ten digital health tensions provide energy of innovation · ten digital health tensions provide...
TRANSCRIPT
May,2017
TenDigitalHealthTensionsProvideEnergyofInnovationPoweringustowardsthemedicineandhealthcareoftomorrow
Dr.ChrisWasdenExecutiveDirector
Ourfocusonhighreliabilityandmedicalpracticesofthepastarecausingustofailtoinnovateandadaptinaturbulentmarket
2
Innovationresearchhighlightsthecentralroleoftension
Innovatorareambidextrousleaderswho
harnesstension
Wehavethegreatest
tensionforinnovationinworldhistory
Ambidextrousleadersmustcreateand
harnesstensions
1 42 3
WemustapplyComplexitySciencetoovercomeourfailuretoinnovate!
Ourfocusonhighreliabilityandmedicalpracticesofthepastarecausingustofailtoinnovateandadaptinaturbulentmarket
3
Innovationresearchhighlightsthecentralroleoftension
Innovatorareambidextrousleaderswho
harnesstension
Wehavethegreatest
tensionforinnovationinworldhistory
Ambidextrousleadersmustcreateand
harnesstensions
1 42 3
WemustapplyComplexitySciencetoovercomeourfailuretoinnovate!
Tensionbetweenincrementallyimprovingthestatusquoanddisruptingit
4
DisruptiveInnovation
SustainingEngineering
Tensionbetweenaddingnewtechnologiesandcreatingnewbusinessmodelsofvaluecreation
5
BusinessModelInnovation
TechnologicalInnovation
Tensioninhowyouregardandmanagefailure
6
LeanStartup LeanScaled
Tensionbetweennurturingtheuglybabyandfeedingthehungrybeast
7
UglyBaby HungryBeast
Experienceandresearchindicatesahugedifferenceinthewaythatestablishedcompaniesandstartupsdealwithinnovation
8
bigsmallSimplexityMDMCNanotissues
Tensionparadoxisthatallinnovationisbornattheedgeofchaosbutonlysucceedsbyapproachingtheedgeofequilibrium
9
MINDF
ULLY
Creatin
gTomorrow
EDGE
OFCH
AOS
MINDL
ESSLEY
Runn
ingToda
yED
GEOFEQ
UILIBRIUM
InnovationLifecycle
Highreliabilityorganizationsstruggletoinnovatebecauseoftheirfearoffailure
10Moto:“Failureisnotanoption”
11
Iffailureisnotanoption
Thenneitherisinnovation
Theproblemisthatleansixsigmadisciplineeliminatestherawmaterialsofinnovation– variation,interactionandselection
12
Failing3timesin1millionattempts
Innovationrequiresadifferentdisciplinethatenablesamindfulandefficientandeffectivewayforfast,frequent,frugalfailure
13
Failingabout90%ofthetime
14
Simplicitydoesn’tprecedecomplexity,itfollowsit.AlanPerlis,FirstRecipientoftheTuringAwardinComputing
Ourfocusonhighreliabilityandmedicalpracticesofthepastarecausingustofailtoinnovateandadaptinaturbulentmarket
15
Innovationresearchhighlightsthecentralroleoftension
Innovatorareambidextrousleaderswho
harnesstension
Wehavethegreatest
tensionforinnovationinworldhistory
Ambidextrousleadersmustcreateand
harnesstensions
1 42 3
WemustapplyComplexitySciencetoovercomeourfailuretoinnovate!
Iconicdigitalinnovativeleadersaremastersareharnessingtensionstopowerdisruptivedigitalinnovations
16
Greatinnovationleaderscreate,enableandharnesscreativetensiontopowertheinnovationprocesses
17
“Myjobasaleaderistocreatediscordandtoimposedeadlines.”EricSchmidt,Chairman,Alphabet(Google)
Thesethreeprocessenablespontaneousordertoemergefromchaos!
18
Istensiongoodorbad?
Howwouldyouanswerthesethreetensionquestions:
• Howmanyofyouenjoyandseekouttensions?
