More than half a century ago, a doctor named Julian Tudar Hart conceptualised the “law of inverse care”. Hart’s notion held that the people in society that are most in need of healthcare are those who have the least access to it.
In the present day, Hart’s law appears to be in full operation. Although Singapore benefits from having a world-class healthcare system, it’s no stranger to health inequality. In an answer to a lawmaker’s question in parliament, the city-state’s health ministry revealed that women with only a primary-level education or less were 3.4 times more likely to develop diabetes than women with a post-secondary education. It said they were also 1.9 times more likely to suffer from high blood pressure and 1.4 times more likely to have high cholesterol levels.
According to the Singapore Ministry of Health, public and private healthcare expenditure is expected to account for 5.9 per cent of the nation’s GDP by 2030. While the generous government spending on healthcare has crowned Singapore as the medical hub of the region thus far, some inefficacies cannot be addressed with money alone.
For Dr Mark Davies, technology offers an answer to these problems that propelled him into his current position at tech giant IBM after 30 years as a practising clinician.
“I joined IBM-UK because I was jealous of how other industries have used the opportunities of technology to modernise and improve their services,” he said. “We cannot allow arguably the most important industry in the world to be the last industry to benefit from this approach.”
No ‘one-size-fits-all’ approach to healthcare
“When designing healthcare, we sort of treat everyone the same, and hope that people will just be able to fit in with it,” said Davies, describing what he calls the “spray-and-pray” approach. “That kind of thinking just doesn’t cut it any more. We need to have a much more profound understanding of the groups within our communities.
“The idea of designing the same service for 24-year-olds and 74-year-olds is, quite simply, ridiculous,” Davies said.
Healthcare is one of the last sectors to personalise its services. Davies said that instead of using a one-size-fits-all healthcare system for all of society and hoping for the best, there was a need to consider the healthcare needs of marginalised communities, in particular. Such communities might include homeless people, those struggling with substance abuse and former prison inmates – all of whom require services designed to suit their particular circumstances.
In addition, Davies said, younger people’s expectations of, and interactions with, healthcare were different.
“Younger people expect to have more tailored and responsive services, and are more used to behaving as a consumer in the healthcare system. This generation is more interested in their wellbeing, and its members expect to be treated as equal partners in their health,” he said.
In light of these considerations, healthcare providers such as the UK’s National Health Service are starting to design services around individuals, allowing them a very active say in setting their own health goals, and prioritising the acquisition of a better understanding of their health risks, Davies said.
Everyone in the UK has a named clinician that is responsible for coordinating their care from cradle to grave, he said, a strategy that not only increases personalisation, but also drives down costs as inefficiencies stemming from a lack of patient understanding are reduced. “This shift towards a much more personalised version of healthcare is really critical,” Davies said.
Using technology to solve problems, not people
Davies said one critical area in which the healthcare sector is lacking is its failure to make full use of digital transformation in the same way that other industries have. Most urgently, digital tools could be used to tackle the issue of burnout among healthcare professionals.
“There is a global lack of doctors, nurses and other healthcare professionals – and the ones that we’ve got are quite tired. In many ways, we’ve not only had a pandemic of Covid-19, but also a pandemic of burnout and low morale in frontline healthcare workers,” Davies said.
The lion’s share of healthcare budgets are accounted for by spending on staff, who are probably the most important determinants of health outcomes and patients’ experiences, which Davies said made prioritising healthcare as a satisfying, sustainable career a critical consideration. Davies recommended a major rethinking of the work of healthcare.
“We’re not really designed to deliver good healthcare – we’re actually more designed to run very effective organisations, which is not the same thing,” he said.
He said the often complex and bureaucratic nature of healthcare processes often deprives clinicians of sufficient time to sit down with patients and do what they are trained to do – talk and treat people.
“Technology gives time back to clinicians to support people when they are at their most vulnerable and provide a level of humanity that I think all of us would want if we were ever unfortunate enough to become ill,” Davies said.
Rethinking care, redesigning work for a seamless patient journey
Instead of having healthcare providers operating in silos and preoccupied simply with meeting their own key performance indicators, Davies said governments should rethink care in a way that creates a seamless patient journey. He said that would require hospitals and clinics to collaborate with ease, and the use of trusted technological infrastructure to support secure flows of data.
Davies is a firm believer that the hybrid cloud can help overcome the significant technological hurdles that many government health providers face. In a single hospital, there may be 400-500 systems that healthcare staff use on a daily basis, he explained. “There are some applications that are never going to be cloud-native, and we need to be able to deal with the heterogeneous nature of those systems,” he said.
In a perfect world, a healthcare provider would be able to preside over all such systems while simultaneously providing a secure environment allowing for modern analytics. It would be able to integrate artificial intelligence and other forms of computational maths into workflows and into discussions of design. To attain anything like this level of integration, however, a high level of trust must exist due to the sensitive nature of personal health information shared with hospitals and other healthcare facilities.
“Many healthcare data-sharing initiatives have struggled because of the lack of transparency or clear consent around how data will be used,” Davies said. “It’s absolutely critical that we don’t undermine the trust that citizens have in their hospitals, doctors and, more broadly, the system.”
Turning to Singapore, he said the country had “impressive ambitions toward integrating population health management in its healthcare system”.
“There are ways to design services based on linked datasets and modern ways of segmenting and stratifying a population, and using those as design principles to create joined-up patient journeys,” he said.” The opportunities here are incredibly powerful.”