IPG - Health

Report: Health and Community Care

Australia’s Nobel Laureates Vol III

State of Our Innovation Nation: 2022 and Beyond

Applying digital technology to the strategic challenges

INTRODUCTION

Health and community care providers were impacted more through the pandemic than any other sector. However, more funding and more change may not have addressed the perennial challenges of these sectors, and in some cases have exacerbated them. Digital technology adds to these risks and is also a way of solving some of them. This selection of articles aims to support Health and Community Care leaders in navigating their way through the continuing complexity towards the promise of what can be achieved.

Mark Nicholls, CEO, Information Professionals Group.

Mark is at the forefront of digital technology transformation, known for his ability to engage people at every level, and honing in on client priorities to find the right formula for organisations to grow their way. He is a passionate advocate for the benefits that effective digital technology brings to industry, community, and the country, and has seen first-hand the challenges around digital technology that organisations face today.

Mark’s passion is contributed through IPG and its clients and his active role across industry and government with the AIIA, the peak industry association for the digital economy, where he serves as National Deputy Chair. https://www.linkedin.com/in/markdnicholls/

CONTENTS

Page 3 - Digital Services – A new level asked from regional providers

How did digital adoption manage to accelerate so significantly through the pandemic? I look back at the dynamics of what happened to create the conditions for this to be achieved, and whether there is some common traits that allow for these to be repeated, by all organisations, with these phenomenon particularly noticeable in smaller and regional organisations.

Page 5 - Digital services post pandemic: the health and community services perspective

How well positioned is Health and Community Care after the last few years of rapid change? Are there lessons, has there been a strong legacy created, or are there some hangovers that will require addressing due to the speed with which some change happened? This articles unpacks that question for leaders in these sectors.

Page 7 - The Healthcare Revolution

This is a very inspiring article by Jeffery Braithwaite of the International Society for Quality in Health Care, that paints a vision for where healthcare delivery can go, why it is so critical to make this change, and the combination of governance, funding, technology and people change to take us there.

Page 9 - Cooperation key to Australia’s digital transformation

Written by Australia’s Nobel Laureates Volume III, they introduce the benefits of finding common ground between parties so that greater value can be untapped and more digital investment justified.

Page 10 - The Information age meets the Golden Years

This case study of an aged care provider shows some good examples of where technology fits into the overall provision of care, as well as those things that technology is unlikely to do. While I don’t know Peter Fuller of Micro Focus, nor do we work with that company, his portrayal of opportunities for community care generally and aged care specifically is very good.

DIGITAL SERVICES - A NEW LEVEL ASKED FROM REGIONAL PROVIDERS

In my experience in the ICT industry, I have witnessed many significant changes surrounding mainstream adoption of technologies and have become familiar with the various factors that play a role in the speed of technology adoption, having been engaged in technology adoption for over 3 decades.

Around 9 years ago, I published a series of articles and delivered several presentations on the topic “The Pressure for Change”. In these talks, I set out to describe the tension created among three parties, namely digital innovators trying to gain traction for new products and services, the community’s ability to change and adopt these innovations and become customers, and government’s ability to either de-regulate or regulate to support the change that innovation brings.

My proposition was that government is generally the slower of these three, and so those innovations that rely on regulatory change will gain traction late. Next slowest was the community. People need a compelling argument to change their habits, and many innovations simply don’t stack up.

Those that did stack up initially, were those where the product or service could be digitalised readily, creating convenience and improved utility for customers. Thus, banking, entertainment (TV/ movies/music), information and knowledge (newspapers, magazines, books and directories) were all “first movers”, as governments had a minimal role to play here and therefore weren’t slowing the process by “getting in the way” (or failing to “get out of the way”).

Other innovations were either digitalising aspects

of existing physical services, or creating new physical services with the help of various digital solutions. This included ride-sharing services like Uber; food and grocery delivery services; and a number of other improvements when it came to researching and buying products and services, even if the final sale and delivery was done in a non-digital way. In fact, house, car, and many other types of purchases are now performed partly online and partly offline, with some providers having moved (or moving into) fully digital sales models.

