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Support Beyond Medication
SUPPORT BEYOND MEDICATION Doctor-patient relationship in the times of a pandemic
HCPs are most trusted sources of nutrition information and therefore, have a more critical role to play for their patients, especially in times of this pandemic. Beyond medication, HCPs can play a significant role in educating their patient’s about right nutrition and ways to leading a healthy lifestyle.
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Kent L Bradley, Chief Health and Nutrition Officer, Herbalife Nutrition
We have often heard of the adage, “A good physician treats the disease, the great physician treats the patient who has the disease.”The relationship patients have with their doctor involves a great amount of trust and vulnerability; and like any relationship, this too deepens with time. The encounters entailed in this relationship may not always be perfect and desirable, but it is one of the most moving and meaningful experiences shared by human beings.
Trust is a function of multiple aspects put together. According to the American National Institute of Health, trust, knowledge, regard, and loyalty are the four elements that form the doctor-patient relationship 1 , and the nature of this relationship has an impact on patient outcomes too. The quality of care, knowledge and time a physician invests in the patient is
1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC473230 8/#:~:text=The%2520doctor%252Dpatient%2520relatio nship%2520has,fiduciary%2520relationship%2520in%2 520which%252C%2520by
an important aspect. But what really drives the trust meter is a personal connection with the patient.
The pandemic has changed the world around us. Lives and functions of doctors and physicians are the most impacted. We are also entering the phase of AI and telemedicine that is enabling better access to consultation for patients who cannot transit in current situations. Conversational Artificial Intelligence 2 (AI) for instance, is changing the way mental health care is delivered.
The current conditions require a new approach and opportunity for doctors. According to a survey R1 conducted by Herbalife Nutrition
2 https://pubmed.ncbi.nlm.nih.gov/31681047/
in Asia-Pacific, it was revealed that the number one reason healthcare practitioners (HCPs) are unable to have an expansive consultation about general health and nutrition with their subjects is the lack of time. To achieve success beyond prescription, sufficient time for coaching and counsel is required. It often relates back to providing support in a patient’s
well-being through counsel on diet, nutrition, exercise and lifestyle. One of the key insights derived from this study was that consumers (74 per cent) in Asia-Pacific were looking to HCPs as the most credible source of nutritional advice.
The physicians do have a new and more significant role to play in the new normal. As a continuum of trust and credibility healthcare providers are often playing the role of the healer archetypes, wearing the hat of health coaches. HCPs acting as a counsel, must adopt the “whole person” approach where, the patients are treated holistically 3 – catering for their physical, mental and social needs. Attempting to better understand not only the patients’ sickness, but also their social, cultural and economic profiles and, above all, their expectations can greatly help the doctors in this new role.
Nutrition counsel
Balanced and right nutrition is one of the key areas where healthcare practitioners can support their patients. The global rise of diet-related non-communicable diseases plus the double burden of obesity and malnutrition means that it is imperative more than ever that all HCPs are able to provide at least basic evidence-based nutrition advice.
3 https://apps.who.int/iris/bitstream/handle/10665/205942/B5022.pdf?sequence=1&isAllowed=y
A study 4 on clinical level students from the University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS), who had covered over 50 per cent of the curriculum noted that participating students believed that doctors should be the first ones to provide basic nutrition care and refer the patient to a nutritionist/dietician for specialised care if needed.
Improving an individual's diet requires more than just information, it requires consistent and long-term support to change and maintain new behaviours. While doctors acknowledge that nutrition plays a crucial role in health and agree that providing nutrition advice is part of their role, it is not a part of their regular practice 5 sessions.
Time is one of the factors that is a critical enabler for imparting any form of advisory; in this case about nutrition. The current pandemic has resulted in more work hours and pressure for many doctors in the frontline and limited their ability to be available for such counsel.
The survey R1 conducted by Herbalife Nutrition in Asia-Pacific, witnessed a participation from HCPs
4 https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5809975/ 5 https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5809975/ and consumers alike. It was aimed at understanding the level of nutrition knowledge and information needs among these respondents. The outcomes of the survey indicated that 7 out of 10 consumers considered it extremely important to have accurate nutrition information and social media was the most frequently used channel in their search for answers. However, there are a cacophony of voices and opinions being paraded as nutrition facts and scientific findings, and consumers often encounter information that are contradictory. The situation is exacerbated when there are unqualified individuals masquerading as experts. Suffice to say, cutting through the clutter to sieve out accurate and reliable nutrition facts is a challenge for many consumers who lack the basic tenets of nutrition knowledge.
