Disruptive power in healthcare

Technology has a fundamentally disruptive impact on the relation between patients and healthcare. Steven de Waal gave two lectures in Zürich on March 7th 2018.

A focus on the social impact on civil behaviour, mentality and civil society

Current profession-dominated healthcare institutions need to change in time and in the right direction. This calls for civil leadership.
Steven de Waal gave two lectures at the StrategyCircle Gesundheitswesen for an audience of executives of Swiss healthcare, mainly hospitals and health insurers. His main topic, as in many international lectures in several North European countries lately, is about how the same technologies causing disruption in markets, are also affecting the mentality, data gathering, knowledge and the self-organizational capacity of citizens, in case of healthcare: patients and their families.

“These changes are already to be seen everywhere”

So he is not focusing on the technological side of this revolution of internet (apps, websites and platforms) as most people do, but on the social impact on civil behaviour, mentality and civil society. In his view this creates a fundamental change in the relations between healthcare and patients. As he showed in many examples, for the real strategic decisionmakers these changes are already to be seen everywhere in developed countries and healthcare.

Strategic analysis

His main line of reasoning and strategic analysis that he lectured about, is the following.

1. The most important strategic phenomenon in markets today is called disruption: the sudden rise of new entrants that take over customers and their choices in an innovative way and thereby take over markets.
2. Beneath these disruptions are new ICT-technologies – like platforms, websites, access through mobile computers and phones with increasingly large ICT power – combined with a globally working and accessible ICT infrastructure both in hardware and software.
3. A lot of attention is now given to the technological side of this revolution. And of course there are a lot of technological questions, issues, problems and activities involved. But it is most important to see that all technology is merely a tool. Although in the case of ICT-technology it is aimed at a very important aspect of human life: our information and communication and organizing capacities. So the big question is: for what purpose do we need and use these technologies? And what effects will this have on human life and societies?
4. Of course there is a very important force and drive of commercial nature beneath these technologies. As the biggest market capitalization companies on earth like Alphabet, Facebook and Apple now show. But the most important impact is on very different aspects of human life: opinion and review-exchange, mentality of self-steering and self-organizing and breaking open of information. This creates a totally new public domain and debate and a new direct channel between citizens about all kinds of public issues, including public services like healthcare.
5. This culminates in the power of information, knowledge, communication and organization of citizens, for themselves, between themselves and in their own interest(s).
6. So while democracy and politics are already disrupted, public services, like healthcare, and civil society will be next. Maybe not in the classic market-definition, but mainly because of the growing power of patients and their families, including their political power. Important signals and cases are already to be seen across the world.
7. In healthcare it is important to also see this is not only technologically driven (wearables, home monitoring, 3D printing for replacement of organs and broken bones) but it directly affects the power, self organization and knowledge of patients.
8. The strategic consequences for healthcare will be:
   * Patient ownership of personal data and information
   * Shared decision making in diagnosis and treatment
   * Increased logistical planning in the total chain, including homestay, family support and ambulant care.
   * The most complex and heated discussion will be about the partnership and even co-production of healthcare between professionals and these collective organizations of patients.
9. To really anticipate on this shift towards more power of patients we need civil leadership in healthcare, the topic of his dissertation: ‘The Value(s) of Civil Leadership’. As he studied and showed this is leadership with a passion for public value and the common good, operating from a common valuepattern of entrepreneurial values (like innovativeness, willfullness, personal ambition) on the one side, and this public passion (like bonding & bridging, (social) justice, respect) on the other. Because of this he called them ‘a breed of their own’. To change current classical supply-oriented and profession-dominated healthcare institutions we need this civil leadership.

“The challenge is to change current healthcare in time, in the right direction”

In the discussion immediately after his lectures most prominently the next topics were raised:
a. Many recognize the trends and technological impacts on patients and current healthcare, but are only at the beginning of the necessary awareness and willingness to change. No one seems to have a clue in which direction the change must go. It is an unsure and searching time.

b. There was much surprise that you could look at these technological shifts as not just restricted to markets. This was not a pleasant eyeopener for most, because most countries don’t have a marketsystem in healthcare and they thought these new technologies would not affect them as markets.

c. Many recognized the changing relations between professionals, including doctors, and patients and their families. Many were preoccupied with the technological change and the financing of it, now they began to see that the main focus should be on culture and behaviour because of the big social impact.

It is challenging to have this discussion as Steven de Waal experienced in many mostly international lectures these past months. There is a revolution going on and it is rewarding to influence decisionmakers and executives to change current healthcare in time and in the right direction, the basis of strategic thinking.