• Howmanyofyoucreatetensionstogetotherpeopletoact?
• Howmanyofyouthinkthatwecaneliminatetensionsinourlives?
19
Innovativeleaderscreateandharnesstensionastheenergysourcetopowercreativity,but…
20
Whatkindoftensiondoyouharness?
MaladaptiveTension
- Fearanddoubt- Threats- Reactive- Belittling- Mindlessfailure- Emergent
- Painful
Innovativeleaderscreateandharnesstensionastheenergysourcetopowercreativity,but…
21
Whatkindoftensiondoyouharness?
MaladaptiveTension AdaptiveTension
- Tweaksandmodifications- Incrementalimprovement- Sustainingengineering- Sixsigmainnovation- Rewarding- Planned,directed
- Predictable
- Fearanddoubt- Threats- Reactive- Belittling- Mindlessfailure- Emergent
- Painful
Innovativeleaderscreateandharnesstensionastheenergysourcetopowercreativity,but…
22
Whatkindoftensiondoyouharness?
MaladaptiveTension AdaptiveTension
- Tweaksandmodifications- Incrementalimprovement- Sustainingengineering- Sixsigmainnovation- Rewarding- Planned,directed
- Predictable
CreativeTension
- Radicalanddisruptive- Freewill,agency- Transformative- Powerful- Inspiredbyfaithandhope- Self-organizing
- Possible
- Fearanddoubt- Threats- Reactive- Belittling- Mindlessfailure- Emergent
- Painful
Theseleadersapplytheinnovationcycletocreatenewsourcesofvalue
23
Value-creatingnoveltyBornoffailurethatcreatespain
PoweredbytensionLeadstogrowth
JosephSchumpeter’sTheoryofCreativeDestructionsaysthatneworderspontaneouslyemergesfromthefailureoftheold
24
KarlWeick’s TheoryofSensemaking saysthatweonlylearnandimprovethroughexperiencefailureandpain
25
RobStone’sTheoryofStrongStructurationdescribeshowwemusthavecreatestructuresandpracticestoinnovate
26
WalterBuckleys’TheoryofComplexAdaptiveSystemsidentifies“tensionasthego”inallselforganizingsystems
27
Thedifferencebetweenmanagersandinnovativeleadersishowtheyapplytheinnovationcycleandlifecycle
28
Foresee
Thedifferencebetweenmanagersandinnovativeleadersishowtheyapplytheinnovationcycleandlifecycle
29
ForeseeBringitForwardHarnessCreativeTension
tochangetheworld
30
Thereasonablemanadaptshimselftotheworld;theunreasonableonepersistsintryingtoadapttheworldtohimself.Thereforeallprogressdependsontheunreasonableman.GeorgeBernardShaw,author
Ourfocusonhighreliabilityandmedicalpracticesofthepastarecausingustofailtoinnovateandadaptinaturbulentmarket
31
Innovationresearchhighlightsthecentralroleoftension
Innovatorareambidextrousleaderswho
harnesstension
Wehavethegreatest
tensionforinnovationinworldhistory
Ambidextrousleadersmustcreateand
harnesstensions
1 42 3
WemustapplyComplexitySciencetoovercomeourfailuretoinnovate!