Considering the high trust consumers and patients lay in HCPs, they have an opportunity to help patients shift to right sources for information, healthier food choices and share strategies to handle their food intake habits. Information about healthier fats, carbs, cutting sugars and overall better food and supplementation intake, active lifestyle, exercise and positive psychology should be incorporated in regular counseling sessions by the HCPs.
How to tread this change?
To know that your healthcare provider is there to support you in your journey, beyond prescription itself, creates a feeling of community and belonging for patients. As strengthening on this relationship becomes critical, so is the responsibility of HCPs to take on the role of providing adequate nutritional and well-being advice to their patients. Here are a few steps that can be taken to include nutrition advice in actual practice:
Start talking about nutrition:
• Your patients may not know that you are available for giving nutrition advice. So, speak about nutrition in general when engaging with patients and encourage them to ask questions • Capture the questions in a form or ask your patients to share their questions in an email. These questions can be answered at the doctor’s availability and convenience • Have nutritional information available at your clinic and on your website. Provide links to evidencebased sites for information.
Include a nutrition checklist:
• Create a checklist that can be a part of your consultation papers and can be filled up by the patient while in the waiting • Apps and online tools too can be used to capture the nutritional awareness and needs of the patients
Create a community:
• Communities are a great way to stay connected with like-minded people and those who share a passion or a common goal. Communities can
AUTHOR BIO
Kent L Bradley has worked in leadership roles in healthcare sector, strategising health related policies and business decisions, he has acted as strategic advisor for multiple health-tech companies. A retired army Colonel, he has Masters Degree in Public Health from University of Minnesota & his medical degree from Uniformed Services University of Health Sciences, Maryland. be on the digital platform too like
WhatsApp, Facebook and blogs. With social media being the most frequently used channel for consumers seeking nutrition information, HCPs can use this wisely to share more accurate sources of information.
In parallel, health care practitioners should also take time to focus on their own wellbeing. We need them to be fully charged in this new normal. Taking care of their own physical, social, and mental wellbeing is critically important. There is a sense of fatigue that can occur and when we do not attend to our own need for nourishing our body and mind, we may burnout. As a healthcare provider, I want to encourage each practitioner to intentionally focus on nourishment for themselves as an essential worker that is needed by so many. Ironically, the patient-provider relationship can be a source of energy when it becomes an enriching experiencing focused on connection and support. Technology is an enabler that can be thoughtfully applied to maintain the human connection that both the patient and provider need. This level of support, beyond medication, may be a way forward that re-energises the HCP and provides hope for the patient. References: R 1. Herbalife Nutrition Myth Survey with 5,500 consumers and 250 healthcare providers in Asia-Pacific (2020)
FIGHTING THE COVID-19 PANDEMIC Siemens Healthineers responds
The growing number of COVID-19 infections worldwide are confronting healthcare institutions around the world with unprecedented clinical and operational challenges pushing many of them to their limits and putting the issue of health into sharp focus for all of us. Many of the already existing challenges such as access to care or shortage of qualified staff, have been further intensified by the pandemic. In this interview, Elisabeth Staudinger explains the role of digital solutions in care delivery and how the current pandemic is accelerating the efforts of digitalising healthcare.
Elisabeth Staudinger, President Asia-Pacific, Siemens Healthineers
Even before the pandemic, digital solutions had started to penetrate our daily lives. Online shopping made our lives more convenient. Navigation systems made our car ride more efficient by avoiding areas of increased traffic. Our watches told us how we were keeping up with our fitness goals. Today, connecting care teams and patients has become easier than ever before and making decisions based on data is easing the workload of care providers and enabling more accurate diagnoses. In fact, even before the pandemic, 9 out of 10 physicians saw the benefits of virtual care technologies 1 . The pandemic has accelerated the adaptation of digital means. For healthcare, that’s good news. Digital solutions will enable
1. Deloitte. (2018). What can health systems do to encourage physicians to embrace virtual care? New York. healthcare providers to deliver higher value care and tackle the challenge of providing access to care in this region.
