Leadership and Innovation in Healthcare
The Proceedings of the Fung Healthcare Leadership Summit 2015
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Sponsored by
Organised by
Conference Proceedings Contents Opening Remarks A Catalyst for Business Collaboration in Healthcare. Mr Ben Chang
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Opening Keynote Making Significant Contributions to the Development and Delivery of Effective Healthcare. Dr. Victor Fung
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Keynote Panel Discussion Opportunities and Challenges in Asian Healthcare. Prof. Dr. Ali Ghufron Mukti Prof. Gabriel Leung Tan Sri Dato’ Dr Abu Bakar Bin Suleiman Prof. London Lucien Ooi Moderator Prof. Datuk Dr. Jeyaindran Sinnadurai
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Leadership in Healthcare Education. Prof. Tan Chorh Chuan
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Leadership in Clinical Research Prof. Marc Alan Pfeffer
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Leadership in Public Health Sir Malcolm Grant
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Innovations in Healthcare Six Emerging Technologies Changing Healthcare for the Better. Dr. Mark Liponis
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Supply Chain Innovation for Healthcare Delivery in Developing Economies. Prof. Hau Lee
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The Innovator’s Prescription A Disruptive Solution to Healthcare. Dr. Jason Hwang
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Dinner Keynote China – The next Era of Growth Dr. Victor Fung
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United States spends an incredible 17% of its GDP on healthcare, which amounts to $8,600 per capita. This is an astonishing amount, which is unsustainable in the long term. On the other hand, OECD countries spend $3,000 per capita. The rest of the world is only spending $88 per capita on healthcare. Hence most people around the world are not getting enough health care. In fact, healthcare is the single biggest business opportunity of the world as more people demand for better healthcare. Despite its incredible economic growth, China is spending under $30 per capita. The government of China is making healthcare available to the entire population in the next ten years. Healthcare spending will grow as much as eight times in the next ten years. China, India, ASEAN nations and developing countries do not have enough money for healthcare. This simply means that leadership, innovation and technology must play key roles.
Mr Ben Chang
Opening Remarks
Group Managing Director, IDS Medical Systems Group (idsMED), Hong Kong
A Catalyst for Business Collaboration in Healthcare A Significant Initiative to Promote Healthcare Education across the Region. Executive Summary IDS Medical Systems Groups (idsMED) is the leading provider of integrated medical solutions to a wide range of hospitals and care institutions. The objective of this summit is to enhance healthcare, leadership and innovation by providing a platform for the sharing and deliberation of key trends, opportunities, and challenges in the healthcare industry. Healthcare Trends in Asia Healthcare accounts for 10% of global GDP. The global demand for healthcare will increase from US$6 trillion today to more than US$12 trillion in 10 years’ time. This is due to an incredible growth of household income of the middle class especially here in Asia. There is a rising demand for healthcare, resulting in increasing costs. There is a rapidly expanding population of senior citizens all around in Asia. The
Convergence of Technology We are seeing a tremendous convergence of the three greatest technologies for the next millennium, which are nanotechnology, biotechnology and advanced wireless technology. This convergence will bring together a more costly effective healthcare. Healthcare will be transformed with modern day technology and innovation. We must review mundane concepts and proven management catalysts like supply chain management, which can transform healthcare. Opportunities in Healthcare The Fung group through idsMED entered the healthcare industry three years ago. The objectives primarily are to apply practices of good distribution and supply chain management so as to drive down costs and inventories, cut wages and enhance the effectiveness and efficiency of the healthcare supply chain. The healthcare supply chain is significantly lagging behind in all other industries. Conclusion Through our agent and distribution network in the eight countries, idsMED can be the enabler for a more efficient and timely delivery of products and services.
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Conference proceedings. 12 June 2015 Grand Hyatt Singapore
6 the financial crisis in 2008, the OECD countries accounted for 80% of global consumption. Within a generation the trend has shifted from less than 20% of global consumption for non-OECD countries to over 50%. This indicates that Asia is driving much of the increase in the economic prosperity and consumption that the world expects to see in the coming decade. The future demand can only be met through leadership and innovation matched by research and training. Challenges of Asia There is an ageing population in Asia as well as in Europe. This creates a demand for geographical medical and support services. However this will put huge pressure on hospitals and clinics as we do not have enough home care or communitybased health care services for elderly people living alone. ASEAN is moving closer to the reality of a single market with the free flow of labour, services and investment. At the same time, there is the deepening of the 10+1 ASEAN relationship with China. This is seen in the one belt and one road initiative of China.
Dr. Victor Fung
Opening Keynote
Fung Group Chairman, Hong Kong
Making Significant Contributions to the Development and Delivery of Effective Healthcare. Executive Summary With an ageing population, there is an increasing demand for quality healthcare services. By providing quality healthcare, the Fung Group believes this will improve the health of patients. Nurturing Leaders Through Education Nearly a decade ago, William and Victor established an education foundation to mark the Fung Group’s 100th anniversary. Every year the Fung scholars’ programs enable 400 undergraduates about 30 institutions in six countries to experience learning outside their own culture. The National University of Singapore (NUS) and the Singapore Management University (SMU) are partners of the Fung Group. Together they nurture leaders for a global future. Global Consumption of Asia By 2030, Asia is said to account for more than 50% of global consumption. Before
The Fung Clinical Fellowship “The Fung Clinical Fellowship” is a collaboration with the National University of Singapore (NUS) at NUS Yong Yoo Lin School of Medicine. An endowment of $3million will be established. The program will support Singapore’s efforts to address unmet clinical needs in the ASEAN countries by training local doctors and developing clinical skills. Conclusion The advancement of healthcare is the continual enhancement of the quality of doctors and health professionals. The Fung Clinical Fellowship will strive to help bridge the gaps in the development of enhanced clinical skills of local doctors in the ASEAN region, which will benefit patients.