Exponentialchangesoccurringinsocietyaretheleadingindicatorsofemergingtensions
32
Thesetensionswillcreate200centuriesofchangeinjustthe21st Century
ThesetensionspowercreativedestructionthatisdecreasingthelifeoftheS&P500tojust12years
34
Theemergenceofmobiletechnologyhascompletelychangedthelandscapeforgreaterconvenienceinhealthcare
35
EricTopol TheRiseofMobileTechnologies
Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit
Thedoubleexponentialdeclineingenomiccostshasledtoanexponentialincreaseingenetictest- creatinganewproblem
36Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit
CostofGenomeSequencing NumberofGeneTests
Oneofthelargestemergingproblemsismakingsenseofthemicrobiome,whichappearsmoreimportantthanthegenome
37Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit
MicrobiomeMentions MicrobiomeJournalArticles&Patents
Healthcareorganizationsaredrowningindata,muchofwhichcomesfromnewtypesoftesting
38
GrowthinBigData GrowthinHealthcareRelatedData
Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit
RFIDandtheIoTareexplodingandwillrevolutionizeglobalsourcing,requiringnewcapabilities
39
RFIDForecast BillionsofConnectedDevices
SocietalProblem
Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit
IoTwillbemoredisruptivethantheinternettoallaspectsofbusinessoperations
40
IndustrialDevices- Largest
Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit
VirtualrealityisanewwayofthinkingandapplyingIoTinconsumer,commercialandindustrialapplications
41
VRRevenue(M) UCLANeurosurgery
SocietalProblem
Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit
Andsimilargrowthinaugmentedrealitywillenhanceproducts,marketingandretailing
42
ARRevenue(M) CaseWesternAnatomy
SocietalProblem
Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit
IoT,SocialMedia,andBigDataaredrivingdemandforanalyticstopredict,prevent,prescribenewbehaviors
43
DataScientistJobs BigDataToolsJobs
SocietalProblem
Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit
ArtificialIntelligence(AI)andchatbotsareconsideredthenextbigthingtopredict,prevent,andprescribebehaviors
44
ArtificialIntelligenceRevenue AlexaYourVirtualDoctor
SocietalProblem
Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit
ThegrowthofUberanditsexpansionintonewmarketswilllikelydisruptothertransportationservices
45
UberDriverGrowth UberEnteringHealthcare
Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit
Dronesrepresentanadditionaldisruptiveforceintheglobalsupplychain,butwhatabouthealthcare?
46
CommercialDroneRevenues HealthcareDrones
SocietalProblem
Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit
Automation,AIarefurtherdrivingchangesinAdditiveManufacturing(aka3Dprinting)
47
Consumer&CommercialAM Healthcare3rd LargestMarket
Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit
WemustabidetheLawofRequisiteVariety&Complexity
48
VarietyintheExternalEnvironment VarietyintheInternalEnvironment=
Organizationsthatfailtoabidethislawfailtosurvive
Areyoulivingthislaw?
WemustabidetheLawofRequisiteVariety&Complexity
49
VarietyintheExternalEnvironment VarietyintheInternalEnvironment=
WemustabidetheLawofRequisiteVariety&Complexity
50
VarietyintheExternalEnvironment VarietyintheInternalEnvironment=
51
Thetestofafirst-rateintelligenceistheabilitytoholdtwoopposedideasinthemindatthesametime,andstillretaintheabilitytofunction.F.ScottFitzgerald,author
Ourfocusonhighreliabilityandmedicalpracticesofthepastarecausingustofailtoinnovateandadaptinaturbulentmarket
52
Innovationresearchhighlightsthecentralroleoftension
Innovatorareambidextrousleaderswho
harnesstension
Wehavethegreatest
tensionforinnovationinworldhistory
Ambidextrousleadersmustcreateand
harnesstensions
1 42 3
WemustapplyComplexitySciencetoovercomeourfailuretoinnovate!
53
Lifeislikeaten-speedbicycle.Mostofushavegearsweneveruse.CharlesM.Schultz,cartoonistandauthor
Weneedtobecomeambidextroustoenableourpeopleandorganizationtorideallkindsofcycles
5
Failure3in1M
Failure90%
TheLawofRequisiteVarietyrequiresdigitalinnovation– WEMUSTBECOMEMORELIKEAmazon,Google,Apple
55
OriginalSinofHealthcare– Failure totreattheconsumerascustomer– digitalprovidesthetoolstoovercomefailurebuthealthcarestrugglesduetoTenTensionofDigitalHealth
56medtechforum.eu
MoneyTension– Requiresnewbusinessmodels
57
CliniciansandhealthsystemswillonlyadoptDigitalHealthiftheycanmakemoremoney;
yettheprimaryvalueofDigitalHealthistoimprovethetripleaim:betteroutcomes,greateraccess,affordablecare(lowercosts).