Some of these generated more interest from Government than others, especially where they conflicted with existing regulation. Ride-sharing is the most notable example here. To their credit, Uber (and others) adopted a “crash or crash through” approach to that problem. It is unlikely they ever would have gained sufficient patience from their

By Mark Nicholls

New community expectations have all organisations trying to keep up with digital transformation.

investors and achieved success if they waited for every government to go about due consideration and change. They created a problem and forced governments to address it. It worked, but was not without damage. A number of legacy license holders were big losers and various governments, even today, are still taking rearguard action.

How has the pandemic affected this dynamic? Firstly, community priorities have changed. The general public needed better ways of going about their lives due to enforced lockdowns or self-imposed restrictions on movement. Industry (and Government) service providers needed new ways of delivering services to customers, citizens, staff and students. And Government, in their regulatory role, wanted to facilitate many of these as it helped to minimise the impact of restrictions on physical movement by supporting as much economic and community activity as possible.

As a result, the interests of all parties aligned, and we gained massive acceleration in digital adoption across so many sectors.

Many of the technologies adopted have been around for many years, even decades, so it was not a question of whether these were new, but whether they were being newly adopted. These technologies created the enablers, the pre-existing capability that could be scaled. This included cloud technologies - allowing services and systems to be accessible anywhere and scaled immediately – as well as video conferencing, which was already gaining wider adoption with Zoom making the services provided by Cisco and others more accessible. Microsoft was already well advanced on its Teams solutions, although they did accelerate their development through the pandemic, as did many technology providers. Even QR codes, first used by millions through the pandemic, have been around for over 25 years - it was defined as an ISO (International Standards Organisation) standard 22 years ago.

As we move slowly (hopefully) out of the COVID-19 pandemic and into an endemic phase, what have we learned in digital innovation adoption and where are the opportunities today/tomorrow?

In many cases, community expectations for digital services are moving faster than some organisations can provide. Those organisations most challenged are smaller organisations, those that operate in regulated environments with restrictions on revenue growth, and this also tends to be regulated service providers in the non-metropolitan regions of Australia. This may include local government, utilities, healthcare, community, and aged care providers. Furthermore, skills are a big challenge generally,

and in regional areas this is an even bigger issue. What is the solution to all this unfulfilled digital transformation ambition?

One answer lies in the lesson of the pandemic. As stated above, “the interests of all parties aligned and we gained massive acceleration in digital adoption across so many sectors.”

If we align the interests of regional service providers, how can they better collaborate, and potentially create economies of scale to digitise more quickly? And with their customers geographically distributed more than most, they have an even more compelling argument to provide digitised services.

Sharing technology platforms, digital skills, and internal technology capabilities all offer accelerators for regional providers. Cloud technologies offer capabilities that support this. Commonwealth and state governments have been quietly adopting various forms of shared technology provision for some years now. This lowers the cost of digital service delivery, allowing scarce funds to be redirected into improving services. That investment in improvements also goes further with shared use of the same capability.

While traditional “shared services” delivered some unfulfilled promises over a decade ago, the new shared models supported by new technologies are now generating many benefits for the clusters, consortiums, and alliances that adopt them.

Our building body of case studies are increasingly reflective of the quiet promise that is delivering results across Australia.

Mark Nicholls is a partner and CEO of Information Professionals Group (IPG), as well as National Deputy Chair of the Australian Information Industry Association.

DIGITAL SERVICES POST PANDEMIC: THE HEALTH AND COMMUNITY SERVICES PERSPECTIVE

Building further on the article series inspired from that published in Australia’s Nobel Laureates Volume III, where we highlighted the amazing speed of technology adoption through the pandemic and then considered the sectors that we work with at IPG. The broad view was very positive on how technology, community and government interests aligned to accelerate technology adoption and create many benefits.