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Opportunities and Challenges in Asian Healthcare Delivering Equitable Healthcare at an Affordable Cost. Executive Summary The healthcare industry accounts for almost 11% of global GDP, which is more than double the 5% GDP spent annually on defence. Hence the healthcare industry is very important to all in many different ways. There is a widely varying level of healthcare within the country and amongst the nations. Financing Health Care Expenditure Between China and India lies ASEAN. With a total of 3.1 billion people, there are 600 million of people living in ASEAN. ASEAN’s GDP is made up of US$2.48 trillion. The percentage of GDP that goes towards a nation’s healthcare varies from 2.1% to 17.5%. Analysis has shown a high but not complete correlation between the expenditure and outcomes. The surrogate markers of health of a nation are the decrease in infant mortality and the increase in life expectancy. However many developing countries are able to achieve impressive outcomes with comparatively low costs, as seen in some ASEAN nations. Based on the law of diminishing returns, relatively low-cost measures such as mass immunization have produced significant outcomes against expensive care of those with multiple co-morbidities due to noncommunicable diseases (NCDs). In these countries, the prevalence of NCDs is now rising. There is also the challenge of the great diversity and disparity of access in healthcare in Asia. Non-Communicable Diseases NCDs will largely determine the future with cancer, diabetics and heart disease as the main causes of death. NCDs accounted for 87% of all deaths in China in 2014. Cardiovascular diseases, including stroke and heart disease, remain the top killers. High rates of smoking and hypertension continue to drive the epidemics. NCDs and environmental threats are largely avoidable if there is early detection and we manage these threats within
our control. We need to be aware of our food consumption, behaviour and lifestyle in order to lead healthy lives. Under the one-belt one-road strategy, there is homogeneity in food, behaviour and lifestyle with trade. Universal health coverage and sustainable development goals are keys to equity. These are targets to meet the NCD challenge. Indonesia Indonesia has evolved from a country facing inadequate and unfair health financing to one that is able to regulate healthcare. Indonesia is made up of over 17,000 islands, with a total population of 250 million. The health system is predominately from the government’s facilities. They have 9,520 health centres and 23,163 sub centres. There are 2,300 public and private hospitals with a doctor/ population ratio of 1:250. In 2012, the health insurance coverage was 72%. Due to health care reforms in Indonesia, both demand of healthcare and access to health care facilities have been increasing. In terms of health infrastructure, over the last 6 months, 230 hospitals have been
Prof. Dr. Ali Ghufron Mukti Chairman, Health Financing Policy and Health Insurance Management, Indonesia Prof. Gabriel Leung Dean, Li Ka Shing University of Medicine, The University of Hong Kong, Hong Kong Tan Sri Dato’ Dr Abu Bakar Bin Suleiman Chairman, IHH Healthcare Bhd, Malaysia Prof. London Lucien Ooi Chairman of Division of Surgery, Singapore General Hospital, Singapore Moderator Prof. Datuk Dr. Jeyaindran Sinnadurai Deputy Director General of Health (Medical), Ministry of Health, Malaysia
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built, with a new hospital being built every two days. Health centres and primary care clinics have also increased.
A high quality, low cost model of healthcare delivery is needed to address the opportunities that Malaysia is facing.
This has led to opportunities in strengthening the health infrastructures such as clinics, hospitals, healthcare technologies/tele-medicine, medicine, medical tourism, as well as growing opportunities in the areas of wellness, screening and prevention. Innovative Healthcare Technology and IT are used to solve challenges in achieving universal healthcare.
Singapore Singapore offers universal healthcare coverage to the citizens, with a financing system anchored on the twin philosophies of individual responsibility and affordable healthcare for all. Singapore has a population of 5.4 million. Healthcare has evolved in the past 50 years in Singapore.
Malaysia The healthcare in Malaysia is managed by government and the private sector. Malaysia has 29,714,000 people with a population growth of 1.3%. Those who are 65 years and above form 5.5% of the population. Life expectancy is an average of 74 years. Public expenditure in terms of total health expenditure is 52.27%. In Malaysia, the public sector hospitals are overburdened and crowded with a lengthy waiting time for the patients. There are insufficient beds for the patients. There is an increasing demand for private care healthcare. The current model of healthcare delivery results in escalating costs which is not sustainable and do not serve the patients well. The funding is made up of public, private and charity. Approximately one third of the funding comes from private payments, one third comes from government payments and the last third is made up of a combination of government subsidies, private payments and NGO funds.
