When Richard Branson revealed that Virgin employees are the company's top priority, he brought a paradigm shift in organisational thinking. It however, has long been known that a team where individuals give their 100%, are proud of the brand and the work they do, will beget happy customers and thus lead to the growth of the organisation.
Similarly, in healthcare, which is extremely complex, it is mandatory that the professionals are given their due share of respect, autonomy and support in discharging their duties. It is also a fact that healthcare delivery needs an overhaul to achieve better client trust, confidence, compliance and better outcomes. With the advent of digital technology, artificial intelligence and machine learning, there is more a demand for precision medicine. This sometimes sounds like an oxymoron, because experienced practitioners will tell you, that the practice of medicine is not exact science and however clever a computer is, it may struggle in situations which it may not have encountered before or the encounter has been sparse. Secondly, the overwhelming importance of matters like compassion, empathy, trust and communication may just not be the strengths of a robot. It is here that the virtual world will need to work as a support to the decision-making capabilities of the traditional healthcare professional.
In today`s world of organisational and managed healthcare, customer delight is of utmost importance. This often determines whether the concerned client will engage further with the organisation or team. Any unsavoury experience or misunderstanding may lead to a trust deficit which will stunt organisational growth. Very often, the reasons for dissatisfaction may not be medical after all. It may just reflect the happiness levels of the client. It is here that the provider which includes the entire team has a high morale, is delighted to provide care and contributes effectively to decision making and thus organisational growth.
A huge source of knowledge regarding patient related behaviours comes from unpublished and unreported accounts of health care professionals themselves. Some of these have come from years of burning the midnight oil. They have tried various solutions and developed a system of practice that works in the microenvironment that they work in. These experiences need to be taken on board to design unique solutions. It is thus quite important to take healthcare professionals into confidence when designing solutions which directly influence them. As much as clients and patients deserve to have a voice, frontline medical personnel need to be heard because unless they are convinced about what they are doing, it will be difficult to expect commitment from them. It has now been long established that money alone is not the prime driver of happiness and satisfaction at work. Things like a purpose and meaning in what they do, along with appreciation are more important.
In the changing world of healthcare delivery, especially with the advent of mobile and digital technology, it is now imperative that professionals are supported with training, legal help and support in adjusting to a new system. Managing change, especially in healthcare delivery is difficult unless all stakeholders are taken into confidence. This is because of the ethical and legal implications of every bit of change.
The burgeoning rise of the camera enabled smartphone has imbibed a compelling need to have reality confirmed and experienced in everyone. No visit or experience is complete without having experienced it through a camera lens most of which are on mobile phones. Following this, the picture travels across the globe in a matter of seconds and more people are engulfed in the experience. The phrase “I was there” is almost incomplete without the customary selfie, whatever the occasion.
The need for visual presentism has not left medical practice untouched. Initially used by medical practitioners to document pathology; with the advent of internet connectivity, images have been transmitted over the last decade for medical opinion. Particularly commonly used has been in the monitoring of wounds. This has now been extended to dermatology, rheumatology, ophthalmology, burns management, occupational and physiotherapy and in surgical specialties. These are however, extremely sensitive medical records that, while they have great potential for medical use, also have the potential to compromise patients’ privacy and confidentiality. There is was always the question of legal and ethical implications.
The democratisation of digital photography with the ubiquitous use of camera enabled smartphones and better internet connectivity has enabled people with medical conditions to record and monitor their own problems and send to healthcare professionals to interpret and take decisive action. Sometimes, there maybe transitory events like a resolving facial paralysis or a rash which maybe recorded by the patient and transmitted or even brought to a consultation which may illustrate the events well. While some are extremely articulate in describing their problems, for others a photograph maybe a way of describing problems. Further, these have been extended to actual screening of eyes and transmission of these images to a central hub for interpretation.
Patient generated photography empowers the patient to produce very relevant information that makes medical consultation more effective. Secondly, it also reduces unnecessary clinic or hospital visits when monitoring various pathology. Patient taken photographs reduce recall bias, selective symptom reporting and improves communication between the doctor and patient. Monitoring of various conditions using mobile photography may instill good health related behaviour habits like being more aware of the condition and adopting specific measures. Camera phones are constantly available and this enables health related information to be collected all day. They are an alternative to journal related behaviours such as recording of food intake and document contextual circumstances in self-management of conditions like diabetes.
“Medical selfies” have ethical and legal implications. Currently there is no standardised system of taking photographs and it is up to the competence of the client and provider`s competence to document, transmit and interpret photographs. There is always a possibility of an error in judgement. This lack of standardisation, legal and data compatibility issues are also the limiting factor in incorporating these into electronic patient records. Client consent is another issue which needs to be sorted especially what is related to patient confidentiality. Ultimately each jurisdiction must navigate the complex networks of legislation, institutional policy and codes of practice to develop a solution that suits the needs of their patients.
However, with the passage of time, self-reporting of medical photographs is slowly emerging as an extremely powerful tool in patient engagement, education and empowerment. This has a direct bearing on healthcare access , which is so important to provide better quality and cost effective healthcare.
