer  use  of  data  and  technology  has  the  power  to  improve  health,  

transforming  the  quality  and  reducing  the  cost  of  health  and  care  services.  It  can  give  pa0ents  more  control  over  their  health  and  empower  carers.  

   

Everything  Connected  By  2025  over  1  trillion  sensors  are  connected  to  mul0ple  networks:  Everything  that  can  benefit  from  a  connec0on  has  one.  We  deliver  10,000x  more  data  100x  more  effec0vely  but  need  to  make  sense  of  the  informa0on  that  flows.  

   

Universal  Healthcare  Data  Access  Informa0on  silos  are  connected  via  third  par0es  able  to  unify,  mine  and  

discover  new  insights.  Integrated  public  and  private  datasets  provide  holis0c  views  of  the  individual  and  value  shiZs  to  decision-­‐making  analy0cs.  

   

Data  PrioriFsaFon  An  increasingly  digital  healthcare  system  is  driven  by  access  to  credible  data  that  is  priori0sed  above  the  noise.  The  value  of  such  key  data  increases  

as  its  ability  to  unlock  opportuni0es  and  improve  diagnosis  rises.  

   

Digital  Autonomy  Increasing  access  to  more  personal  and  group  data  allows  individuals  to  take  

informed  views  on  their  health.  As  informa0on  is  decoupled  from  the  professions,  the  public  become  more  specific  about  their  needs.  

   

Ubiquitous  Tracking  Health  monitoring  through  the  use  of  wearables  and  implants  improves  and  more  people  share  their  data  with  trusted  independent  pla\orms.  Poten0al  

issues  are  predicted  and  dealt  with  earlier  –  so  fewer  interven0ons  are  needed.  

   

A  Data  Marketplace    Data  is  a  currency,  it  has  a  value  and  a  price,  and  therefore  requires  a    market  place.  An  ecosystem  for  trading  data  is  emerging  and  anything    

that  is  informa0on  is  represented  in  a  new  data  marketplace.    

   

Data/Human  Teaming  Faster  and  more  convenient  access  to  raw  and  sophis0cated  data  analysis,  

through  mobile  and  wearable  technologies,  means  that  data-­‐enabled  decision  making  will  increasingly  become  the  norm  for  consumers  and  ci0zens.  

   

TECHNOLOGY  ENABLED  CHANGE  

Through  Body  VisualisaFon  High  resolu0on  imaging  and  fast  developing  holographics  provide  us    

with  the  ability  to  see,  interrogate  and  explore  within  the  body    before  first  incision  –  as  well  as  throughout  the  surgical  process.  

   

Real-­‐Time  Bio-­‐Manufacturing  In-­‐theatre  prin0ng  of  bio-­‐materials  brings  mul0ple  opportuni0es    

for  the  3D  building  of  biological  0ssue  and  bespoke  organs.  We  can    create  replacement  parts  that  are  made  from  our  ‘own’  cells.  

   

Nothing  is  Hidden  Everything  in  the  opera0ng  room  is  tagged  and  interconnected.    

Physical,  chemical  and  wireless  sensing  link  with  open,  transparent,  interrogable  data  sets  allow  us  to  see  what  was  previously  unknown.  

   

Remote  RoboFcs  Miniaturised,  data-­‐rich  and  increasingly  autonomous  robo0cs  enable    the  surgical  team  to  improve  efficiency  and  impact.  Gesture-­‐based    

control  allows  surgeons’  requirements  to  be  automa0cally  recognised.  

   

Smarter  Sensor  Systems  Ubiquitous,  miniaturised,  intelligent  systems,  built  around  common  standards,  enable  an  affordable,  pervasive  and  connected  world.  This  leads  to  improved  

security,  greater  personalisa0on  and  the  ‘massifica0on’  of  data.    

   

Full  ManipulaFon  Mul0-­‐axis,  conformable  manipula0on  devices  allow  surgeons  beUer    and  less  invasive  access  within  the  body.  Coupled  with  more  accurate    posi0oning  and  precision  ac0ons,  collateral  0ssue  damage  is  minimised.  

   

Specialised  Training  SimulaFon  As  surgeons  focus  on  being  more  expert  at  fewer  procedures,  the  use  of  simula0on  in  training  increases.  Virtual  and  augmented  reality  become  

commonplace  and  accelerate  familiarity  with  technologies  that  enter  the  OR.  

   

The  Rise  of  Machines    The  growth  in  the  intelligence  and  capabili0es  of  machines  presents  both  a  threat  and  an  opportunity.  Greater  automa0on  frees  up  0me,  but  also  has    the  poten0al  to  threaten  more  jobs  in  managerial  or  administra0ve  roles.      

