One step forward, Two steps back.
We have to swap that dance. In order to overcome the deep socioeconomic divides, we must take ‘Two steps forward’ and deal with ‘One step back’ on the way.
We are living in extraordinarily challenging times.
Our cities are burning. Our healthcare systems are on fire. Our economies are bleeding. The Covid-19 pandemic meanwhile has killed over 350,000 people worldwide. Additionally, this health crisis has triggered record unemployment rates with over 40 million Americans who have lost their jobs and livelihoods in the last 3 months alone.
In very short succession, two massively disruptive crises are affecting the world in general and the United States in particular: a health crisis and a socioeconomic racial disparity crisis. As it turns out, they are both tightly entwined. These types of events have been described by some as ‘black swan’ phenomena, referring to a black swan being ultra-rare and unlikely. The truth is though: neither this pandemic nor the racial divide that is erupting after Mister George Floyd was ruthlessly killed by a white police officer last week qualify for this black swan description of being rare, surprising and unpredictable.
Instead, both events and their heart-felt consequences are arriving on a soil of deeply rooted disparities, widespread inequalities and pre-existing flaws in our healthcare infrastructure and societies.
They are phenomena that are much more common than we want to think; as common as a white swan. Scientists had long predicted a pandemic to arrive and even thought it to be overdue. Many recall Bill Gates’ video from five years ago, when he urged the world leaders to prepare for a pandemic. Many others joined with similar calls for action; all as we know went unheard. Instead, an unprecedented lack of preparedness made us vulnerable to a health crisis that then has been causing too many casualties. Lives and livelihoods have been taken directly and indirectly by a novel virus. Also, what has become very clear, very quickly, is that the Covid-19 pandemic has disproportionately impacted minorities in the US and elsewhere because of long preceding socioeconomic and healthcare disparities in black and hispanic communities.
Although the formal ban on racial separation in the US was issued some 50 years ago, it has actually not been completely overcome in people’s minds and behaviors. It lingers in the form institutionalized racism and casual acceptance of inequalities. Amidst the grieving for the too many who have shared the tragedy of George Floyd, and the legitimate protests calling for justice, violence has been breaking out and has been undermining the peaceful protest. It has brought additional hardship onto the already underprivileged with yet another setback onto the livelihoods of so many.
One step forward. Two steps back. No wonder that the widespread anger and despair are growing very, very deep.
However, as Mayor Lori Lightfood expressed last weekend — and I very much share her belief and conviction on this topic— we need to create an environment that transforms the passion. Channeling negative energy doing bad into positive energy doing good.
Both the pandemic and the racial unrest are co-incidentally catalyzing an opportunity for our society to change course for good.
We know that there is no simple answer. No easy way out to fix our underlying healthcare crisis. And certainly no simple solution to revert decades of ingrained behavior around racial disparities.
STEP ONE: EVERYONE HAS A ROLE TO PLAY
The only way forward to master the complexity of these underlying distortions in our societal systems is for all of us to take action.
Every one of us. Individually. Controlling what is in our control. “Be the change that you wish to see in the world,” as Mahatma Gandhi said during his revolutionary times. It is about our duty to care. Our social contract and acting as humans with empathy towards each other. This comes with the moral obligation to care for those who are disadvantaged. We need to transform our systems, laws and regulations towards an infrastructure that allows social welfare and economic growth to co-exist and build off each other.
Each of us carries the responsibility to drive the change in our own areas of expertise, in our jobs and in our communities. We know that small steps can lead to big impact. Easy for everyone to remember are the 15 words that Jamahl Cole, activist and founder of MyBlock*MyHood*MyCity, is promoting:
“What’s something simple I can do that’ll have a positive impact on my block?”
In any situation of collective interest, be it in healthcare or in social welfare, it is the responsibility of leaders to show the way and provide clarity amidst a confusing complexity. What we need in our societies — now more than ever — are calm and mindful leaders who act as integrators. This week, I have been especially encouraged by two prime examples of leaders who have spoken up with reason and compassion.