There are many health challenges among the ageing population in Singapore. There are multiple tiers of protection to ensure that no Singaporean is denied access to basic healthcare because of affordability issues. In terms of public funding Singapore has the 3M model namely Medisave, Medishield and Medifund. Through a mixed financing system, Singapore uses the market-based mechanism to promote competition and transparency and the adoption of technology to improve the delivery of healthcare services. Singapore has secured good healthcare outcomes for its population. Conclusion By 2016, for ASEAN Economic Community (AEC), regional economic integration will be a reality. Healthcare is a priority sector and this will bring both challenges and opportunities.
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10 with the solutions. This is a good way of applying basic sciences across disciplines in a problem-based way. There have been three generations of reform. In 1905 it was the sciencebased medicine. This was packed with basic science curricula with little clinical correlation. In the 1960s, problem based learning was adopted. This involves the integration of basic and clinical sciences. The trend of the future is systems-based, where the focus will be on patients and population-centred. The focus is also on competency-driven goals and interprofessional training. This will nurture health professional leadership. Health System Transformation How can health education enable and help drive health system and transformation? Why do we need a healthy system transformation in the first place? The geography may differ but the challenges are similar across different countries. The challenges include global epidemic of chronic non-communicable diseases; financial affordability; the rapidly ageing population and the demand for healthcare professionals. Prof. Tan Chorh Chuan President, National University of Singapore, Singapore
Leadership in Healthcare Education How Healthcare Education Enables and Drives Transformation in the Healthcare Industry. Executive Summary There have been major historical shifts in healthcare education and compelling drivers for its further transformation in the future, with particular relevance to Asia. There are key thrusts which could also underpin such a transformation, alongside with the opportunities and challenges for healthcare education and leadership in spearheading fundamental changes in healthcare education. Healthcare Education Historically there have been changes to health education. With the introduction of problem-based learning, students can approach problems that they have with little prior knowledge. Students would have to start with the problem. In seeking the answer to that problem they would have to identify what are the most important issues and work out how to come up
Currently we have one new patient starting dialysis in every nine hours. More recently a new patient starts dialysis in every five hours. Two thirds of these patients are diabetic. With a large number of diabetic cases, there is a high probability that the number of patients on dialysis is going to grow. Ageing Population There is a rapidly ageing population. Singapore residents who are aged 65 years and above were 350,000 in 2012 and will grow to 1 million in 2030. There is a three-fold effect. (3X increase) This will result in them going to hospitals more often (4X increase). When the elderly visit the hospital, they tend to stay longer (2X increase). The equation is put this way: 3X x 4X x 2X = 24X By 2030, we have 24 times (the effect of the patients) on the hospital. This is the impact of ageing on our hospitals if we maintain the current way of managing older patients.
11 Optimise Healthcare for “Today” Our current health system serves us well but it is not structured for the rapidly changing health landscape. There is a need for trained health professionals. We have to optimise healthcare for “today” by using current models with some improvements. This can be in the form of: in-hospital innovation; advising our patients on the level of care that is applicable to them, whether primary, step down or community care that is completely adequate and satisfactory for their needs. We also have to enhance the healthcare financing by providing universal coverage and incentives that drive health care choices. There is a great deal of work to be done to optimise healthcare Redesign Health Delivery for the Future There is a need to redesign public health and clinical approaches, to establish transdisciplinary teams with trained lay persons, to deploy low cost technology so that it can be well integrated and aligned to the financing framework and to evolve around behaviour at the personal level and the community level. Transforming the Health System In order to transform the healthcare system, we would need trans-disciplinary teams that will work well together, use technology and skills to provide and empower healthcare in varied home settings (home-community-hospital) through re-designed clinical and public health approaches. However for the current healthcare education, doctors and nurses are trained in professional silos. The focus is on patient-based clinical care, i.e. care of single patients. Pedagogical Innovation We need to transform healthcare education. One aspect is by pedagogical innovation. There is the TeamLEAD programme developed by Drake-NUS School Graduate Medical School. Medical schools in the NUS Yong Loo Lin School of Medicine are trained in problembased learning and stimulation-based training throughout the five years of study undertaken. The NUS Yong Loo Lin School of medicine has now moved to outcome-based curriculum. With an inter-professional education, the NUS Yong Loo Lin School is preparing a “collaborative practice-ready”
health workforce through inter-professional core curriculum and inter-professional enrichment activity. The students go through stimulation-based training and are also embedded as part of the health care teams. Leadership Training Nurturing leadership requires a certain number of health professionals who actively support and contribute to the transformation of health. There is a demand for people to lead that change and to nurture individuals who can become change agents in the healthcare sector. Conclusion Leadership in healthcare education is to nurture competent healthcare professionals who work well in transdisciplinary teams and are active change agents and leaders to facilitate and drive trans-formative health systems.
12 will be outdated. Indeed there are macro and micro forces in biomedical research and development, which will impact the interests of the government, the medical industry, the healthcare systems and hospitals. Clinical trial is defined as a research study in which human subjects are prospectively assigned to interventions to evaluate the effects of those interventions on healthrelated biomedical factors. Clinical trials define the quantitative investment of the benefits and the risks involved. In order to make the distribution system more efficient, there are ongoing changes sufficient to change practices. This may be disruptive to the healthcare systems. Hence we need to generate more data and find ways to measure how strong is the data to ensure that healthcare systems run smoothly.