The WHO Constitution enshrines “…the highest attainable standard of health as a fundamental right of every human being. The right to health includes access to timely, acceptable, and affordable health care of appropriate quality.
There are five dimensions of accessibility (Approachability; Acceptability; Availability and accommodation; Affordability; Appropriateness) and five corresponding abilities of populations (Ability to perceive; Ability to seek; Ability to reach; Ability to pay; Ability to engage). It is this complex interplay between the healthcare provider and the client that decides the success of good healthcare delivery and thus good health. In short, access to healthcare thus has three principle dimensions: Physical accessibility; Financial affordability and Acceptability.
As much as there is a pressing need to provide physical access to quality healthcare services, which are affordable according to the socio-economic need of the person, care must be taken to win the confidence of the people that these services are required and will make a positive difference. Irrespective of the socio-economic status of the person, there is need of education regarding health and disease, health promotion and relevance of healthcare strategies. Along with social and cultural practices that maybe barriers, there is also a perceived deficiency of trust. There is a growing discontent among people that many of the strategies are superfluous and counterproductive. Due to the explosion of information which is disseminated through various channels, there is a great deal of confusion regarding accuracy of healthcare information. Negative publicity by a section of the media has not helped. This has led to shunning of healthcare by a section of the community.
Digital health is an excellent tool in this regard. As mobile technology is now viewed as an essential element of daily living, is ubiquitous and affordable, healthcare can now be taken to the people. Carefully constructed, succinct and two-way communication can be established and dedicated portals created for education regarding health and disease. This is important so as to avoid misunderstandings and improper communication which is often the basis of dissatisfaction. Overloading of information may be avoided and healthcare maybe viewed as an essential part of day to day life. As the first step in any behaviour modification is to know about and win the confidence of the people, this kind of proactive education can be a useful learning tool.
As we have seen earlier, one of the most expensive areas of healthcare is the costs of transporting patients and waiting in outpatient clinics, mobile health can be used to remove all non-essential clinic visits and provide more efficient and comprehensive care. This will also mean more efficient monitoring of patients even when they are not in clinics and watching trends in patient status may mean earlier intervention in deteriorating patients.
Another important aspect of remote monitoring and management is the ability to gain personalised insights into patients and study behaviour on an individual basis and intervene appropriately.
The most contentious albeit most important issue is the management of social determinants which determine the success of healthcare. Though this needs a lot of strategic and design thinking, mobile technology has entered this space and strategic partnerships maybe entered into which may be helpful.
Any kind of change needs the acceptance and will of the population at large. It is upto the healthcare providers to build a system and a network that does not raise any questions about the efficacy and safety of delivery. Though it is extremely simple to conceive and strategize a plan, it is in the execution that success or failure on a large scale and over a long term depends. There will be lessons learnt everyday and it calls for the providers to be extremely pragmatic because it is not just a cohort of people that this system deals with but it is managing the microenvironment and the person which is the most challenging.
Providers with a committed workforce and yeoman leadership at all levels will succeed and will be in a position to provide the greater objective of universal healthcare access for all.
Technological advancement and modernisation of medicine has come with a hefty price tag, which healthcare providers and clients are grappling with. However, this has also led to more definitive, democratised and precise solutions in healthcare, which is quite important. Though technology is the favourite whipping boy when costs are calculated, they bring a definitive value that we cannot do without. In both healthcare systems where the expenses are borne by the state or insurance companies and when borne by the client, there are some significant sundries, which add up quite significantly. These expenses in the developing world are quite significant because they hold the key to pushing an individual with a not so robust financial condition further into poverty. Data from India show that most of the expenditure (74%) was incurred for outpatient treatment, and not for hospital care; only 26% was for inpatient treatment.
Travel to hospital by personal and public transport, parking if applicable over long periods of time are extremely significant expenses. The cost of transporting ill people and their relatives in an already financially stretched household is telling. The cost of waiting at a public health facility that does not have operating hours convenient to working patients is the loss of that day’s wage. In addition, a large population waiting to access free care ensures long waiting times, causing missed work days and consequent loss in income. Having an ill person at home means not just the cost of medicines and several other expenses, such as costs to treat side effects and other ancillary tests and procedures. Illness demands rest hence employment must wait. Patients also require appropriate nutrition. Therefore, expenses on food increase and others within the household must give up either their share of food or add to the household costs.
Poverty exacerbates disease, but disease further pushes households into poverty. This may lead to families being malnourished, selling of assets, taking children out of education and stigmatisation.
Though correcting the social determinants of disease is an extremely complex problem, internet and mobile technology may help. Telemedicine and remote monitoring of patients may help in reducing unnecessary hospital visits and appropriate intervention when needed. Digital platforms maybe used for continuous patient education and advice on matters of health and related issues. Multidisciplinary care can be instituted and most importantly, the quality of care, which now continuous can make a big difference.
The cost of instituting mobile healthcare is not prohibitive, but can make a big difference to the physical, emotional and financial health of the patient and the family.