Professor, NYU Stern School of Business, is also very true of Health and Community Services. The pandemic accelerated pre-existing trends, underway prior to the pandemic. Health and community care providers were impacted more through the pandemic than any other sector. While they got more funding, they were impacted by more change and had a lot more responsibility than most in helping their communities get

By Mark Nicholls

As we consider those sectors, we work with at IPG, in Government, Local Government, Utilities, Health and Community Services and Growing Companies, this article unpacks the Health and Community Services sector.

The phenomenon put forward previously and well unpacked by Scott Galloway 1 ,

safely through the pandemic.

This acceleration occurred across a range of pre-existing trends, some in digital technology, but many others beyond digital technology, and with broad consequences.

Across health and community care, burnout, stress, and turnover has been occurring among

The pandemic accelerated digital technology adoption. But it also accelerated other trends, and the experience across health and community services reflects that.

clinicians, healthcare professionals and support staff prior to the pandemic. The aging population, the shift to remote working and increasing digitisation of care are some of those trends that have continued or accelerated. And with it so has the burnout, stress, and turnover.

While digital technology is driving some of these pressures, it is also part of the solution. And so progress on digital technology adoption has been a differentiator.

In health and community care, smart use of technology, that can support clinicians and administrators, coupled with new staffing models, and new care models can lift both quality and productivity at the same time.

Firstly, some data points on the trends being faced by the Health and community care sector, thanks to Sharon Hakkennes of Gartner, are:

• In a recent poll of approximately 1,200 healthcare workers in the U.S., 84% reported that they were burnt out and almost half reported that they were likely to exit the workforce in the next few years. Of those likely to quit, 71 per cent sighted staffing shortages among their primary reason. The International Council of Nurses estimates that prior to the pandemic there was a global shortfall of 5.9 million nurses and that due to these underlying shortages, the aging population and the impact of the pandemic this number is expected to grow to 13 million in the future.

• Ongoing technology advancements and the dramatic increase in adoption of virtual care experienced since the beginning of the pandemic means healthcare organizations need to find and develop a workforce with new skill sets. In the 2020 NHS England staff survey, of the 579,400 respondents, 36 per cent reported that they had been required to work remotely as a result of the pandemic. While digital technology is driving some of these pressures (e.g. remote health care and remote working), it is also part of the solution. If this dilemma can be resolved to maximise the advantage that digital technology can bring and manage the challenges of digital technology adoption, then a successful journey ahead can be mapped. Hence digital technology becomes a critical input into strategy setting and delivery.

Examples referenced by Sharon, of ways in which this dilemma can be addressed include:

• Strategically adopting technology, such as artificial intelligence, machine learning and robotic process automation, to assist clinicians in interpreting tests and accessing relevant patient history and provide automated pre-defined diagnosis to augment clinician decision making. This can create productivity benefits and lift quality at the same time.

• Utilising digital tools in recruitment, credentialing,

onboarding, and rostering. This can reduce administrative overhead, speed cycle times and in the case of rostering, optimise rosters based on patient acuity and volume and enhancing the employee experience through access to self-rostering capabilities.

• Digital capabilities, supported by smart rostering allow healthcare organizations the opportunity to deploy new staffing models, such as increasing flexibility with regards to time and location of work. For example, MercyOne Des Moines implemented a virtual nursing program to offset nurse shortages. Using this model, virtual nurses assist bedside nurses by performing various clinical tasks such as reviewing charts, patient education, patient observation and managing the discharge process. Such a model can also support skill shortages, where an experienced nurse can “virtually” support more junior staff at the bedside.

The organisations that have proven their ability to adapt and adopt these solutions are those with the culture, capability and technology that is able to support these shifts in strategy. This adaptability, includes having the digital technology platforms, the capability to leverage and adapt those digital technology platforms, and the culture to drive and accommodate change.

Hence for all health and community care organisations, we recommend:

• That senior clinicians and administrators have the ability to select and implement these solutions effectively, via an effective Governance, operating and financial model design that will deliver the whole of organisation strategic needs.

• That these decisions support the establishment of adaptable digital platforms, that can continually be evolved to the needs of the clinicians, staff, and patients.