Prof. Marc Alan Pfeffer Victor J. Dzau Professor of Medicine, Harvard Medical School, USA
Leadership in Clinical Research Maintaining Clinical Investigation for a Healthcare System Striving for Excellence. Executive Summary Clinical research, by its very nature of probing, examining and comparing, generates new information to better understand and improve public health. At its best, new discoveries are identified to lessen disease burden, improve quantity and quality of life of future patients. The implementation of these recommended changes however can be disruptive and costly for the healthcare system to adopt for its current patients. Conducting clinical investigation is also a resource-intensive endeavour with a revenue stream that is often independent from clinical care. Clinical Trials The amount of money that we spend on biomedical research is sky-rocketing. Research is disruptive on what we do today. We can practice medicine today and live in today. The other alternative is to continue research or today’s medicine
Handling Heart Attack There is a whole new paradigm shift on how heart attack is being handled. In the midst of having a heart attack, the number of heart muscles can be changed. Heart attack is time dependant on how soon the artery can be operated. When one is suffering from a heart attack, it is the responsibility of patients to know the symptoms of heart attack and to head to the hospital immediately. Patients also need to know the route of the nearest hospital. Nowadays all hospitals are required to have a coronary care unit. A coronary care unit is a hospital ward specializing in the care of patients with heart attacks and various other cardiac conditions that require continuous monitoring and treatment. This involves using trained personnel, nurses, equipment and beds. This may be disruptive to the hospital as there may be a shortage of manpower resources and beds for other patients who may be in a more critical stage. Research strives to improve conditions and issues in the environment. Medicine which was not available several years ago is now made possible through research, thereby offering the latest care and hope to patients. Research also gives a sense of professional satisfaction, attracting and retaining the most talented trainees who take pride in the work they perform.
13 How to Change the System Heart failure is a common diagnosis and also the biggest burden for health care system. We can prevent heart failure by the lifestyle we lead. This is by taking responsibility of our heart condition, by exercising, taking our medicine and being aware of our cholesterol level.
Through research, there was the discovery of the HeartMate II, which is one of the most advanced devices to treat advanced heart failure. It is available today. The HeartMate II is a heart pump called an LVAD (Left Ventricular Assist Device). An LVAD is designed to help the left side of the heart pump the blood the body needs.
It is difficult to educate people to take responsibility for their health. When patients have stroke, they rather see an occupational therapist than take medicine to prevent stroke.
It does not replace the heart. This discovery has improved the survival rate from 25% to 68%. Patients with advanced heart failure have improved survival rates and quality of life when treated with implanted pulsatileflow left ventricular assist devices as compared with other medical therapies.
Hospitals receive report cards on their performance and they are ranked. For those hospitals at the bottom of the list, they have to improve on their rankings. It is reported that patients at the higher-ranking hospitals perform better. Performance measures are part of the feedback in improving the healthcare system. The biggest cost comes from people who need intensive care. There are measures to prevent them from reaching that stage. Currently, there are about 3,000 heart transplants in the whole world. Previously for heart attacks, drug coated stents are implanted into the heart, hence allowing people to live longer.
Conclusion Hospitals need to make a commitment to innovations. Through cardiovascular research, more people can live longer. Hospitals should focus on giving the best patient care, having the best trainees, and establishing innovative research. Change by definition is disruptive. However let us approach the change process with the mindset that although change may be a costly practice for today’s medicine, this is done so that tomorrow’s medicine may be even better.
14 Public Health Classic Model Under the public health classic model, there is protection against externalities. This includes attacking causes of infectious diseases, population protection through regular vaccination; controlling environmental pollution; regulating food quality and improving quality of public health. There has been a significant shift in global incidence of diseases. According to the World Health Statistics in 2014, in 22 countries, mainly African countries, 70% years of life lost is due to premature death caused by infectious diseases and related conditions. Between 1995 and 2012, 56m people were treated with tuberculosis and 22m lives were saved. National Healthcare Systems The proportion of GDP that is invested in national healthcare systems varies significantly. In the UK, 8% of the GDP comes from the state, while 1.3 % comes from private contributions. In the US, 8% of the contribution comes from the state. However private contribution from mainly out-of-pockets has doubled.
Sir Malcolm Grant Chairman, NHS England, UK
Leadership in Public Health Promoting Healthier Lifestyle, Reconceptualising Health Policy. Executive Summary The current models of healthcare in economically advanced societies are heading towards financial disaster as the cost impact of growth in demand outstrips growth in national GDP. With the inexorable rise of non-communicable disease, such ill-health and hospital admission is unavoidable. However the policy levers to promote healthier lifestyle are notoriously difficult to operate particularly in open liberal societies that impose tight limits to government interventions. NHS England The UK model runs under the model of single care provider. The hospital system and primary care system are owned by the state. As a high-income country, England can no longer sustain investment at comprehensive universal health care system.
