Image sources: Unsplash/Nick Fewings / Centers for Disease Control and Prevention (CDC) / Alissa Eckert, MSMI; Dan Higgins, MAMS; Editing: HiE/Behrends
In February 2019, Dr Jonathan Quick, chair of the Global Health Council, told Raconteur: “Our greatest fear is being blindsided by a new virus, most likely due to animal-human spill over, which then readily spreads from human to human, has at least a 5 to 10 per cent fatality rate, does not respond to existing medicines, and for which an effective vaccine and accurate diagnostic test cannot rapidly be developed.”
We were confident this could happen. We just did not know when.
In many ways, Covid-19 was at the most optimistic end of forecasts. The death toll has been lower, and the economic impact smaller than worst case scenarios. This was our warning. So, what do we do next?
Perhaps the most important lesson we can learn is about readiness. While the pandemic threat remains, and there may be future pandemics following similar patterns, these are not the only challenges on the horizon for healthcare operations. Looking beyond the current situation for other pressures and trends, we can begin to identify from where the next challenges will come and scope out a response.
A century of change
The rest of the 21st Century looks particularly challenging for healthcare operations. We can already foresee clear pressure points arising from climate change, our ageing population and elsewhere.
Our rapidly changing climate creates huge healthcare risks. From forest fires, as we saw recently in California or Australia, and their impact on respiratory diseases, to the potential for floods and droughts in other areas. Food production is likely to be disrupted, and there is already forced migration as some regions suffer the worst of the climate effects.
The greatest impact of climate change on healthcare operations is uncertainty. The instability and unpredictability in weather it creates can have a huge variety of impacts on the population, even in currently temperate climates in the UK and Europe. Considering the impact of climate change is the first of many signals that the future of healthcare operations will need to be extremely adaptable to a fast-changing situation.
As the latest research from the University of Washington shows, the global population is ageing faster than we previously understood. That the size of the population will peak lower and earlier than previously forecast is in many ways positive. It reduces pressure on the planet, and it is driven by rising freedoms for women around the world who, given the chance, are choosing education and careers rather than large families. But it also creates huge challenges. Countries like Italy are forecast to see their populations collapse by up to half this century.
In the UK, the Old Age Dependency Ratio, the number of people post-retirement age for every thousands of working age, is set to rise from 289 in 2017, to 360 by the early 2040s. But this rise will be very uneven. By mid-century, areas like West Somerset could have a 1-1 ratio of old age to working age persons. This not only places an enormous potential burden on the healthcare system, it creates enormous challenges in terms of funding.
We live in an increasingly networked world. Products and people, services and ideas, flow around the world more easily than ever before. This is part of what makes the pandemic risk so great. One infected person can board a plane on one side of the world and a dozen carriers disembark on the other. It is hard to isolate any country now without the risk of serious economic harm. These are competing challenges that leaders have struggled to balance through this pandemic.
Alongside physical movement there is digital travel as well. Information and collaboration are its positives, misinformation and attempts to profit from it, its negatives. While we may have a more informed public now, we also have a more misinformed public, and this creates its own health emergency.
All of this may contribute to critical point in the progress of globalisation. While many have benefited from falling friction in international trade and travel, the tenor of international conversations has hardened in the recent past. Rancorous relations between the US and China, the UK and the EU, and increasingly nationalist and protectionist politics in many countries may see borders hardening.
This could create enormous challenges for healthcare operations in terms of the supply of drugs, equipment, and staff.
With a declining and ageing population, the challenge of maintaining a healthy populace becomes greater than ever. States need citizens to be living healthier lives if those lives are to continue to be extended, so that they minimise their reliance on the healthcare system and can remain economically active. But right now, we are facing several public health crises, not least in obesity.
In the UK, one in four adults and one in five children is obese. And the UK is not an outlier, with the WHO putting the proportion of obese adults across Europe at 23% for women and 20% for men. With obesity being a risk factor for a variety of health conditions – including the current pandemic – and levels rising rather than falling, the public health challenge in the next decades is enormous.
There is also the quieter challenge of mental health, the second largest source of burden of disease in England, and something that costs 4% of GDP across the Europe according to the OECD.
But there is some good news on the public health front. Two of the critical campaigns of the last few decades, on drinking and smoking, seem to be having an impact. While the reduction in smoking and alcohol consumption remains small today, the trends are both moving in the right direction.
Acceleration and efficiency
To understand how these global issues will affect healthcare operations specifically, we also must understand the macro trends that are transforming the way we live and work. The advance of technology in recent years has stripped friction from so many activities: innovation, operations, communications. The consequences of these changes have a clear and visible intersection with some of the pressures facing healthcare, and perhaps present ways to ameliorate some of those pressures.
The most obvious application of technologies that augment and accelerate is in addressing challenges of staffing and funding. The ageing population, the risks to international recruitment, and the post-Covid weakness in the global economy, all point to healthcare systems having to find increased efficiencies in the coming years. Technology that augments each human in the workforce can allow organisations to do more with less, trading some capital investment for much lower operational costs.
These savings can, perhaps counter-intuitively, map to better health outcomes. For example, by improving the flow and management of diagnostic data, time can be saved that is reallocated to analysis and patient care. More patients can be screened, raising the prospect of early diagnosis and treatment – preferable by every measure to a later, more acute response.
Technologies can also improve the collection and sharing of information, as well as its analysis. At Karolinska University Hospital in Sweden, video feeds from cameras and instruments can be presented in the operating theatre, stored against patient records, or streamed anywhere on campus, for example to teaching rooms and lecture theatres, using Sony’s NUCLeUS platform. Streamlining the flow of rich information to people allows wider expertise to be brought in on diagnosis, accelerates learning, and improves record keeping for future analysis.
Creating these digital flows also prepares the operation for perhaps the most discussed incoming technology, Artificial Intelligence. While the term itself is a little hyperbolic at this point, early applications of the more accurately titled Machine Learning have demonstrated the incredible capability of algorithms to analyse patient data and make fast and accurate diagnoses to assist healthcare professionals.
Optimisation and agility
What we must take from the observation of the pressures facing healthcare is not just the need for efficiency but the uncertainty on the near horizon. The challenge of foresight is frequently not in identifying what will happen but when – as it was with the Covid-19 pandemic. Bodies like the WHO were only beginning their preparations for such a virus when it struck. Looking at the varied issues on the near horizon and their many possible effects, it is nearly impossible to say which will strike first or how the different effects will combine to create new challenges.
In response to this uncertainty, what our healthcare operations really need, even more than absolute efficiency, is the capability to adapt to a changing environment and the intersecting impacts of these various risks. With the likelihood that future shocks will require rapid changes of direction, we need infrastructure that can be turned quickly to new challenges, allied with improved information gathering and accelerated decision-making.
The future of healthcare operations is about building structures, systems and processes that can operate efficiently, but adapt rapidly to face new crises. Leveraging technology to strip friction from the organisation can free people to do more with less. Building the right infrastructure today will ensure they have the tools they need tomorrow, whichever challenge they face.
Attribution: ‘Applied Futurist’, Tom Cheesewright in collaboration with Ludger Philippsen, Director Healthcare Solutions Business Unit at Sony Professional Solutions Europe