   

THE  WIDER  TEAM  

Complex  CollaboraFon    Increasingly  integrated  services,  end-­‐to-­‐end  provision  as  well  as  deeper    and  wider  collabora0on  provide  the  ability  to  work  more  effec0vely    

within  a  system  designed  for  con0nuous  improvement.    

   

CollaboraFve  Business  Models  Partnerships  shiZs  to  become  more  dynamic,  agile,  long-­‐term,  democra0sed  and  mul0-­‐party  collabora0ons.  Big  challenges  are  addressed  by  global  groups  

of  diverse  stakeholders  built  around  new,  non-­‐financial  incen0ves.    

   

High  Quality  Support  Surgeons  are  are  like  technicians  -­‐  the  more  surgeries  they  perform,  the  beUer  they  get  at  it.  But  behind  every  skilled  doctor  you  need  to  have  at  least  two  

highly  skilled  nurses,  at  least  four  or  five  technicians,  and  good  administrators.  

   

Shared  Authority      Decision  making  authority  is  shared  by  surgeons,  pa0ents,  and  other    

clinical  and  opera0onal  staff.  There  is  increasing  emphasis  on  the  complex  range  of  agendas,  understanding  and  responsibili0es  in  play.    

   

Stressed  Surgical  Load    The  supply  /  demand  limits  of  the  overall  surgical  load  is  increasingly  tested  in  

some  areas  due  to  an  imbalanced  surgeon  pool,  increasing  pa0ent  expecta0ons  and  regulators  focused  on  performance-­‐led  efficiencies.  

   

MoFvated  Surgeons    Industry  efforts  are  taken  to  re-­‐mo0vate  the  surgeon  pool.  These  include    more  public  discourse  about  surgery,  greater  alignment  of  process  and    

pa0ents  and  system  wide  ini0a0ves  toward  improving  its  image  and  credibility.  

   

FUNDING  CONSTRAINTS  

The  Healthcare  Debt  Time-­‐Bomb  The  rising  cost  of  healthcare  results  in  ra0oning  and  the  end  of  universal  

healthcare.  Individual  health  budgets,  preven0on  technology,  migra0on  and  working  longer  all  increase  as  new  approaches  seek  to  improve  efficiency.    

   

IncenFves  in  Flux  Budgetary  pressures  con0nue  and  reimbursement  models  will  need  to  change.  There  is  greater  emphasis  on  paying  healthcare  providers  based  on  measurable  

outcomes,  rather  than  simply  for  the  number  of  procedures  they  perform.    

   

Living  While  Dying  We  will  see  policy,  product  and  service  innova0ons  in  the  field  of  end-­‐of-­‐life  planning.  Businesses  and  professions  will  come  to  recognise  the  need  to  provide  more  (end-­‐of)  life-­‐style  choices  to  individuals  and  consumers.  

   

EnFtlement  is  not  Universal  The  implica0ons  for  some  are  clear:  we  need  a  different  healthcare  model,    we  need  technology  to  really  deliver  improvements  at  scale  and  at  low  cost  and  to  reduce  the  level  of  cover  to  a  good  propor0on  of  some  popula0ons.    

   

CollecFve  AcFon  to  Control  Chronic  Disease  To  stem  the  runaway  costs  of  trea0ng  chronic  diseases,  mul0ple  stakeholders  

collec0vely  seek  to  halt  key  condi0ons:  Remote  monitoring,  educa0onal  programmes  and  focused  budgets  are  all  integrated  around  common  aims.  

   

Sustainable  Healthcare  With  limited  resources,  rising  demand  and  escala0ng  costs,  decoupling  healthcare  spend  from  economic  growth  is  a  global  challenge.  A  more  sustainable,  integrated  model  may  emerge  from  beyond  the  US/EU.    

   

AGREED  PROCEDURES  

Prescribed  Surgery  Payers  increasingly  dictate  how  surgery  is  performed  based  on  quality  and  

cost.  League  tables  of  hospitals  and  surgeons  and  wider  sharing  of  informa0on  provide  greater  transparency  that  helps  to  define  the  op0mal  approaches.  

   

Personalised  Healthcare  For  the  privileged  few  with  access,  personalised  healthcare  tailored    around  individual  medical  and  pyscho-­‐social  needs  provides  therapies    

that  are  beUer  aligned  with  specific  rather  than  generic  profiles.    

   

InfecFous  Diseases  Post-­‐Ebola  The  world  prepares  for  infec0ous  disease  outbreaks  with  renewed  vigor.    There  is  increased  prepara0on  and  coordina0on  among  both  public  and  provider  stakeholders  and  greater  investments  in  early  warning  systems.    

