The hit-and-run tactics of guerrilla warfare may seem a strange analogy to use in healthcare but, to those in the know, when it comes to implementing digital innovation, healthcare feels like battlefield controlled by conventional forces where only guerrilla tactics offer a hope of success. It’s uncomfortable to do battle with the incumbent elite to get digital implementation under the radar but I’d argue it’s the answer (at least for now!)
What am I talking about?
Well firstly there’s plenty of excitement about a digital healthcare revolution but little action. And let’s be honest, the divide between how we use technology in our everyday lives and how we use it to manage our health seems to keep getting wider. My brother, a hospital doctor can pay for his pre-shift coffee using his watch, buy on Amazon Prime a pair of running leggings that arrive by the time the shift finishes and yet at work he carries life or death information around on scrappy bits of paper whilst battling to access a computer to check blood results. The gap between what is possible and what actually happens on the front line is madness. But to ‘get digital’ this mad gap has to be understood in detail – not just in terms of work processes but technologically, culturally and emotionally.
The skillset and knowledge required to navigate this complexity must never be underestimated. Thankfully there are people out there who have found a route through this hostile territory – and they are our guerrilla fighters.
Healthcare is a highly regulated industry for good reason but so are many other sectors. If conditions were ripe for the rise of Fintech, and with it the disruption of the traditional financial services giants, then why has consumer demand and technological advances not pummelled healthcare with new business models? One reason could be the myriad of players in the market, which create complex and often contradictory incentives – such as governments and insurance companies.
The system I know best is the UK’s National Health Service (NHS).
Here, digital developments are taking place in small pockets but, given the potential rewards to the public and the exchequer, it feels anything but an arms race. In most parts of the UK health service, digital territory belongs to the IT department. Aside from the odd maverick clinician digitising their patch, IT transformation is a pretty segregated rather unloved function that’s someone else’s responsibility that most people don’t really understand. Disconnect between the clinician, the patient and the IT professional is just the tip of the iceberg but an important element. Getting digital sounds sensible to all but the knowledge/power dynamic are such that no one can make it happen at scale alone.
As change theory goes, what’s needed is the first mover – someone to do something new and for someone else, the first follower to copy and get momentum going. I headed up the digitalhealth.london accelerator programme for a year until I became a first time mum nine months ago. Moving out of a NHS hospital operations role to take up this role was an exciting challenge. I couldn’t wait to bring together innovators with potential solutions with those working within the system desperate to solve problems and transform. Most people in the NHS, my brother included, thought an accelerator was something to do with physics rather than a programme to support digital health start-ups. But the entrepreneurs thought any help to navigate the complexity that is the NHS would be better than the status quo and competition to join was fierce.
A few of the start-ups, despite due warning, thought joining the programme would instantly lead to contracts and over-night success. The savvy start-ups took up all the opportunities offered to ensure their product solved a real problem and built meaningful relationships with relevant clinicians, patients and managers. Slowly we delivered success stories of partnerships between entrepreneurs and healthcare providers and began a little dance encouraging others to follow suit. The people involved in these collaborations are the guerrilla fighters – those who are brave, have vision but most importantly start small and make an impact. They ask for forgiveness rather than permission – they don’t wait until everyone is on side as they know they never will be. Like everyone else in the NHS they don’t have time to do ‘innovation’ as a stand-alone process and they’re not necessarily very techy but they do have grit and the vision to team up with talented entrepreneurs.
I’m not sure what I expected to happen in the nine months whilst I was knee deep in poo and all consuming love (his name is Will btw). This week I decided to be the old me a bit and attended a few health tech events to get back in the game so to speak. I’ve spoken to scaling start-ups, concept stage start-ups, clinicians, NHS bodies, managers and patients and would describe the current landscape as follows: Imagine a battle field – I’m talking Game of Thrones scale. There are a couple of oil tankers at the sides now (various NHS bodies like NHS digital) that are there to provide infrastructure to support innovation – they move slowly and carefully but have increasing oomph. The ocean is filled with all sorts of different vessels bobbing up and down, many in increasing distress, but all with passionate crew (the UK health system) – on the horizon (binoculars required) there’s very modern craft with AI and precision medicine and genomic capabilities. Most of the vessels in the sea know that there’s no economics in empire building anymore – sharing knowledge, building networks and collaboration is where happiness resides and in an ideal world collaboration by conventional forces should already be delivering sustainable change.
I’m sad to say that for now however guerrilla warfare remains king. Even the most capable NHS CEO struggles to carve out the time to set up a meeting with an entrepreneur who might just have the solution to their biggest problem and even the most determined entrepreneur has to get on with selling their product without interoperability and with customer meetings cancelled at the drop of a hat.
What’s required to break this dreadful stalemate? More guerrilla fighters!
I put my faith in start-ups with grit like Oviva, digital pioneers like Dr Anatole Menon-Johannson and of course programmes like digitalhealth.london to get the party going!