MoneyTension
58
PracticeTension– abandoninganalog,outmodedpratices
59
DigitalHealthmustdrivecreativedestructionofmedicineandtransformthepracticeofhealthcaretoonethatusesfewerclinicians;
Pharma,medtech,payersandprovidersmustleadthistransformationbyembeddingworkflowintotheirDigitalHealthsolutions.
PracticeTension
60
EngagementTension– engagedinpersonalhealthbehvaiors
61
Consumers/patientsneedtobemoreengagedinmakinghealthydecisionsbutlessengagedinthehealthsystem;
DigitalHealthprovidestheplatformstoenablenewandbetterformsofengagement.
EngagementTension
62
EngagementTension
63
400Students100judges81universities14countries
$64,000prizemoney
AdoptionTension– focusonthosewhoareearlyadopters
64
ThosethatneedDigitalHealthcaretheleastarethemostlikelyandwillingtoadoptitthefastest,whilethosethatneeditthemostwillbeslowadopters;
Earlyadoptersprovidegreattestscasestodriveinnovationandincreaseadoptionamongthosewithchronicdisease.
AdoptionTension
65
TechnologyTension– itsNOTabouttechnologybutworkflow
66
Wehaveanoverabundanceoftechnologiesbutanunwillingnessandinabilityofclinicianstousethem;
Technologyadoptionmustbecomeassimpleaswritingadrugscriptandrequirenomorethinkingandeffortfromclinicians.
TechnologyTension
67
SatisfactionTension– consumersaredemandingdigital
68
NearlyeverystudyandsurveyonDigitalHealthshows70-85%+consumer/patientsatisfactionduetosignificantlybetteroutcomes(shorterhospitalization,feweradmissionsandreadmissions);
ConsumersmustbecometheoutspokenrevolutionariesdemandingDigitalHealthsolutions.
SatisfactionTension
69
Cost Convenience
Confidence Compensation
1
3 4
2
Why isn’t it malpractice to not use Digital Health?
20% (20%) reduction in hospital admissions 25% (14%) reduction in bed days of care
86% patient satisfaction
20-57% reduction in chronic disease care46% reduction in mortality
85+% reduction in cost of care, $1600 vs $13K PCP, $77K SNF
UK NHS Whole System
Demonstrator
FeedbackTension– admitthereisNOfeedbacklooptoday
70
Therecurrentlyisvirtuallynofeedbackloopinhealthcareforthevastmajorityofconsumers/patients;
DigitalHealthenablesrealtimefeedback,butrarelybythehumanclinician.
FeedbackTension
71
UtilizationTension– increaseproductivitynotactivity
72
NearlyallstudiesofDigitalHealthshow20-40%reductionsinhealthsystemutilizationyethealthsystemsindevelopedcountriescan’tfigureouthowtoturnthatintoeconomicvalue
EmergingmarketsandconsumerdrivensystemsarecreatingnewDigitalHealthsystemstoleapfrogdevelopedmarkets.
UtilizationTension
73
ValidationTension– don’twaitfor10yearsandeverybodyelse
74
DespiteaplethoraofpilotsandstudiesofDigitalHealthapplicationsandusecases,welackasystematicwaytoevaluateandvalidatewhichonesworkandhoweffectivetheyare;
weneedsocialandcrowdsourcedmechanismstorapidlytestandshareDigitalHealthsolutionsandavoidPilotitis.
ValidationTension
75
BehaviorChangeTension– consumershaverightdigitalbehaviors
76
DigitalHealth’svalueonlyreallyaccruesbychangingconsumer/patientandclinicianbehaviors,yetclinicianslackanytraininginbehavioralpsychology,economicsandchange;
DigitalHealthvendorsmustincorporatebehaviorchangescienceintotheirsolutionsjustasGoogle,Amazon,FacebookandAppledoindigitaltechnologysolutions.
BehaviorChange Tension
77
Wouldthiscreatetensioninyourorganization?Coulditbeacreativetension?Coulditbetransformational?
78
Howdowe“OwntheDisease”andincreasemarketshareby5X,tripleprofits,andradicallyimproveoutcomesinfiveyears?