First, President @BarackObama on Monday shared an inspiring post “How to Make this Moment the Turning Point for Real Change.” He is urging for bipartisan solutions on federal, state and personal levels to support the young generation of activists to develop the solutions akin of this century. He provides useful facts and lessons from the past around police practices and required justice reforms that can help inform solutions to bridge the big divides. He combines this with an unmistakable call-for-action for every citizen to seize their opportunity to vote:
“So the bottom line is this: if we want to bring about real change, then the choice isn’t between protest and politics. We have to do both. We have to mobilize to raise awareness, and we have to organize and cast our ballots to make sure that we elect candidates who will act on reform.”
Second, in a short yet decisive video, Ken Freizer, CEO of one of the major pharmaceutical companies, shares his view on the current unrest and laments the long existing casual acceptance of the racial divide in society. In his remark for action, he specifically calls out the responsibility of leaders in times of crisis. In his case, he specifically speaks about:
“business leaders be a unifying force in helping to calm a nation convulsed by protests over police brutality and economic destruction from the coronavirus.”
Everyone of us, and the leaders among us in particular, can elicit change and — we will succeed if we all work together.
STEP TWO: THE JOURNEY OF HEALING HEALTHCARE DISPARITIES
On the healthcare front more specifically, we have seen the earth shattering eruption that a health crisis can provoke on economies and societal disparities. The transformation that needs to occur is not only in our infrastructure and systems, but more soever in people’s minds:
Healthcare should not be considered as a privilege for some, but as a human right for all.
As I suggested a few weeks ago in my article “It Takes 5 to Tango,” technically speaking, the renewal of our broken healthcare systems will require a shift from a volume & quantity driven model towards a quality & value-based one. However, in order to be successful, this also demands a collaborative approach by the top 5 leaders, which I referred to as the ‘5Ps’ (patient, provider, pharma, payer, policymaker).
Now, the truth is that in this unprecedented moment of disruption, it is the responsibility of all 5P healthcare leaders to seize the chance for change, individually and collaboratively. It is in this moment of crisis and despair that new paths forward can be forged.
Within the realm of healthcare disparities and within my own area of medical expertise, I am suggesting two steps of action. With the aim to stimulate the debate, they are seeking out solutions to optimize efficiencies in the healthcare ecosystem. They are both tailored to disrupt and innovate the top two portions of the current healthcare expenditure pie:
- wasteful healthcare delivery that accounts for $1 trillion in the US every year, a tremendous amount of money that could be repurposed otherwise
as well as
- among the 5Ps, the hospital-provider sector, which represents the single largest portion of the healthcare spending, equaling also $1 trillion.
Action 1 _ Learning & training to reduce wasteful healthcare delivery
Earlier this year, I came across a thought-provoking article entitled “Does value mean doing less?” In the article, Dr Lisa Hicks, chair of the American Society of Hematology (ASH) committee on quality, stipulates that an excess of ‘overtesting and overtreating’ patients can do more harm than good. In other words, in a culture of excessive care, resources that are urgently needed to fix gaps in the healthcare infrastructure, are being unnecessarily wasted elsewhere.
This whole idea of turning ‘waste’ into a potential value-driver on the journey to transform healthcare systems sparked my interest. Essentially, what we are seeing in the current healthcare ecosystem is an increasing amount of inefficiencies with 30% to 50% of funds being ‘wasted’ depending on estimates from various sources.
Dr Hicks is hinting to a very important cultural change that needs to happen to put a halt on the upward cost spiral. She elaborates that “as physicians, we’ve been trained to test, test, test. We are, I think, appropriately concerned about missing things, but that culture can lead to harms from overtesting.” Albeit, as physicians we always want and seek for the best care for our patients: this care needs to be the appropriate care.
The goal is to choose the right test and the right procedure, for the right patient at the right time.
A key driver to more appropriately allocate resources and enhance productivity is starting with the training of the next generation of caregivers, physicians and nurses. Starting with the end in mind. Indeed, the medical educational systems have not seen major revisions or modernization at scale to integrate digital tools and technologies akin of the 21st century. What we are still seeing today is students and residents being forced into an ‘analog’ and transactional type of learning. It involves consuming quantities of medical and scientific knowledge rather than using technology as a resource and focusing on the quality of training.
