The strategic context for healthcare leaders is arguably more challenging than ever. Faced with increasing demand, rising consumer expectations, resource pressures and rapid technological change, leaders across the healthcare ecosystem are having to redesign healthcare business models. This move towards value-based integrated care models requires individuals and organisations across the health and care system to work together to make the best use of shared skills and knowledge.
Rise of the systems leader
In response to the challenges ahead, there will be further emphasis on developing systems leaders to drive business model and digital transformation. These visionary leaders will operate at senior levels across the health and care system and possess four key traits enabling them to lead innovation in a changing strategic context:
- The ability to deliver value-based healthcare through integration and collaboration at scale
When I started as Clinical Director for Camden Community Services, there was little integration between the health and care system. Elderly patients would be visited multiple times daily by different local services, often for similar purposes, with little coordination between services. This was expensive and did not lead to a good patient experience. The Camden Integrated Care Service (CICS) was developed as a result. CICS was based on the principles of an integrated practice unit - a simple idea where multiple agencies meet to agree on a proactive care plan for a patient with case management for those with complex needs. It reduced duplication and led to better value healthcare in terms of both resource use and patient outcomes.
Such early examples of integrated services were systematised by the NHS in 2016 through Sustainability and Transformation Partnerships (STPs). Integrated Care Systems now cover one-third of the population of England and bring together NHS organisations, local councils and other organisations with collective responsibility for the health of local populations. They deliver value-based healthcare (delivery models that pay providers based on patient health outcomes).
Evolving integrated systems need leaders who can motivate and influence people to work differently across service and organisational boundaries. They need leaders with drive, persistence and influencing skills to promote collaboration between stakeholders who have spent decades working in isolation.
Furthermore, to deliver value, the health and care system also needs to mirror industries like aviation that have been using the concept of improvement science for decades. Improvement science is about systematically examining what methods and factors best facilitate quality improvement. However, although clinical practice is broadly evidence-based, we have been slow to implement improvement science principles to health system management.
- The ability to unlock the value of population health data
At Imperial College Health Partners (ICHP) we have seen first-hand how the availability of data across health and social care organisations delivers a real understanding of a population’s health and can help to plan new interventions.
For example, ICHP population health analysis showed that there were around 17,000 people with undiagnosed irregular heartbeats (Atrial Fibrillation) in North West London at increased risk of strokes. It is estimated that stroke care costs the NHS £2.2 billion in direct care each year.
ICHP supported our partners in North West London with the roll-out to primary care of an upskilling education package together with a digital health solution called Kardia, an ECG device linked to a smartphone enabling easy diagnosis of irregular heartbeats.
Future health leaders will be intelligent in their use of population health data to drive service model innovation, deliver better value, and ultimately save lives.
- The ability to nurture innovation ecosystems
There are many exciting MedTech start-ups at the moment. As a clinician working with the elderly, I am impressed by MySense, a member of the DigitalHealth.London accelerator. This company takes information from discrete fixed and wearable sensors applied around patients’ homes and uses machine learning algorithms to identify anomalous behaviour. MySense informs carers and health professionals of anomalies, enabling early identification of problems and treatment.
To create an environment where start-ups like MySense can scale, health leaders will need to understand how to support digital innovation so that adoption is accelerated where appropriate and not subject to the long timescales usually associated with traditional clinical R&D. They will need to understand the role of data, the value and limitations of technologies such as AI, machine learning, robotics and digital therapeutics and will need to be able to advise local health systems about the opportunities offered by these technologies.
Furthermore, knowledge of the innovation process including key concepts like intrapreneurship, design thinking, patient centricity and, increasingly, frugal innovation, will also be key to fostering an innovation ecosystem.
- The ability to scout and implement global best practice
Finally, system leaders will need to have a global perspective and bring the best of global practice back to their own health systems.
Leaders could, for example, look at the work done by Mercy Virtual Care in the USA where specialists remotely care for patients. Or they could look at the Ko Awatea in New Zealand - a health system innovation and improvement unit embedded within the district health system.
Reasons to be optimistic
There is no doubt that now is a particularly challenging time to be a leader in healthcare. But, equally, never before have there been such incredible opportunities. I believe that sustainable improvement will come with strong leadership that nurtures innovation, promotes value-based healthcare, fosters integration and collaboration, uses data intelligently, and implements global best practice.