Access to care in Asia Pacific
Improving access to care is one of the most pressing challenges in many countries in Asia. While countries such as Australia and Japan are ranked 4th and 8th respectively in the Global Access to Healthcare Index, others such
as the Philippines, Indonesia, Vietnam and India still have much room for improvement with their ranks ranging from 35 th to 45 th position 2 . Those living on distant islands, remote mountains or rural regions face even harder challenges than those living in the cities. Ironically, the fewest healthcare professionals are usually found where the health needs are greatest, the so-called “inverse care law” in healthcare. In addition, in 2014 countries in South Asia spent on average just US$67 per capita on health – significantly lower than the OECD average of US$4,735 3 . At the same time, the Asia-Pacific region has the highest
2. The Economist Intelligence Unit. (2017). Global Access to Healthcare: Building sutainable health systems. London. 3. The World Bank. (2019). Current health expenditure per capita (current US$). Retrieved May 21, 2020, from World Bank website: https://www.google.com/ search?client=safari&rls=en&q=Current+health+expendit ure+per+capita+(current+US$)&ie=UTF-8&oe=UTF-8
level of dependence on out-of-pocket expenditure of any region according to the World Health Organization (WHO) and the highest number of households driven into poverty in order to pay for healthcare 4 .
Improving access to care means making care more affordable, available and accepted by the population. Affordability means that patients can ‘consume' or use health services such as state-of-the-art diagnostics and treatment without causing financial hardship. Availability means that healthcare services are there when and where they are needed, in particular, close to the patients. Finally, accepted means helping populations to understand the value of care and utilise their care options.
4. World Health Organisation (WHO). (2008). Health in Asia and the Pacific. New Delhi.
Access to care during the pandemic
During the pandemic, even countries with the best healthcare systems struggled. Availability became a challenge as most resources were shifted to care for COVID-19 patients. Even patients who usually would have had access to care were suddenly left with none or very little. Outpatient services, elective procedures and non-emergency cases were put on hold. Access became more difficult with limited transportation or higher cost of travel due to social distancing. As financial struggles grew among the poor, healthcare became even more unaffordable. Yet, others may have actively chosen not to utilise care options either to stay away from the potential risk of infection or because they could not justify a visit during the crisis. The result is an increased disease burden. In fact, delaying treatments can
have lasting consequences. For example, in breast cancer patients, delaying treatment from two weeks to more than six weeks can lower the five-year survival rate by as much as 10 per cent 5 .
5. Caplan, L. (2014). Delay in breast cancer: implications The vision for healthcare is to keep people as healthy as possible and that requires people to be able to access care. More than ever, the efforts of MedTech players like Siemens Healthineers need
for stage at diagnosis and survival. Front Public Health, 2(87). to be geared towards improving access to healthcare in many parts of the world, and especially in Asia.
Connecting care teams and patients During the pandemic, people started seeking ways to obtain care from
Connecting care teams – staff shortages
The lack of skilled healthcare professionals became painfully obvious during the pandemic. Despite all efforts to attract, train and retain healthcare professionals, the WHO projects a global deficit of about 12.9 million skilled health professionals globally by 2035. In South-East Asia, the absolute deficit is projected to be 5 million and thus highest in the world – representing 39 per cent of the global total 1 . Highly qualified personnel are scarce, and also a relevant cost factor, for hospitals that are already trying to cut costs while keeping quality high. At the same time, most of these health professionals live centrally, making access difficult for the large populations living in distant, remote or rural areas. We must find ways to do more with less and to ease the burden of the overworked healthcare professionals while also extending their reach to farther
1. World Health Organisation (WHO). (2014). A universal truth: No Health Without A Workforce. Geneva
away locations. There is no healthcare without people to deliver it.
Remote scanning assistance can help in realising this. It helps to make expert knowledge accessible across sites in real time. Technologists can always call on an expert for live support. During the pandemic, such technologies also helped reduce staff exposure to infectious patients. In India, at the Sree Chitra Tirunal Institute for Medical Sciences and Technology, remote scanning assistance has been of immense use during the pandemic. While there are normally three personnel in the console room during an MR exam, only one technologist managed the exam on site, while the other two worked remotely. This not only helped to keep the staff safe but also required less personal protective equipment which is a scarce resource in current scenario.