• The digital health capability of the workforce is built with both foundational digital health literacy and solution-specific knowledge to enable effective use of solutions. And then supplemented effectively with external skills as required.

For more on getting the building blocks of innovation delivery in place, see this article, by IPG CEO, Mark Nicholls. These examples prove once again, that regardless of sector, the organisations that have found most success are those with the culture, capability and technology that are able to support the delivery of, and shifts in, strategy and policy.

We would welcome your views and input on all aspects of this article, so please get in touch to share your views.

THE HEALTHCARE REVOLUTION

Jeffrey Braithwaite, gives a preview of

Consulting a doctor from the comfort of home for your suspected cancerous tumour or a fractured collar bone, and artificial intelligence (AI) interpreting the subsequent medical image in the blink of an eye. This is the tip of the innovation iceberg in the revolution of the Australian healthcare system brought on by technology, and hurried along by the impetus of the COVID-19 pandemic.

The revolution is being built out of innovations everywhere you look. If we are scientifically smart and sociologically astute, this will add up to real and sustainable transformation.

Not that long ago, it would have been inconceivable that appointments with general practitioners and specialists would not be held face-to-face. The old adage said you only had to look in a waiting room to see why everyone was called a patient – they had to be. But the COVID-19 pandemic catapulted telehealth from the edges of clinical practice to a nationwide front-and-centre-response.

This is a particularly good news story for those who are older or living with disability, and now no longer needing to leave home to consult a healthcare provider. With the use of technology, they can receive advice and obtain prescriptions and referrals in a time and place that suits them.

The shift to telehealth is not on its own truly revolutionary – it is more of a natural evolution, because the technology has been around for a while.

The backstory that it’s part of – the problem that needs to be solved – is worth recounting. Already a million Australians are aged over 80 years and this is on the rise. A woman aged 65 years today can expect to live almost another 25 years, and a man perhaps 20.

This is good news, but it also places a huge

load on the health system. Older people, even healthy ones, need more care. One in every two Australians is now living with at least one long-term chronic condition such as diabetes, heart disease, kidney disease, arthritis, asthma or cancer. Regular and more frequent contact with health professionals is needed to support such people – and not just treat them, but help them manage their own health and avoid acute episodes that may result in hospitalisation.

Health systems and medical researchers, alongside many clinicians, had for some time advocated the normalisation of telehealth to lift the burden of frequent out of home healthcare. It took the self-isolation and physical distancing requirements brought on by COVID19 to drive the policymakers to move barriers and enable the change, and of course, for the Federal Government to fund it.

Canberra did that overnight. But that innovation is only a modest down-payment on the

By Jeffrey Braithwaite

what Australia’s future healthcare system should look like: AI-assisted, remote care for an increasingly older and chronically ill population.

We will know we have succeeded when every Australian has access to the care they need, where it suits them and at a cost and in a form that is sustainable to the individual and the health system

real revolution encapsulated in the march of astonishingly clever machine learning in healthcare. Not only are AI models now able to interpret medical imaging with great accuracy, AI enabled decision-support technologies are unlocking the possibility of truly personalised medicine like never before. If we can support clinicians through AI we can get faster and better diagnoses, tie together huge data sets including genomics data, and genuinely take on board patient preferences. We will be witness to a prodigious leap forward in care.

But what’s often lost in the headlong rush to exploit technology is that it all comes at a cost and health systems and governments will need to think and act strategically to stay ahead of the curve. Telehealth funding models were devised in haste due to demand brought on by the coronavirus pandemic and will require fiscal retrofitting to be sustainable.

In the future, funding models should anticipate change and lay the foundations for well resourced, equitable and safe implementations – whether in

times of crisis, or more considered eras.

Yet there’s something more. We have to figure out how to package all this change into a modernised health system for everyone. At the crossroads of people, technology and funding is the development of what we call a learning health system. This is one that is able to unite these innovations and adapt to them in real-time – because change is not a thing, and never a destination, but a journey.