5th placewith10%marketshare,-10%margins,readytosuchdownthebusiness– GrowthHormoneTherapy
79
Couldweownthedisease?
Adigitalhealthfeedbackloopdramaticallyimprovedresults– willingtotakerisk
80
Innovation in the new healthcare paradigm
Wireless Easypod injection device records dosage data and transmits to clinicians
Nurse call center intervenes when notified by device of patient non-compliance
Moleculardiagnosticmitigaterisk,enabledgreaterrisktakingandvaluecreationthroughdigitalhealth
81
Innovation in the new healthcare paradigm
Molecular Dx screening IDs patients who would benefit from treatment
Wireless Easypod injection device records dosage data and transmits to clinicians
Nurse call center intervenes when notified by device of patient non-compliance
Nursesassistingpracticesprovidebetterriskmanagementwithanalogcaretocomplementdigitalcare– enhanceclinicianworkflow
82
Innovation in the new healthcare paradigm
Molecular Dx screening IDs patients who would benefit from treatment
Wireless Easypod injection device records dosage data and transmits to clinicians
Nurse call center intervenes when notified by device of patient non-compliance
Clinical nurses in physician’s office assist intreating patient
Electronicmedicalrecordsensureddigitalhealthdatacapture,improvedanalytics,andmeasuresofvaluecreation
83
Innovation in the new healthcare paradigm
Molecular Dx screening IDs patients who would benefit from treatment
Wireless Easypod injection device records dosage data and transmits to clinicians
Nurse call center intervenes when notified by device of patient non-compliance
Clinical nurses in physician’s office assist intreating patient
EHR Integrates patient information
OwningtheDiseasethroughdigitalhealthenabledvalue-basedpaymentandsuccess
84
Innovation in the new healthcare paradigm
Molecular Dx screening IDs patients who would benefit from treatment
Wireless Easypod injection device records dosage data and transmits to clinicians
Nurse call center intervenes when notified by device of patient non-compliance
Clinical nurses in physician’s office assist intreating patient
EHR Integrates patient information
Value-based reporting to NHS demonstrates compliance and improvedoutcomes
Personalized Digital System-based Value driven
MarketShare:10%à 50% Profits:-10%à 20% Salesforce:20à 0
Wouldthiscreatetensioninyourorganization?Coulditbeacreativetension?Coulditbetransformational?
85
Howdoweeliminate50%ofallclinicalvisitswithin5years?
DoctorsAdamsonandBachmanhaveshownthewayintheir2010research
86
Largeststudyofitskindtotesttheideaofpushingmorecaretothehome
87
2years(2007-2009)4,300patients56cliniciansin4locations24hourturnaroundPortaltechnology2,531onlinevisits1,159werebilledNomarketingorpromotion
Thereweretwoprimarypersonasamongtheseonlinepatients,youngmomsandolderdaughters
88
71%womenMonday25%Weekend5%8AMto4PM
WorkingMom WorkingDaughter
40%ofallproblemswereaddressWITHOUTanofficevisit– thiswasconservative– couldeasilyhavebeen50%
89
45%
10%
10%
5%
16%
14%
NewPrescriptionRefillPrescriptionRadiographsLabsBypassnurseOther
…butdiditmakemoney?
90
11%justprescriptionrefill14%senttotheofficeforanappointmentManyseenintheofficepreviousweekorregularfollowupsWhatisthevalueofbeingabletoseemorepatientsinoffice?
Dr.ErinClarkinMaternalandFetalMedicineattheUniversityofUtahwantstocutmaternalvisitsby50%
91
Fornearly30yearswehavebeentryingtocutthenumberofvisitsinhalf
92
1989:U.S.DepartmentofHealthandHumanServices
CaringforourFuture:TheContentofPrenatalCareReportofthePublicHealthExpertPanelonthe
ContentofPrenatalCare
Proposedreducedfrequencyprenatalscheduleforlow-riskparouswomen
basedonthetimingofspecificeventsandteststhatoccurinpregnancy.