Having the most effective healthcare system can still result in poor outcomes. A shortfall of healthcare and incidence of diseases are attributable to human behaviour. Adult smoking and obesity are behaviour components. The obesity rate is alarming especially for UK, US and Australia. There is a universal squeeze on the healthcare system. The challenge is to provide improved healthcare quality outcomes without increasing costs. There is a crowding-out impact for England. Social Burden of Obesity Smoking, obesity, and alcoholism are major challenges in the country. Obesity is one of the top three social burdens generated by human beings. The phenomenon of obesity causes an increased incidence of cardiovascular disease, Type 2 diabetics and cancers. Obesity is causing extraordinary ill health among our population. In terms of childhood obesity, 44million (6.7%) of the world’s children under the age of 5 are overweight and obese in 2012.
15 Physical Inactivity Associated to obesity is physical inactivity. The global impact as cause of disease is: Coronary heart disease
6%
Type 2 diabetics
7%
Breast cancer
10%
Colon cancer
10%
Physical inactivity impacts globally life expectancy. For premature mortality about 9% or more than 5.3millon of the 57 million deaths worldwide in 2008 are attributable to physical inactivity. If inactivity decreased by 10% to 25%, more than 530,000 or 1.3 million deaths respectively can be averted every year. This is the challenge for the healthcare system and public health. Health Situation in England The summary for England comprises 20% of adults smoking; 33% of adults drinking alcohol; over 60% of men are overweight (25% of these are obese); and 57% of women are overweight (28% of these are obese). 70% of the NHS budget is now spent on long-term health conditions. People are living longer lives but are not living healthier lives. Many diseases can be detected earlier and better managed to prevent deterioration and hospitalization. Reconceptualising Health Policy There is a need to re-conceptualise health policy. In England more money is spent on the bariatric surgery for the obese rather than spending time on how to prevent obesity in the first place. There is a need to review three elements: namely, population health, per capita cost and experience of care. The context of public opinion is that of the rights of citizens to lead unhealthy lives. It is their entitlement to smoke, drink and become obese. The 5-year forward view of the NHS is to have radical new reforms to healthcare and improvement of public health from October 2014. Since 1996, the number of people living with diabetics has more than doubled. This will exceed 4 million in England in 10 years if no action is taken. This will result in complications such as blindness, stroke and heart attack. Diabetics already accounts for 10% of the NHS budget. There is a new diabetics prevention programme
which is targeted for 100,000 high-risk people. Towards New Model Looking at the new models that would improve healthcare, this would mean enhancing personal responsibility and empowerment through knowledge. There is also the collusion of new technologies. Conclusion It is a challenge to provide improved healthcare quality outcomes while ensuring that costs do not increase. People are living longer lives but are not living healthier lives. Radical new reforms to healthcare and improvement of public health need to be looked into.
16 Singapore on the other hand is at the top of three countries with an average life expectancy of 84 years. Happiness The 10 elements of happiness are selfesteem, optimism, social engagement, personal control, work, personality, health, altruism, humour and purpose. When we look at happiness by country from the UN source, we observe that the US has risen from No. 30 to No. 17. On the other hand, Singapore has dropped from No. 3 to No. 30. Optimal health by country comprises of health and happiness for the population. Switzerland takes the lead, followed by Sweden and Iceland. Doctors are making people live longer. It is seen that people are living longer in countries with many physicians. Trained physicians have a reasonable way to improve the longevity of the population. On the other hand, doctors are not making people happy. Prevention Is Better than Cure It is easier to have preventive measures than having to cure or manage a condition. Treatment that is rendered may be unnecessary or dangerous. Dr. Mark Liponis Corporate Medical Director, Canyon Ranch, Lenox, USA
Innovations in Healthcare: Six Emerging Technologies Changing Healthcare for the Better New Therapies Will Improve both Health and Happiness. Executive Summary Medicine in the 21st century promises better quantity and quality of life for all. Presenting the latest data on health and happiness, we are able to identify and discuss six emerging technologies that will change health for the better during our lifetimes. These include energy medicine, smartphones, microsensors, 3D printing, nanotechnology and stem-cell therapies. Life Expectancy People who are health consciousness are at an all-time high. Motivated people will generally be interested in health and wellness as these represent the ability to achieve one’s full potential. In terms of life expectancy by country, the US is not ranked in the top 30 countries for life expectancy.
According to a 2013 Bloomberg review, about two thirds of the cardiac stents placed in the US may be unnecessary. In 2013, there are 773 deaths from installing the stents and 4135 injuries. In the US, people consider the healthcare system as the safety net to lead the lifestyle that they want. Children are lining up for bariatric surgery. They do not want to learn how to eat healthily, nor do they want to exercise. Children are having surgery so that they can get rid of the extra fats. Unfortunately the fats come back in other areas. In the near future, the issue is on how to improve the quality and quantity of health and happiness without spending more money on treatment.