So, system-wide, clinically oriented and patient centred outcomes will be possible like never before – if we exploit technology well. Last century we were asked to think global and act local. In the 21st century a better aphorism is to reimagine change over and over again, off into the distant future.

A learning health system is what is going to make this work. For Psek and his colleagues, this is one which can “utilize sophisticated technologies … to integrate clinical operations, research and patient participation … to continuously generate knowledge, improve care, and deliver value". Or, in ordinary language, make the health system better each day than the day before.

It’s a set of arrangements that leverages learning –whether via sophisticated information technologies, or data mining, or machine learning, or genomics. This will enable us to more quickly and more precisely match the best available approaches to treat every patient’s unique and individualised needs. Essentially, we will be putting all the information that is needed in the hands of clinicians and patients so they can make much better decisions.

Australia’s healthcare revolution is not about small intubations brought about by any one new technology, nor a knee-jerk reaction as experienced due to COVID-19. As important as that is, it won’t last forever. But the continuous revolution I have in mind comes from the significant changes to our population demographics, our opportunities with technology that we haven’t even invented yet, the dedication and professionalism of our healthcare workforce and our ability as a prosperous nation to support new funding models to pay for it all.

It was Buckminster Fuller, the American architect, who said, “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”

Let’s do that continuously. We’ll have healthcare that will flourish for decades to come.

Jeffrey Braithwaite is President-Elect of the International Society for Quality in Health Care, and Founding Director of the Australian Institute of Health Innovation.

COOPERATION KEY TO AUSTRALIA’S DIGITAL TRANSFORMATION

While the coronavirus may not be as “novel” as it once was, the remarkable advancements in applied digital innovation during the pandemic are. Several technologies and processes, for example, QR codes, online shopping, at home video conferencing and eLearning, have become part and parcel in the daily lives of so many Australians.

Time travel back to 2019 and anyone invested in digital transformation, whether in the private or public sector, would have suggested that these examples were marginally useful additions to the lives of Australians, and perhaps some years away from becoming mainstream.

We have seen the government’s ability to pool and direct resources, industry’s ability to deliver at scale and quite often at pace, and lastly, we see the community’s ability to adapt and adopt, if there is a sufficient reason for them to do so.

When combined, these newly adopted technologies illustrate how governments, industry and the community can work together to innovate, adapt, adopt and ultimately make everyone's lives better by solving common challenges. It has been good to see what can happen when these three forces collaborate to the extent we have experienced.

New South Wales, Victoria and ACT governments vie for being the leading jurisdiction in the country when it comes to digitising everyday interactions between citizens and their government. This is according to the recent history of Telstra’s Digital Inclusion Index, Cisco’s Digital Readiness Index and Intermedium’s digital government report card. The Federal Government is also moving quickly and has set its plan to be one of the top three digital governments in the world by 2025. Meanwhile, industry is getting on with the job of continually improving and refining their digital capabilities for their clients, their staff and other stakeholders.

As we manoeuvre out of this pandemic (albeit there may still be a way to go), the best legacy seems to be the continued collaboration for the greater public good. This working

together in harmony is vital when considering the number of other significant challenges Australia is facing (not limited to climate change and growing external geo-political threats as two examples) that require the country’s best and brightest minds to work together.

For more than 20 years, Information Professionals Group has supported growing companies, councils, government, utilities and health and community organisations, to navigate the complexities and sensitivities associated with implementing change in challenging environments. The company’s leadership has always informed its work by asking “How does the customer benefit?”

While we hope it is a long time before the next crisis of pandemic proportions, we know that this spirit of collaboration can undoubtedly go a long way to tackling other complex challenges. It is in this vein that we should collaborate: understand the strengths and constraints of each other and, in concert, devise and implement solutions accordingly – for the betterment of the country and for the life of each citizen.

A pandemic has required Australian industry and governments to work in concert like never before, with better community outcomes.

By Duncan CampbellAvenell.

THE INFORMATION AGE MEETS THE GOLDEN YEARS

1MG spoke with Peter Fuller, Managing Director of Micro Focus Australia and New Zealand, about what the IT industry is doing in digitalization of Australia’s aged care sector.