   

ElecFve  PrevenFon  Equipped  with  greater  understanding  of  the  individual’s  gene0c  predisposi0ons  

and  new  interven0on  technologies,  we  proac0vely  undertake  minimally  invasive  surgery  and  reduce  the  need  for  major  surgery  in  later  years.  

   

Greater  Evidence  Wider  genera0on  and  sharing  of  data  shiZs  the  scale,  type  and  accuracy  of  evidence  used  to  make  decisions.  The  best  procedures  become  more  visible  and  are  beUer  supported  by  payers,  surgeons  and  the  wider  health  industry.  

   

PrevenFon  Wake  Up  Call    The  combina0on  of  spiraling  healthcare  costs  and  a  subsequent  demand  for  efficiencies,  leads  to  the  ‘wake  up  call’  for  all  payers  with  less  focus  on  costly  correc0ve  procedures  and  greater  emphasis  on  the  ability  to  keep  people  well.  

   

GLOBAL  SOLUTIONS  

MulF-­‐Step  Care  Journey  The  idea  of  surgery  as  a  discrete,  scheduled  interven0on  is  replaced  by    an  understanding  of  surgery  as  part  of  mul0-­‐step  process  involving    

tailored  planning,  prepara0on,  aZercare.  

   

Sources  of  Global  SoluFons  Global  healthcare  affordability  will  not  come  from  the  Unites  States  …    

but  rather  from  those  na0ons  of  the  world  that  have  liUle  today  and  have  no  choice  but  to  perform  at  the  highest  levels  possible  in  the  future.  

   

Need  for  Process  InnovaFon  Today,  most  healthcare  interven0ons  are  not  accessible  to  nearly  90%  of  the  world’s  popula0on.  The  way  forward  is  not  a  new  medicine  or  a  new  scanner  or  a  new  opera0on  -­‐  it  is  a  process  innova0on  to  bring  healthcare  to  everyone.  

   

Small  and  Distributed  Surgery  With  the  democra0sa0on  and  digi0sa0on  of  personal  health  data,  surgical  

support  shiZs  to  more  local  systems  for  earlier,  minimal  interven0on.  Providers  correspondingly  become  smaller,  de-­‐centralised  and  more  outcome  focused.    

   

Greater  RegulaFon  Rising  regula0on  drives  up  costs,  reduces  innova0on  and  limits  small  

companies’  ability  to  develop  new  products.  As  global  and  regional  standards  become  more  stringent  proac0ve  lobbying  by  larger  organisa0ons  increases.  

   

Mass  Medical  Tourism  Medical  tourism  goes  main-­‐stream  as  low-­‐cost  cardiac  surgery  and  broader  

healthcare  provision  join  den0stry  and  cosme0c  surgery  to  have  global  impact.  Western  systems  pay  for  pa0ents  to  travel  to  leading  loca0ons  abroad.  

   

Human  Approach  We  see  a  diverse,  plural,  human-­‐centric  approach,  or  simply  wider  access.  Pa0ents  are  treated  as  individuals,  and  technologies  emphasise  usability    

and  ergonomics  as  much  as  their  innate  technical  func0onality.    

   

Some  QuesFons  

Some  QuesFons  From  these  discussions  on  and  around  the  future  of  surgery,  there  seems  to    be  a  number  of  key  ques0ons  to  be  addressed  by  payers,  providers  and  

pa0ents  –  some  global  and  some  more  local  or  regional  in  focus.  

1.  In  an  increasingly  cost-­‐conscious  world,  how  will  payers  take  greater  control  away  from  surgeons  and  pa0ents  and  who  will  set  the  global  prices?  

2.  How  quickly  can  we  knit  together  the  mul0ple  data  streams  to  make  more  informed  decisions  and  reduce  systemic  waste?  

3.  With  more  technology  in  the  opera0ng  room  and  increased  automa0on  will  the  surgeon  remain  the  team  leader?  

4.  As  ever  more  global  standards  emerge,  how  will  individual  states  and  health  systems  best  op0mise  healthcare  delivery?  

5.  How  will  the  pa0ents  voice  be  heard  in  the  changing  system,  both  in  terms  of  choice  as  well  as  (co)funding  of  surgery?  

Future  Agenda  84  Brook  Street  London  W1K  5EH  +44  203  0088  141  futureagenda.org  

The  world’s  leading  open  foresight  program  

What  do  you  think?  Join  In  |  Add  your  views  into  the  mix  

 www.futureagenda.org