Such technologies also help to extend reach. Prachachen Imaging Center (PCC), a leading imaging centre based in Bangkok, Thailand has 17 centres across the country. Normally, their expert radiology team in Bangkok would often travel to these centres, especially for clinical consultation. When an emergency case came in during the lockdown from a centre 500KM away from Bangkok, the experts could make a timely and accurate diagnosis of the patient thanks to remote assistance.
In cancer care, HealthCare Global Enterprises Ltd (HCG) is relying on the hub and spoke model of delivery. Dr. B.S. Ajaikumar, Chairman and CEO of HealthCare Global (HCG), is using this model to take cancer centres to the furthest away places. He has 100 oncologists at the central hub supporting the spokes through telemedicine, tele-radiology, multidisciplinary tumor boards and remote consultation. In addition, during the pandemic, more than 200 oncologists located across the country were providing virtual consultations, too. The clear goal was to ensure consistent, ongoing patient care.
Knowledge sharing is also crucial to keep the quality of care high. Technologies that allow you to share image studies to discuss cases with your peers, even beyond the borders of your own institution are meaningful. It fosters knowledge exchange and research and helps to get the opinion of a more experienced radiologist. By making scarce resources available to more people, we can improve access and quality of care.
Centralizing all expert technologists in one room and providing remote assistance.
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home for the reasons mentioned above. First, digitalisation made inroads in the self-assessment of COVID-19 symptoms. Second, we have seen providers ramping up their telemedicine capabilities and recruiting more doctors faster than ever. These services connect healthcare providers and patients though virtual platforms. Third, various digital solutions are being developed in the area of home monitoring to support the patient, monitor vitals and provide alerts. Bendigo Health became one of the first hospitals in Australia to roll-out telemonitoring in the fight against COVID-19. Our digital care application supplies doctors and nurses with a dashboard of daily updated symptoms and health vitals to remotely stay on top of their patients’ health.
Governments play a vital role in accelerating the adoption of such technologies. In Indonesia, for example, the Ministry of Health partnered with ride-hailing technology firm Gojek and telemedicine provider Halodoc to offer quick online consultations for those experiencing COVID19 symptoms. South Korea eased restrictions on telemedicine to treat COVID-19 patients remotely, while Japan launched a free governmentsupported remote health consultation. Australia extended Medicare coverage for telemedicine consultations.
In essence, digital solutions can provide better access and triage patients, starting as ‘digital front door’ and – depending on the condition – continuing with the provision of health services, such as telehealth. In doing so, we can keep non-urgent patients away from the hospitals that are overloaded, and patients can get care in the comfort of their home, avoiding travel, cost, waiting times and the potential risk of infections. In short, by creating ways to connect care teams and patients we can make healthcare delivery more efficient.
Future perspective on access and digitalisation
Asia is at the forefront of digitalisation. In fact, eight Asian nations are in the top 10 when it comes to leading the customer shift to mobile payments, out of which six are in Southeast Asia 6 .China is leapfrogging the world and has already reinvented ways of accessing primary care and enabling patient self-management as well as expanding telehealth. Access to primary healthcare is a challenge in China, and there is great variability in the quality of care delivered. To cope with this,
6. PwC. (2020). Mobile payments in Vietnam fastest growing globally, Thailand emerges second in Southeast Asia. Retrieved May 25, 2020, from PwC website: https:// www.pwc.com/th/en/press-room/press-release/2019/pressrelease-30-04-19-en.html
Empower data-driven decisions
Given our lack of skilled professionals, we need to make sure they can allocate most of their scarce time to focus on patients. That means we need to enable them to spend less time on administrative tasks, ease their workload and aid their decision making. Artificial Intelligence (AI) can help remove or minimise time spent on routine, administrative tasks, which can take up to 70 per cent of a healthcare practitioner’s time 1 . With AI, for example, if you have robust, validated data from one patient, you could compare that to an enormous quantity of data from other comparable patients. We call this clinical decision support. For example, AI applied to CT images can be a useful tool for the detection of COVID-19 symptoms and to help with follow-up and treatment planning. AI-powered analysis of chest scans has the potential to alleviate the workload of radiologists, who must review and prioritise a rising number of patient chest scans. We will also see decision support for patients or consumers, working in a similar way. Algorithms can assess patients’ needs and prompt them to make lifestyle changes or talk to a care provider in order to better manage—or even prevent—chronic conditions. Healthcare that starts from home is much more efficient than care that starts at a hospital. The later we intervene, the higher the disease burden, requiring more cost and resources.