17 Six New Technologies Changing Healthcare For The Better 1. Smartphones The future of medicine is in the smartphones. The phone becomes a personal health optimisation and notification engine. The individual can be informed whether they are doing the right thing, eating the right thing and behaving the right way. They can also be notified to do something different with their lifestyle. These phones now can be powerful tools that can empower personal health. The smartphones are able to track their health and the quality of sleep they get per night. By Wearing Fitbit’s New Heart Rate monitoring trackers on the wrist, they can track their fitness. The automatic ingestion monitor is a food tracker for the diet. It resembles a wearable Bluetooth headset that wraps around the ear. The system is able to identify the food the person is eating and accurately estimate how much of it is consumed. 2. Microsensors Mircosensors are devices that convert non-electrical physical or chemical quantity into electrical signals. Microsensors can produce low power and flexible sensors. Google has unveiled a prototype of lens implanted in the eye to measure the glucose levels of diabetics. Wireless Eye Implant is able to continuously measure intraocular pressure. If a patient has cataract, this lens can test whether he is having glaucoma or has developed high pressure in the eye. 3. 3D Printing 3D printers are able to print a wide range of medical devices. 3D printing can enable customized knee replacement surgery. Based on MRI images, the digital image is then used to create customised cutting blocks for that patient’s specific knee. The patient can have specifically customised in terms of design and built for his specific knee. With 3D printing, one can also build the cast with ultrasound, which helps the bones to heal faster. The cost decreases tremendously with 3D printing.
4. Nanotechnology Nanomedicine refers to highly specific medical intervention at the molecular level for curing disease or repairing damaged tissues. Researchers have developed synthetic platelet-like nanoparticles that can be injected near a wound to act like natural platelets in helping to treat it. Patients who are suffering from leukaemia, or having a bone marrow transplant, can consider using nanoparticles for their treatment instead of blood transfusion. Magnetically-directed nanoparticles could help heal broken bones. New cancer treatment kills the bad cells with nanoparticles and lasers. Hence cancer can be treated at lower costs. 5. Stem Cells Stem cells are cells that have the ability to transform into many cell types. Bone marrow stem cells can be injected into the heart. This can transform, heal and repair dead muscle tissues of the heart. A combination of stem cell and 3D printing can print organs on demand. There is a potential to grow a new organ such as using stem cells to grow a new ear. 6. Use of Energy Medicine There are different types of energy, which includes light, heat and sound. People who feel anxious or agitated will recover quickly when they listen to sounds of nature. Ultrasound with the use of the scalp can produce effects that can improve our cognition, enhance better memory and increase levels of productivity. This can help patients with Alzheimer’s disease. Magnetic stimulation of the brain can improve conditions of depression. Conclusion We are healthier than ever. We are happy and we could be happier. We are getting more tools, for tracking and taking personal responsibility for our health. These therapies will improve health and happiness and enhance the quality and the quantity of lives.
18 It is not easy to obtain information due to a lack of transparency. For information flow, there is lack of visibility and usage; distortion in demand information; lack of information sharing or collaborations across organizations. Under the material flow, there is a missing or misplaced supply inventory; long resupply lead times of equipment or materials or stock-outs of key materials; materials shrinkage or perishability. For the financial flow there is a series misaligned incentives for resources acquisitions and ineffective pricing of products and services. There is a distortion of end information for the supply chain. Using the analogy of the bullwhip effect, at the crack of the whip, the handle moves a few degrees. However the tip of the whip moves 360 degrees. Order variability is amplified at the supply chain. There is a lack of good information. Even if you have information, the information is not accurate.
Prof. Hau Lee Thoma Professor of Operations, Information and Technology, Graduate School of Business, Stanford University, USA
Supply Chain Innovation for Healthcare Delivery in Developing Economies Re-engineering the Flow to Make a Difference. Executive Summary It is a daunting task serving the health care needs of patients in extreme conditions like those in developing countries with poor infrastructure. Using an innovative approach, Riders for Health were able to re-engineer the material, information and financial flows of the healthcare supply chain to make a difference. Supply Chain Management Supply chain management uses a single concept to orchestrate and coordinate three flows: namely material, information and financial. It is a flow from suppliers to manufacturers to distributors to retailers and finally to the customers. The supply chain is more complex in healthcare as the information, material and financial flows fluctuate all the time.
For a typical export transaction, several signatures are required. For some countries, it is extremely difficult to get these signatures to get things done. Studies from the World Bank have shown that Singapore is an efficient country with a simplified procedure and digitalized documents. It only takes two signatures for export transactions in Singapore. Healthcare Supply Chain Healthcare in Africa Infrastructure and logistics challenge are evident in Africa. There is no integrated road, transportation and logistics network. For instance, trucking a cargo container from Matadi to Kinshasa in Congo can cost more than shipping from New York to Mombasa. This results in high cost and inefficiency. The majority of the population (62% of the population) of Africa live in rural areas where the best roads are little more than dirt tracks. Public transport is infrequent and the delivery of healthcare on foot or by bicycle between sparse villages is an exhausting and ineffective task. Only 2030% of the population live within 2 km of a road. Re-engineering the Three Flows Andrea Coleman and Barry Coleman did a case study with Riders for Health. Riders for Health is an international social enterprise. They manage and maintain
19 vehicles for health-focused partners in sub-Saharan Africa. Their expertise in transport management enables health workers to deliver vital health care to rural communities on a reliable and costeffective basis. The motorcycle is a form of transport. In Africa, there is a lack of maintenance and repairs of motorcycles. In health care delivery there is a need for good documentation. However in Africa, information is not recorded properly resulting in the lack of good documentation. The case study sees how to re-engineer the three flows of information in relation to the motorcycles and healthcare delivery. Under the information flow, scientific inventory management was established. This allowed for the tracking of assets, inventory usage, mileage and utilization and performance. Training in knowledge management was provided for the health workers. In terms of material flow, there was a standarization of the motorcycle fleet. Preventive maintenance was established such as self pre-ride checks and service by Riders-trained technicians. There was a hub and spoke logistics network with high availability of spare parts A financial service at cost per km model was formed. This provided choice of asset ownership by Riders, with credit guarantees for asset acquisition. A study based on Riders for Health in Zambia was done. The health delivery system involved seeing patients from the hospitals to the urban health centres; rural health and rural health posts, which are all outreach sites. The health services delivered by environmental health technologists included inspections (water, sanitation, food, premises), mosquito control, health education and immunizations. Improving Effectiveness In order to improve effectiveness, the following processes were undertaken. First there was the need to access the operability, availability and utilization of the fleet. Next the productivity of the health worker was accessed in terms of the trip and outreach they make before accessing the cost efficiency. Health care
interventions were then done to enhance public health performance. At the end of the two-year time frame, study showed that all the motorcycles were utilized. On an average, there were more days the vehicles were used by the health workers. Outreach visits also increased. This led to an increase in outreach interventions with more immunizations for the children. People living in remote areas are now able to get medical access. By improving the effectiveness of the health workers, public health performance has also improved. More patients are receiving immunization and medical care. It is recommended that doctors and nurses make use of the supply chain to reengineer the health care system and make a difference. Conclusion Managing the three flows in value chains is critical for superior health service delivery performance. Although challenges to efficient flows in developing economies are huge, there are also opportunities to use smart ways to re-engineer information, material and financial flows for valuecreation.
