futurepoints

8/7/2019 futurepoints

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The future of health

care

Richard Smith

Editor, BMJwww.bmj.com/talks


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The possible agenda Dangers and difficulties of looking to

the future

Why bother then? How best to think about the future?

What is Foresight?

Drivers of the future

Three scenarios

Pictures of the future of health care

Two reports on the future of health care

What does the future mean for now?


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Dangers of predicting the

future

I never make

predictions,

especially about

the future.

Sam Goldwyn

Mayer


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Predictions of Lord Kelvin,

president of the RoyalSociety, 1890-95

"Radio has no future"

"Heavier than air flying

machines are impossible"

"X rays will prove to be a hoax


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Looking to the future: common

mistakes

Making predictions rather than

attaching probabilities to

possibilities

Simply extrapolating current

trends

Thinking of only one future


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Looking to the future: common

mistakes

People consistently

overestimate the effect of short

term change and underestimate

the effect of long term change.

Ian Morrison, former president of the

Institute for the Future


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Why bother with the

future?

"If you think that you can run an

organisation in the next 10

years as you've run it in the

past 10 years you're out of your

mind."

CEO, Coca Cola


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Why bother with the

future? The future belongs to the

unreasonable ones, the ones

who look forward not backward,who are certain only of

uncertainty, and who have the

ability and the confidence tothink completely differently.

Charles Handy quoting Bernard Shaw


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Why bother with the

future?

The point is not to predict the

future but to prepare for it and

to shape it


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How best to think about the

future?

No answer to the question, but one

way

Think of the drivers of change

Use the drivers to imagine different

scenarios of the future

Imagine perhaps three; each shouldbe plausible but different

Extrapolate back from those future

scenarios to think about what to do

now to prepare


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What is Foresight? Foresight is a method of thinking

about the future in order to think

about what should be done now The British government has

conducted two rounds:

startingin1994 and 1999

The first round was concerned

mainly with informing research

policy; the second was much

broader, including social impacts


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The aims of Foresight To produce a report on how the

future might look

To provide material for central

and local government and

public and private organisations

to prepare for the future To shape the future

To get a whole lot of people

thinking about the future


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The methods of

Foresight Decide on subjects

Gather a group together--

diversity is important

Ask them to think about the

future, using whatever methods

they want

Oblige them to think along way

ahead (2020 in the latest round)


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The methods of

Foresight Oblige them to be bold and creative (hard)

Try and persuade them not to be too linear

(hard) Oblige them to think about scientific,

organisatiomal, political, and social

implications

Ask them to make recommendations on

what should happen now to prepare for the

future

Disseminate with energy


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The Foresight panels

1999 Healthcare

Ageing population

Crime prevention

Manufacturing

Built environment and transport Chemicals

Defence, aerospace, and

systems


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The Foresight panels

1999 Energy and natural environment

Financial services

Food chain and crops for industry

Information, communications, and

media

Materials

Retail and consumer services

Impact of e-commerce on future

business models


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Healthcare task forces Public and patients

International influences on

health and healthcare

Older people

Organisation and delivery of

healthcare

Information


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Healthcare task forces Delivering the promise of the

human genome

Pharmaceuticals, biotechnology

and medical devices

Neuropsychiatric health

Transplantation


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Drivers of change in health

care Internet

Beginning of the information age

Globalisation

Cost containment

Big ugly buyers

Ageing of society

Managerialism

Increasing public accountability


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Drivers of change in health

care Rise of sophisticated consumers

24/7 society

Science and technology --

particularly molecular biology and

IT

Ethical issues to the fore Changing boundaries between

health and health care

Environment


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Examples of future

scenarios forinformation and health


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Three possible futures:

titanium Information technology develops fast

in a global market

Governments have minimal control People have a huge choice of

technologies and information

sources

People are suspicious of government

sponsored services

There are many truths


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iron A top down, regulated world

People are overwhelmed by

information so turn to trusted

institutions--like the NHS

Experts are important

Information is standardised

Public interest is more

important than privacy


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wood People react against technology

as against genetically modified

foods Legislation restricts technological

innovation

Privacy is highly valued Internet access is a community

not an individual resource

There are no mobile phones


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Pictures of the future of

health care


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Pictures? Asking people to draw pictures can free up

their thinking as well as those who look at

the drawings

Its the conversation around the drawings

rather than the drawings that matters

Having said that, here are two pictures of

the future of health care that I carry in my

mind. The first is from Tom Ferguson, an acute

observer of the digital age, and the second

from Uwe Reinhart, professor of economics

at Princeton


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Fee for service for the rich

Marks and Spencer style managed

care for the middle classes

Safety net service for

the poor


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Two reports on the

future of health care


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Healthcare 2020

Foresight Healthcare Panel

Department of Trade andIndustry, London

www.foresight.gov.uk


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Selections from

Healthcare 2020 42 recommendations

Institutionalise thinking about

the future--otherwise, as with

genetics, the future may take

longer to realise

More rolled back healthcare--more community and home

based healthcare with IT

support


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Selections from

Healthcare 2020 Chronic disease management will be

a cornerstone of future healthcare

Diagnosis needs to be made morerational--as the Cochrane

Collaboration has done for treatment

Patients and the public will come to

the heart of healthcare--but how will

this happen with the public?