➔ Reducedrecommendedvisitsfrom14to8.
Dr.Clarkranaclinicalstudywith200womentotesttheideaofcuttingvisitsby50%
93
ENROLLMENTEligiblePatients
Approached,n=466
Randomized,n=200
ALLOCATION
Declinedparticipation,n=266(57%)
AllocatedtoRemotePrenatalCareArm,n=100
AllocatedtoTraditionalPrenatalCare,n=100
Withdrawn,n=9• Technicalissues,n=4• Switched
insurance/provider,n=4• Pregnancylosspriorto
16weeks,n=1
Withdrawn,n=4• Switched
insurance/provider,n=3• Pregnancylosspriorto
16weeks,n=1Analyzed,n=96 Analyzed,n=91
ANALYSIS
Sheuseddigitalhealthdevicesandapplications
94
Shefoundnomeaningfuldifferenceinoutcomes
95
Traditional(N=96)
Remote(N=91)
GestationalAgeatDelivery,wks 39.4 39.4PretermBirth 7(7.3%) 4(4.4%)InductionofLabor 39(40.6%) 41(45.1%)CesareanDelivery 12(12.5%) 9(9.9%)BirthWeight,gms 3427 3345IUGR 3(3.1%) 1(1.1%)FetalDemise 1(1%) 1(1.1%)
Shefoundpatientswerejustassatisfied
96
0.
25.
50.
75.
100.
125.
Not Satisfied (n=2) Satisfied / Very Satisfied (n=173)
Traditional (n=89)Remote (n=86)
Patientswereveryhappywithdigitalhealthremotemonitoring
97
0
18
35
53
70
Strongly Disagree
Disagree Neither Agree or Disagree
Agree Strongly Agree
I am satisfied with remote prenatal care for monitoring my health during pregnancy.
Thereweremanyreasonstheylikedandpreferredittotraditionalprenatalcare
98
0
25
50
75
100
125
Time Savings Convenience Cost Savings Feel More Empowered /
Involved
Other
What are the 3 most important reasons you liked receiving remote prenatal care?
MoreFocusedTimewithProvider
Theynearlyallpreferredamixofdigitalandanaloghealth
99
0
25
50
75
100
<20 wk 20-36 wk after 36 weeks
Only in-person vistsA mix of in-person and remote visitsOnly remote visits
100
WhathappensifyouharnesscreativetensiontoOwntheDiseaseorcutvisitsby50%in5years?
ClinicianShortages PatientAccess QualityOutcomes HealthCosts
ByapplyingComplexitySciencetoinnovateyouenablespontaneousordertoemerge!
Ourfocusonhighreliabilityandmedicalpracticesofthepastarecausingustofailtoinnovateandadaptinaturbulentmarket
101
Innovationresearchhighlightsthecentralroleoftension
Innovatorareambidextrousleaderswho
harnesstension
Wehavethegreatest
tensionforinnovationinworldhistory
Ambidextrousleadersmustcreateand
harnesstensions
1 42 3
WemustapplyComplexitySciencetoovercomeourfailuretoinnovate!
102
IthoughtofthatwhileIwasridingmybicycle.AlbertEinstein,oncomingupwiththeTheoryofRelativity
Physicshasstruggledtounifytheworldofthebigandthesmall…muchlikeorganizationsdotoday
103
Tensionsmallprobableuncertainfreewillradical
BIGPREDICTABLE
CERTAINCONSTRAINEDINCREMENTAL
StringtheoryhasemergedasacrazyideaofhowharnessingtensionunifiesbothbigandsmallinComplexAdaptiveSystems
104
VibratingstringsatvarioustensionstodeliverspecificfrequencieslooktobethefoundationforallexistenceandunifyGeneralRelativityandQuantumPhysics
Strings QuarksLeptonsHadrons
ElectronsProtonsNeutrons
Atoms Molecules
Isatheoryoftensions andcomplexitycrazyenough?
105
“We are all agreed that your theory is crazy. The question that divides us is whether it is crazy enough to have a chance of being correct.”Niels Bohr