20 Centralization Followed by Decentralization of Computing A brief history was mentioned on how computing has evolved. There are different tiers of users in the market place. The first tier of users comprises people with the most money and expertise. They are the early and first adopters of technology in the market. The decentralization of computing also creates a final tier of users comprising people with less money and expertise. They are the last adopters of such products and services.
Dr. Jason Hwang Co-Founder and Chief Medical Officer, Icebreaker Health, USA
The Innovator’s Prescription: A Disruptive Solution to Healthcare Sustaining Healthcare System with Affordable Tools and Technology. Executive Summary Disruptive innovations have led to increasingly affordable and accessible products and services in myriad industries. This model can guide investments and innovations to reduce costs and improve the quality and accessibility of healthcare. Business model innovations can transform today’s hospitals and physician practices. Challenges Healthcare costs have been escalating with United States taking the lead and outspending every nations. Changing demographics and the increase in noncommunicable diseases all contribute to the costs of healthcare in every country. How can we bring down healthcare costs and increase the value return of spending?
With reference to computing, the mainframe is faster and more accurate. The trade-off led to subsequent waves of decentralization in the computing industry. The first wave of decentralisation came in the form of the mini-computer. Although smaller than giant mainframe computer, the mini-computer was simpler to operate. Subsequently, some users wanted the computer at home. This then led to the personal computer, another wave of decentralization. The personal computer performed simple tasks at work like spreadsheet, word processing and gaming. The need for computers on the road led to laptop computers, which was the next wave of decentralization. Finally came the computing portable devices, which we carry along with us. At each wave of decentralization, there was disruption to the industry in terms of coding, universal access and tremendous affordability. Decentralization through Disruption Leads to Accessibility The theory of disruptive innovation explains the high turnover and predictable turnover of the computing industry. The PC industry focuses on computing and processing. Customers on the other hand require performance over time. There is a group of powerful and demanding users of the industry. They want the next most powerful gadgets to be in the market and are willing to pay for them. There is another group of customers with simple problems and are easier to be satisfied. However, they do not have the means to pay. Hence they only buy simple things that satisfy their needs. Companies actively seek out this group of profitable customers by building better and more powerful products, packing it with more features. While the focus of companies is on profitability, the door
21 is open for a competitor to produce a different product, which is sufficient to satisfy the needs of the consumers. This is a different kind of innovation, which is also described as disruptive innovation. Disruptive innovation is the new entrant into the industry that succeeds. Whenever a product comes into the market place, it is not meant to displace its predecessor but to grab a foothold in the market place. With that foothold, that technology will improve its products, chase its own profitable customers and steal away the market share from its predecessor. Decentralization in Healthcare Industry and business change with business cycles over time. How does this affect healthcare? Medical training is the main framework for healthcare. This is the centralized source of the best technology and talent where issues can be fixed. Disruption in business model has been the dominant factor. We have to address the non-consumers of healthcare who may be people who live in a geographically remote area or who are financially poor. Many feel that this is a cumbersome process to access the healthcare system. The decentralization that follows centralization is only the beginning in healthcare. There are many services in a centralized service producing higher speed with a negative trade-off. We need to change and improve care, thereby putting care where the patient is. The medical centre has many highly skilled individuals yet it is very expensive to deliver health care. We have to find tools and technology that are affordable for patients who can take care of themselves and sustain the healthcare system. Democratization of Health Care Everybody has access to healthcare. There should be self-directed care where we can rely on ourselves to manage our own health care with tools such as mobile and home diagnostics. It is not the technology but the business model that determines success or failure. The temptations are great not to selfdisrupt health care. Companies have to consider profitability, reputation, historical notations such as cultural resistance, external normalities such as regulations
and payment policies. Plugging new technologies into old business models has caused health care costs to rise rather than fall. We have to look for the early adopters of the existing products and services to become loyal purchasers and to grow from there. This will lead to a new ecosystem of disruptive business models. This can be in the form of the following: mobile care services; hospital at home; wireless healthcare devices; worksite clinics and retail clinics. Conclusion It is possible to bring down healthcare costs with disruptive innovation. A new ecosystem of disruptive business models needs to be established. This will sustain the costs of healthcare system and make it affordable.