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Selections from

Healthcare 2020 Improving health through innovations in

social policy rather than through high

tech Putting health at the centre not the

edge of politics

Regeneration medicine will become a

major component of healthcare--use ofstem cells, xenotransplantation, tissue

engineering, induced regeneration,

modulation of the ageing process


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Selections from

Healthcare 2020 We have done badly with

neuropsychiatric illness, but it will

become steadily higher profile withrising prevalence and a sharp

increase in diagnostic and

therapeutic possibilities

Dementia may eventually strike 85%of the population

A greater emphasis is needed on

prevention


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Selections from

Healthcare 2020 Beyond electronic patient

records to health biographies

Cyberphysicians

Moving from information to

knowledge


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Information and health:

technological developments

Think for itself hardware and self-

generating software by 2020

Wearable computers; intelligentclothing

Personal agents-- digital butlers;

smart sensing

Electronic circuitry can be

connected to nerves and tissues


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Cyberphysicians: the

problem Healthcare is a knowledge based

business but information is poorly

delivered Doctors now suffer from the

information paradox--drowning in

information but cannot find the

information they need Patient information is often neither

evidence based nor easily

accessible


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Cyberphysicians

The number and form of

infomediaries--knowledge brokers will

proliferate All the information available to

professional will be available to

patients

Cyberphysicians will look after peopleshealth, detecting changes through

sensors, prompting preventive

activities and treatments


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Infomediaries: doc.coms

People will be able to use

doc.coms to:

Ask questions

Interact with others with similar interests

Use software that will help with health risks

Use decision support systems

Consult with professionals

Access their own health records

Buy health related products


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Health records: the

problem Current health records are: Paper based

Disorganised Often illegible

Lost

Scattered

Poorly linked


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Health records

Health records might be Electronic, lifelong, perhaps recording all

food and drink consumption, exercise, etc Accessible from anywhere

Linked to other records, like social care

Multimedia

Collect information from sensors in thebody or home

Data mined

But beware Big Brother


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Crossing the quality chasm

A new health system for the

21st century

Institute of Medicine, 2001


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Reports opening quote

Knowing is not enough; wemust apply

Willing is not enough; we

must doGoethe


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IOM report: the problem

Between the health care we have

and the care we could have lies not

just a gap, but a chasm A system full of underuse,

inappropriate use, and overuse of

care

Unable to deliver todays scienceand technology; will be even worse

with innovations in the pipeline


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A fragmented system

characterised by unnecessary

duplication, long waits, anddelays

Poor information systems;

disorganised knowledge Brownian motion rather than

organisational redesign


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A system designed for episodic

care when most disease is

chronic

Health care providers operate in

silos


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IOM report: moving forward

Commit to a national statement of

purpose for the health care system

Six aims

safety, avoid injuries

effective, evidence based

patient centred, patient values guide

decisions

timely, reduce waiting and delay

efficient, avoid waste

equitable, care doesnt vary by gender,

ethnicity, etc


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IOM report: 10 rules for

redesigning health care 1. Care based on continuous healing

relationships--care whenever its

needed, not just through face to facevisits

2. Customisation based on patient

needs and values

3. The patient as the source of control 4. Shared knowledge and free flow of

information


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redesigning health care 5.Evidence based decision making

6. Safety as a system property

7. The need for transparency--allinformation available, including the

systems performance on safety,

evidence based practice, and patient

satisfaction

8. Anticipation of needs


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redesigning health care

9. Continuous decrease in

waste

10. Cooperation among

clinicians


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IOM report: getting started

Concentrate on the conditions

that account for most health

care (cancer, heart disease,mental health)

Produce plans that will lead to

substantial improvements--likeEnglands national service

frameworks

A fund for innovation


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IOM report: six challenges for

health care organisations

1. Design seamless, coordinated

care

2. Make effective use of IT,including automating patient

records

3. Manage knowledge so that itis delivered into patient care


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IOM report: getting evidence

into health care delivery Ongoing analysis and synthesis of medical

evidence

Delineation of guidelines

Identification of best practices in design of

care processes

Better dissemination to professionals and

public

Decision support tools

Goals for improvement

Measures of quality for priority conditions


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IOM report: six challenges for

health care organisations

4. Coordinate care across

patient conditions, services,

and settings over time 5. Advance the effectiveness of

teams

6. Incorporate measurement ofcare processes and outcomes

into daily practice


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What will survive as the

world changes completely: 1. Clear ethical values

2. Being clear about our mission

3. Putting patients first

4. Constantly trying to improve

5. Basing what we do on evidence

6. Leadership

7. Learning


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Conclusions

Patients will have the same access

to knowledge as professionals

Self care or rolled back care willbecome steadily more important

Professionals and patients will

become much more equal partners

Evidence will become steadily more

important


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Conclusions

Health care systems will increasingly

be concerned with chronic not acute

disease

Health will increasingly be at the

centre not the edge of politics

There is a chasm between what health

care could do and what it does do Some things--ethics, learning,

leadership--will continue to be

important whatever happens


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Conclusions

The future is highly unpredictable

Nevertheless, it is important to think

about the future; those who do prosper A good way to think about the future is

to imagine different futures, usually

called scenarios

Two reports, one American and oneBritish, have had similar thoughts about

the future

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