What is urgently needed is a shift towards learning on how to think at the patient’s bedside.
Remember, $1 trillion wasted due to a culture of excess care. We do not have an issue of shortage of funds in healthcare. We have an issue of redirecting them to the right places that generate value for all.
Action 2_ Redesigning the patient experience in the care circuit
In a novel value-based healthcare system that incentivizes quality and outcomes, the patient is at the center core. Yet, can we answer the question: ‘What does the patient experience feel like?’
Mapping out the patient journey on their way through a hospital circuit may illustrate some of the idiosyncrasies of a complex hospital care reality to date. On the search for a definitive diagnosis and curative treatment, patients navigate through the labyrinths of different departments and engage in a close dance with their caregivers. They can feel overwhelmed and confused by the sheer amount of tests and exams. Adding on administrative redundancies with multiple inquiries asking the patients to repeat their stories over and over. Not to mention endless hours of waiting times — first, for the exams to be scheduled and occur, then for the results to arrive. All in all, more often than not, this patient experience can be a stressful one, which as we know is contra-productive to the goal of improving health outcomes.
Last year, Dr Stephen Klasko, CEO of Jefferson Health, represented the US provider perspective during a global healthcare panel discussion. Concerning the implementation of a value-based healthcare model, he provided a compelling summary on what success will look like once a system transitioned from quantity to quality: “We will start to be paid based on how healthy our population is versus how many people come in to fill our beds.”
In a novel era of health management, the patient takes on a new role as consumer and owner of their health continuum. This is particularly true in the context of health disparities, as the emphasis will shift onto disease prevention and the required educational efforts to support patients as the owner of their health and lifestyle management. Technologies using smartphones and telemedicine will complement the ability to effectively manage chronic conditions such as diabetes, hypertension and immune related diseases with the patient being at home.
The idea of keeping the patient out of the hospital as a major disruptor carries a true potential to transform, generate and increase value. Indeed, experts believe that the Future of Hospitals will lie in two areas: first, to provide acute and intensive care; second, to act as a ‘care-orchestrator’ for the patient. This represents a fundamental step change from what traditionally has been a transactional exchange of services and products for money in a fee-for-service model. Some prestigious institutions such as the Mayo Clinic have already embarked in this direction of travel. Years ago, they initiated a successful redesign of the holistic patient experience in their health system. This did not only increase patient satisfaction, but also led to efficiencies in patient adherence to treatments and effectiveness of the hospital operations; so much so that this pilot project subsequently led to the founding of the Mayo Clinic Innovation Center.
STEP THREE: EMPHASIZING THE HUMAN TOUCH
We are living in unprecedented times of major disruption to the socioeconomic fabric of our society. Deeply rooted disparities and vulnerabilities have become unmistakably visible to all of us. Nevertheless, history has shown that even in the darkest moments of despair, countries and societies can re-emerge and forge a path forward. We have a unique possibility to make this moment a true turning point to refocus on societal values, social welfare, equality of justice, diversity and sustainable healthcare for all. As beacons in a society, it is even more so the responsibility of leaders to swap the dance and persistently drive real change by taking two steps forward and managing one step back along the way if need be.
As one of the major pillars in our economies, healthcare is still prone to deep socioeconomic disparities. However, the cracks in the healthcare ceiling cannot be paper-patched. They require fundamental reforms and a transformation into a modern model akin of the 21st century, growing the value pie for all. This means re-centering our systems and infrastructure on the patient experience. Increasing the quality of patient health outcomes from prevention to cure and using modern technologies as a vehicle will enable the acceleration of this transition into a sustainable new model.
But let’s be clear, despite the greatest technological advances possible and the most futuristic healthcare models, we must not lose sight of the human touch. Being an oncologist myself, I know all too well the importance of holding a patient’s hand whilst breaking bad news during the healing process. The empathic touch cannot be replaced by machines nor technology at large for that matter. If we truly want to improve on equality in healthcare, we have to put all emphasis on the patient as the owner of their health journey and create an environment where health outcomes that matter to people are prioritized.