22 year, President Xi Jinping announced the concept “One Belt, One Road” (OBOR), also known as the two Silk Roads. He called for the revival of the ancient Silk Road by establishing a new “Silk Road Economic Belt”. The Silk Road Economic Belt, known also as the One Belt, originated from the traditional Silk Road, which is the route from China to Central Asia, to Turkey, Russia, the Baltic countries, and then to Venice. One Road, called the “21st Century Maritime Silk Route Economic Belt”, is a complementary initiative aimed at investing and fostering collaboration in Southeast Asia, Oceania, and North Africa. The road is from the eastern coast of China, down to Hong Kong, Singapore, Southeast Asia, the Malacca Straits, India, the eastern parts of Africa, up to the Middle East, and then to Turkey. The traditional Silk Road also known as the Northern Silk Road and the Maritime Silk Road also known as the Southern Silk Road together form the One Belt, One Road initiative. Dr. Victor Fung
Dinner Keynote
Fung Group Chairman, Hong Kong
China – The next Era of Growth One Belt, One Road Initiative of China Executive Summary One Belt, One Road initiative is a development strategy and framework, proposed by the People’s Republic of China that focuses on connectivity and cooperation among countries primarily in Eurasia, which consists of two main components, the land-based “Silk Road Economic Belt” (SREB) and the oceangoing “Maritime Silk Road” (MSR). These two Silk Roads would connect China with Europe by both land and sea. One Belt, One Road Initiative There were various initiatives by China in the last three years. In 2013, President Xi Jinping was in Moscow when he announced the railroad the link between Chongqing, the western province of China, to Moscow. However this was hugely inefficient, as passengers had to change trains along the way. At a major conference in March this
This is a significant concept being developed. Based on the Fung in-house research, this initiative encompasses 60 countries involving 4.6 billion people. These people produce 37% of global GDP and a third of global consumption. The Northern Silk Road has about a quarter of the global population and the Southern Silk Road has three quarters. The focus is now on the Southern American region in terms of economic development. Before the financial crisis, 83% of
23 global consumption was in the OECD countries, namely, Europe, North America and Japan. The remaining 17% of the global consumption belong to the rest of the world. By 2030, over half of this consumption will go to the non-OECD countries. In one generation, there will be a major shift of consumption out of the OECD countries. The emergence of a new global class of 3.5 billion people in the developing countries will drive the shift in consumption. More than half of this consumption comes from people living in the Southern and Northern Silk Road countries. The Silk Road Economic Belt is the access to the new consumption of the world. It is also the place where the growth markets of the future will be. The Northern Silk Road consists primarily of a quarter of the global population. It is rich in natural resources and raw materials. The Northern Silk Road leads to an inward flow of commodities and resources into China. The Southern Silk Road is a linkage to the future markets and is an outbound zone for Chinese exports. This is the strategic significance of the two Silk Roads. All the consumption and global markets are concentrated in the US, Europe and Japan. The world has been focusing on the production in the developing countries located in the East and exporting to the West. Hence the supply chain is to buy in the East and sell in the West. The structure of the supply chain is not quite fixed. There will be more activities in the countries in the Silk Road with the One Belt One Road concept. With the example of a giant shopping
centre, with China and Europe being the two anchor tenants, everybody will benefit. Hong Kong and Singapore act as gateways to one part of the region, while Turkey acts as a gateway to the other part. Asian Infrastructure Investment Bank With the two Silk Roads forming a huge region, infrastructure is needed to build railroads, bridges and ports. The Asian Infrastructure Investment bank (AIIB) was established. There was a meeting in Singapore to set up the corporate structure. As of April 15, 2015, almost all Asian countries and most major countries outside Asia have joined the AIIB. The purpose of the multilateral development bank is to provide finance to infrastructure projects in the Asian region. AIIB will kick-start the building of infrastructure on the Silk Road. The bank is regarded by some as a rival of the IMF, the World Bank and the Asian Development Bank (ADB) which have to change to accommodate the realities of market and global consumption. AIIB will build the hard infrastructure. The soft infrastructure, which is made up of the flow of people, education, exchange, research and healthcare, will provide the linkage to form the economic zone where people cooperate and work together. Conclusion This will definitely be the Chinese government policy for the next decade. It will be looking at new markets and the changes in the world. There will also be opportunities for countries to think about a new global order with a new multilateral system fit for today’s world.
About the Fung Foundation Victor and William Fung Foundation was set up in 2006 to commemorate the Centenary of the Fung Group (formerly known as the Li & Fung Group). The Foundation is supported by Dr. Victor Fung, Group Chairman and Dr. William Fung, Group Deputy Chairman of the Fung Group with their personal funds to promote (i) leadership development principally through sponsoring programs in partnership with universities, and (ii) thought leadership principally through think tanks and educational institutions.