How Do We Get to a Future Where Doctors and Patients Collaborate on Care?

A Conversation With Aaron Dignan and Dr. John Reeves

With the rising prevalence of digital health and the apps that were meant to ease awareness of our own wellbeing, it’s disappointing that the healthcare industry has yet to catch up to the disruption that has long affected sectors like personal finance, transport, and hospitality. Emergent technologies, such as Theranos’ Edison device, that were supposed to channel our curiosity and keenness have fallen by the wayside because they’ve failed to adhere by the ecosystem’s long-established processes.

Healthcare.gov org chart.

That much is clear: healthcare is undergoing an organizational design crisis.

It’s complicating the integration of external disruption, and deterring able constituents from the inside from even trying. Most importantly, it perpetuates the public’s feelings of confusion, reluctance, and dread regarding their own health. Americans are visiting their doctors only four times a year — a significant decrease compared to Japan (13 times), Germany (9.7) and Canada (7.4). Money is a factor. Yet, if you can’t be guaranteed of a simple patient pathway while undergoing diagnosis and treatment, it’s no wonder conditions such as ovarian cancer—despite having a 94% survival rate when detected early—have a mortality rate of 64%.

If patients can’t trust the system to enable these crucial relationships of care, where and how should the industry begin to resolve that? Cossette Health’s managing director Dr. John Reeves and Aaron Dignan of The Ready discuss the options for aspiring innovators, eager healthcare providers, and the patients who are more than ready for a system that works for everyone.

What is the most important lesson of 21st century organizational design?

Aaron: The most important shifts are around changing what’s static and what’s dynamic. Instead of having fixed structure, rules, and roles, we move to a world where we’re adapting these things on a more regular basis. We’re questioning how we sense, react, and respond on a more rapid clip, as a dynamic organism.

Sounds like industries have to do a lot of forgetting of now-stifling traditions — unlearning, if you will. What is the most necessary unlearning for the healthcare industry?

Aaron: This system is built on metrics, data, measurement, and efficiency, despite being a system about care and patient outcomes at the heart. We need to pull back out of this edifice of over-engineering and get back to what it’s really about, and redesign around that with new technology and capabilities.

That said, what elements of healthcare should be kept?

Aaron: The commitment to the craft, practice, and process of scientific inquiry. That dedication is missing in a lot of categories. In that way, the bar is high; the stakes are high; and the intellect and curiosity are high.

John: The one thing that has to be continuous — in fact, elevated and amplified going forward — is the relationship between the healthcare professional and patient. Right now, we live in a world where that relationship is powerful, but episodic. You see your patient once every six months or a year, depending on the severity of the clinical scenario. Technology allows that moment to be a continuous one. It’s providing healthcare professionals with the true data they need to course-correct and manage patients.

“The one thing that has to be continuous — in fact, elevated and amplified going forward — is the relationship between the healthcare professional and patient.”

Because the healthcare industry is an entirely different beast in its complexities and regulations, should innovators be regarding patients and consumers differently?

Aaron: I don’t think there should be a difference. That’s the problem, right there. The bar for the consumer experience is, “I’m paying with my own dollar, so I want attention at a minimum.” So I expect the best-in-class experience. But in a system where the insurer’s paying, your employer’s paying, someone else is paying… suddenly, that’s one step removed from the bar. My choices change dramatically. I don’t have choices, really, outside of my system. That, to me, is the disconnect. We need to treat everything — a B2B sale, system sale — like it’s a consumer marketplace.

John: Certainly here, in Canada, there’s a great example where customers don’t pay. So we’re just happy to see a doctor. There’s no expectation that healthcare experience will mimic any other industry. I think what we have to do, as consumers and patients, is to challenge the healthcare system.

So how should innovators approach this going forward?

John: Every agency lives and dies by that customer pathway and each single touchpoint along that. In healthcare, the patient pathway is very complex, and the longevity is extreme. Healthcare innovation is not just about a single touchpoint, like how Airbnb or Uber dealt with booking. Those technologies deal with a very specific point in time, and disrupters built solutions around that.

Episodic point-of-care, getting it done fast, on-demand, 24/7… that’s great in many industries. But in healthcare, that’s where we see dangers. If you have an episodic telehealth consult around a certain condition, that healthcare professional may know nothing about your previous history, your family history, your genomics.

Aaron: I do wish the current system was as good and accurate and sophisticated as you’re making it sound. But in actuality, a lot of the doctors I meet don’t have a good set of data on me. They don’t have the right EMR connectivity among systems. And they don’t have the time to really go deep with me. So on some level, I’m getting a slight improvement, but not what ultimately could and should happen in that personal environment.

“Healthcare innovation is not just about a single touchpoint... The system is so complex, and has been for so long. It’s absolutely critical that the innovation respects that.”

How can the industry foster better collaboration?

Aaron: It’s not that dissimilar to what large multinationals are experiencing. When you are working with heavily siloed systems, the first thing you have to do is break those walls down, create cross-functional teams, and give them problems to solve. It’s about these different constituents coming together and saying, “Let’s pick a problem we all have and do some work together to pilot a solution.” Somebody’s going to have to be the gathering force for those coalitions, and that’s hard to do.

John: I think that’s coming out of the hacking movements in healthcare. They’re very effective in getting healthcare professionals out of the rigidities of the ecosystem, and into an external environment that allows them to work with other stakeholders. Because [Cossette Health] is fully activated on the innovation side, that’s where we’re seeing massive changes in ideation.

Now, of course, ideas are great. But then the question becomes whether or not we can pull them through, and turn them into products that customers will actually use.

“[Hackathons] are very effective in getting healthcare professionals out of the rigidities of the ecosystem, and into an external environment that allows them to work with other stakeholders.”

As we innovate against this new standard, how should the patient’s role and responsibilities evolve?

Aaron: I say we need to be explicit about separating the experience and the outcomes from the diagnosis and the treatment. Because they’re co-mingled, the system essentially designs everything without patient input. In the future, we can say no — that the patient is the expert in what kind of experience they want to have. Solving for that interaction will be a design thinking challenge.

John: That’s a great point, because I think some of those subtle connections between the physician and the patient are actually the ones that drive the best healthcare outcomes. It’s not the scientific or diagnostic part of it. It’s the connections, the nudges, the outbound emails. It’s hard to believe that just by touching your patient, listening to them, showing empathy… that actually drives much of the benefit to the patient in a long run. And you know what? Technology’s going to have a tough time replacing it, but they’ll change it in a way that would potentially make it even more powerful.

Aaron: It’s mom’s chicken soup.

John: Is Pfizer now making that? Might not be such a bad idea.