Digital Services Post Pandemic: The Utilities Perspective

DIGITAL SERVICES POST PANDEMIC: THE HEALTH AND COMMUNITY SERVICES PERSPECTIVE

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

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 Galloway1 , 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

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

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

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

By Jeffrey Braithwaite

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.