1, eit Health, McKinsey & Company. (2020). Transforming healthcare with AI.
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the Chinese government is investing in Artificial Intelligence (AI). Digital means are already being used to access primary care, to schedule appointments and to triage patients based on AI. Ping An Good Doctor (PAGD) is a good example with its online one-stop healthcare ecosystem in China with over 315 million registered users 7 . In fact, during the pandemic, their platform recorded 1.1 billion visits with a 10 fold increase in newly registered users and a 9 fold increase in daily consultations 8 . And they are not the only one – big players like Alibaba and Tencent are also changing the way primary healthcare is delivered.
If we look at India, the government has launched ‘Ayushman Bharat’ – and demonstrated its strong commitment to providing healthcare for all. Several other initiatives such as ‘Digital India’, ‘Start-up India’, ‘Make in India’, are part of the county’s development plan paving the way for improved access to care. With increasing focus on healthcare sector through these initiatives, I am bullish on India’s growth story. For both these growth markets, we will continue to optimise our offerings for local demands to meet the country’s specific needs.
Overall, I believe that the pandemic has accelerated the speed of digitalisation. The COVID-19 pandemic reminds us that healthcare is part of a country's critical infrastructure. Expenditure for healthcare will come to be viewed as an investment in a country’s prosperity and competitiveness, and no longer as an annoying and unproductive cost factor. Consequently, development of the
7. Ping An Good Doctor. (2020). Ping An Good Doctor’s Revenue for 2019 Amounted to RMB5.065 Billion, with its Losses Continuously Narrowed and Online Medical Services Revenue Doubling by 109% over the Same Period. Retrieved May 21, 2020, from Cision PR Newswire website: https://www.prnewswire.com/news-releases/ ping-an-good-doctors-revenue-for-2019-amounted-tormb5-065-billion-with-its-losses-continuously-narrowedand-online-medical-services-revenue-doubling-by109-over-the-same-period-301002912.html 8. Ping An Good Doctor LinkedIn Page. (2020). Retrieved May 21, 2020, from LinkedIn website: https://www. linkedin.com/company/ping-an-good-doctor/ healthcare system will become a central issue on the long-term agenda for each country’s growth, along with ensuring ecological sustainability and expanding the digital infrastructure.
Our role in fighting the pandemic
Every hour, around 240,000 patients are either diagnosed or treated on systems we have built, supporting our customers in the delivery of healthcare. We play a crucial role in fighting the disease. This includes the development and CE certification of a molecular test kit to detect a SARS-CoV-2 infection in record time, the fivefold increase in production capacity of blood gas analysers in just a few weeks, and the development of an antibody test with an outstanding sensitivity of 100 percent (14 days post PCR) and specificity of >99.8 percent 9 . We have put CT scanners in containers to help increase the supply in emergency hospitals and have developed AI
9. Siemens Healthineers. (2020). Siemens Healthineers to expand SARS-CoV-2 testing to include a total antibody test to aid in the COVID-19 pandemic. Retrieved May 21, 2020, from Siemens Healthineers website: https://www. siemens-healthineers.com/press-room/press-releases/serologytest-covid-19.html algorithms to diagnose the disease. Beyond this, our role is to further enable the exchange and collaboration across nations. During the pandemic, we have provided a platform to share the lessons learned and actionable insights on how to tackle the COVID-19 challenge. As a global company operating in 70 different countries, we can help by connecting key stakeholders.
For our company, this means we will become even more important and relevant in the future. More than ever before, our customers and, beyond that, society and politics expect us to provide technical solutions to meet the enormous challenges we face. For example, these include solutions to digitalize healthcare systems, to improve the quality and efficiency of care, or to improve access to modern healthcare. As a company providing solutions for in-vivo and in-vitro diagnostics as well as in image-guided interventions and digital solutions, our goal is to enable healthcare providers across the world. I am glad to be in an industry where we can make a significant difference to people’s lives. It is up to us to play a decisive role in shaping the future of healthcare.
