July 28, 2010
Being educated as a biologist with a special interest in evolution has left an indelible imprint on my psyche. Like all of us, I suspect, the core of my education has moulded the way that my mind looks at problems and issues. There are many parallels between the world of biology and that of business and one of those is now in sharp focus. As we face a period of economic austerity the obvious and increasingly used comparison with the world of evolutionary biology is that tough times stimulate and accelerate change. In business this is innovation and in biology the phenomenon is rapid evolution and speciation. A tough environment means that businesses and animals alike need to change fast or die.
Can this logic be similarly applied to health systems? I would argue that it should but may be it does not. Publically funded and managed health systems tend to retrench and become more conservative when economic pressure is applied rather than becoming more innovative and adaptive. This may be because of a tendency to towards ‘top-down’ management which is a striking impediment to innovation. Innovation is essentially a bottom up process and however companies or governments try to stimulate entrepreneurial thinking from the top the only real way to tackle the need for change is to structure the enterprise in a way which allows small operating units to be creative and experiment with new ways of doing things. For public health systems this is often the exact opposite response to that which is instinctive i.e. the system is in trouble we must intervene from the top and politicians seek to take control and ‘sort the problem out’. In the short term they cut here and cut there but struggle to bring about lasting change which addresses the problem of improving the quality and quantity of care at lower total unit cost.
In an interesting interview with Euractiv’s Gary Finnegan, Accenture’s Managing Director for Health Operations in Europe, Africa and Latin America, Javier Mur, touches on some of the issues that I have described above and argues for decentralisation of health care and according more responsibility to citizens. Following this path will facilitate and incentivise the multiple actors in the health care system to be creative and innovate but dare Government’s, particularly those of the Beveridge calling, give up the power of the national bureaucracy and free the system to evolve at a rapid rate. We can utilise and harness the economic pressures as a force for good rather than reverting to old fashioned price fixing and rationing which attempt to suppress the forces for change.
There are some encouraging green shoots that the ‘innovation is the key’ message is getting through although it is clear that there are no widely accepted models for how health systems should be structured to maximise innovative potential and adoption of technology as an enabler of change. Some of the public-private partnerships that are being established appear to have more flexibility to adapt and exploit opportunities afforded by all forms of technology. Others are imposing price and reimbursement cuts and eliminating incentives for innovative people and businesses to contribute to a sustainable future. Will this create a two tier Europe with excellent, efficient, innovative and high quality health systems versus those with old-fashioned inefficient state bureaucracies with limited offerings and poor choices for the citizen?Author : MedTech Europe