When the tsunami of COVID-19 crashed, uninvited, onto Australia’s shores, industries of all stripes were swept up in its destructive wake. But in the subsequent months, few were confronted with the same literal life-or-death stakes as the aged care sector, whose raison d'être is to look after those Australians who are most vulnerable to the virus.

Readers will know that some providers rose to the challenge better than others, and that troubling issues in the for-profit segment are coming to light under the glare of the Royal Commission into Aged Care, forcing an overdue reckoning for those private operators that have not been toeing the line.

It’ll be a shame if the ensuing reputational damage tars the industry at large, because good-news aged care stories do exist, if you know where to find them. One is how the technology and IT industries are helping aged care facilities through the COVID crisis, and, more broadly, how leaders from those cutting-edge fields are increasingly helping to shape a brighter future in which technology will improve older Australians’ quality of life.

A case in point is MannaCare, a not-for-profit aged care facility headquartered in Doncaster, in Melbourne’s north-east. The largely government-funded organisation is owned by the Manningham community and steered by a board of seasoned corporate leaders from diverse fields. Commendably, the board works pro bono, and it bases its decisions on a set of

humanistic values rather than the profit motive.

MannaCare can accommodate around 150 live-in residents in its two residential facilities (one is for those who are mobile but require assisted living, the other for those with dementia and other high-care residents). All residents are cared for by a staff of highly trained nurses and carers with supplementary support provided by an energetic squad of local volunteers. The organisation also provides a range of vital at-home and other services for hundreds of locals who require them. The costs of private aged care remain high for many Australians, and a key pillar of MannaCare’s philosophy is to provide high-quality care for those who

need it, rather than those who can afford it.

Among the silver linings of COVID (squint hard, and you’ll see them) is the growing realisation that, while the in-person element will always be indispensable, high-quality aged care does not always need to occur face-toface – and that emerging technologies have the potential to revolutionise the field. Mannacare – whose board of directors includes IT industry captains Peter Fuller, of the software giant Micro Focus, and Mark McNamara, an expert in digital transformation – is fully embracing those transformative ideas.

So what are the current and potential future applications of tech in the evolving aged care ecosystem? Peter Fuller says, “For now, at MannaCare, they include residents being able to meet remotely with their GPs and specialists, as well as socialise with families and friends, through video applications (crucial during Melbourne’s 2020 lockdowns); access to video-on-demand and pay TV services; and the use of tablets and other smart devices in the rehabilitation of people with disabilities.”

At-home care is a growing part of the industry’s big picture, and here, the possibilities that tech opens up are almost endless. As Fuller says, they include “wearable tech that can measure an individual’s heartrate and other vital signs, including blood pressure (going far beyond the old ‘panic button’, which has to be physically pressed); motion pressure detectors that can perceive falls; and tech that can remind people to take their medications in

ways a plastic pill box never could. The Internet of Things (IoT) will open up a whole new world of once unthinkable possibilities; suppose, for example, that pill box could record whether its lids had been opened each day and alert the user if they hadn’t.”

The IT industry has in recent years had a collective epiphany: that it can create social as well as corporate value in a range of areas – healthcare, disability services and aged care, for example – and it’s already directing significant intellectual capital towards that end.

“Of course, industry can’t do it alone,” Fuller notes. “Getting high-speed, cost-effective, reliable internet into more aged care facilities is crucial to improving residents’ lives, and government is the key player in that area. Government can also help by improving the regulatory and funding landscape to speed the development of cheaper and simpler-to-use smart devices.”

Fuller continues: “Tech will never fully replace the human element of aged care – a volunteer’s warm smile or a nurse’s thoughtful gesture can achieve what even the smartest device cannot. But tech can be – and already is – a valuable supplement to the existing infrastructure.”

MannaCare’s use of technology in its operations, its strong leadership structure and its sense of social mission are good news for Australia’s ageing population – and point to a better way forward for the industry as a whole.