Elisabeth Staudinger is currently President of the Asia-Pacific region within Siemens Healthineers. With a successful track record in international management roles, she is a remarkable senior leader in the healthcare industry. Leading a team of over 7,500 people who are passionate about shaping the future of healthcare, is her source of inspiration. She and her team share a common goal: to enable healthcare providers, particularly in Asia-Pacific, to deliver high-value care.
Elisabeth studied sinology and economics in Vienna, Nanjing, and Beijing and holds a master’s degree in both subjects. She has worked in Asia-Pacific since 2013 and is currently based in Shanghai. AUTHOR BIO
Improving Patient Experience By engaging your employees
Susan Haufe, Healthcare Chief Industry Advisor, Qualtrics
Healthcare organisations (HCOs) have long been focused on improving patient experience. They have set up elaborate systems to listen to their patients and families, redesigned their incentive programs to align with this commitment and organized teams to improve the experience they are providing.
As the leader accountable for patient experience, I watched as leaders around me struggled to understand how to respond to the voice of their patients. Teams desperately wanted to do the right thing, but were burdened by the complexity of the system and by competing priorities that overwhelmed their days. They wanted to understand their patient experience data and respond in a way that would change the experience their teams were providing. However, they felt trapped by the inadequate information provided by traditional surveys and frustrated that nothing they seemed to do had any impact.
When they would call me to their offices to review their data and make recommendations of what they could do (remember, they all desperately wanted to do the right thing!), they were often surprised by my response. Instead of pressuring them to study that data and continue to search for answers within the feedback directly from patients, I would often encourage them to stop looking at their patient experience data and instead focus on their employees.
Now, don’t get me wrong. I was not telling them that the voice of their patients and families did not matter. In fact, my intention was quite the opposite. My hope was that if leaders could feel a little relief from the burden of work and turn their attention to the wellbeing and engagement of their people, they would ultimately see the dual benefit of improved employee experience leading to improved patient experience.
Well, the short answer is a resounding yes. Research clearly shows a correlation between the two. Study after study report that engaged employees lead to higher patient satisfaction, not to mention higher quality care and stronger financial margins. A recent study from nearly 150 VA medical centers over a three-year period shows that higher employee engagement correlated with higher patient satisfaction, lower nurse turnover and better all center performance.
The infamous article from HBR in 1994, titled Putting the Service Profit Chain to Work, has tremen-
dous value in HCOs today. It’s quite simple actually: when you invest in taking care of your people, they are more productive and committed, resulting in a superior experience for your customers (ahem, patients) - and ultimately leads to strong financial performance. We don’t need more research to tell us these things are inextricably linked.
However, patient experience and employee experience are often separate initiatives today.
For as long as I have been leading experience work and for as hard as I tried to link these strategies, measuring the experience of our patients and the experience of our people has been siloed. We haven’t looked at the data in a comprehensive manner, much less gained insight in a way that drove improvement. The fact is, disconnected efforts often result in disconnected results.
There is tremendous opportunity to create an authentic connection between your patients and your employees. It takes cultural transformation and a commitment to activate your employees, and the result is a better experience all around.
Qualtrics healthcare experts and XM Scientists have designed a 4-part webinar series to help healthcare providers and systems deliver the services and experiences the entire sector needs during this period of unprecedented demand. In this series, you will hear how leaders are putting strategies into practice.
BIO AUTHOR
Susan Haufe, Healthcare Chief Industry Advisor, Qualtrics, With 20 years of experience combining the tools, discipline, expertise, and passion to design and drive a customer-centric culture, Susan Haufe is known for organisational transformation built on brand promise, purpose, and values. She currently serves as the Chief Experience Officer, Healthcare Practice at Qualtrics. Prior to joining Qualtrics, Susan served as the inaugural Chief Experience Officer for Yale New Haven Health.
To watch Qualtrics Healthcare Experience Management webinar series, please scan the QR code or visit: https://tinyurl.com/q-healthcare Advertorial
