The biggest thing holding back health tech and innovation…
The Culture Chasm
Each week I get asked a heap of questions about healthtech and innovation (shock). What I’m excited about, trends, cool programs, and companies…
But the most reoccurring topic these past few weeks (ok, months), is just how we get more technology and innovation uptake in healthcare. Inevitably, what follows is then the question of what exactly are the biggest problems, and blockers, stopping it?
Well… it’s certainly not the tech or science…
The single biggest blocker, in my view, is culture.
Investing culture. Political and systemic culture. Startup culture.
And most importantly, the deeply embedded traditional healthcare and medical culture. Which is what we’re (mostly) focusing on today…
The Culture Chasm
As I opened my inbox Sunday, I found a new piece from Startmate’s CEO, Michael Batko, with the line“Culture is the ultimate long-lasting system”.
Talk about hitting the nail on the head.
Culture, whether for better or worse, sets the tone for all behaviour, attitudes and mindsets of groups and individuals. And once instilled, it’s darn hard to change.
For anyone who’s had the slightest thing to do with healthcare, thats obvious. But still, for outsiders, or those on the periphery and trying to navigate this madness, the true depths of it can be darn hard to comprehend.
And, it creates one hell of a set of hurdles.
So what's the deal? Why is it this way? And how on earth do we begin to change this?
Let’s try break it down. What we cover today:
Outdated Principles & Systems
Hierarchy, Egos & Playing the Game
Scarcity, Fear & Fixed Mindsets
Optimism vs Pesimissm
Age vs Knowledge - The new paradigm
Redesign, Feedback & Co-design
Operating Off Seriously Old & Outdated Principals
Healthcare principles and systems have largely gone unchanged for 10s to 100s of years. With many things exactly the same as initial conception.
Meanwhile - the world has changed. A lot. Yet somehow, Medicine has remained the same.
And, this lack of evolution has left it lagging behind as a somewhat patriarchal cornerstone of an evolving world. How on earth do I have the authority to make this claim? Well, 5 years in it from the student/clinical side and now weekly touchpoints as a patient (and ofc all this silly stuff in healthtech) has given me some ok insight.
While other professions have undergone reforms, had regulations introduced, and added this little thing called HR - medicine, mostly, has not.
Do not get me wrong - things are improving. But still, women are asked questions about life plans in job interviews (it's not legal but it has its own laws). Abuse is normalised, and considered a rite of passage. And if you report it, you risk decimating your career and your carefully curated network.
Challenging the status quo, though becoming more common, has previously been a very big no-no.
Hierarchy, Egos & Playing the Game
Healthcare has very set structures with a clear hierarchy. And some of the craziest bureaucratic nonsense you will ever see. Decisions come top-down. And usually, you have to be in the game for decades before you can get a say.
The deal - You work hard, (often) suffer, and “do your time” to accumulate knowledge, credibility and standing. You’re taught to know your place, and often, progression is not based on merit, instead how you appease the forces at play (ie your specific superior) to get the right referrals and sign-offs. It's a people game, just with a different set of rules.
This isn’t only clinical medicine, but the system as a whole.
Trying to speak up, or out, and advocate - in the best of cases is often in vain. Or can even result in the destruction of your career prospects.
Just look at the media’s response to Vascular surgeon Gabrielle McMullin, calling out sexual harassment in the profession who, in 2015 spoke out saying that sexism was so rife among surgeons that young women should accept unwanted sexual advances or risk ruining their careers. Or the #medbikini movement following a paper that was published in a leading journal in 2019, stalking doctors’ personal social media accounts in the name of research - to conclude it is “unprofessional” for women clinicians to post photos in swimwear on their social media. Cool.
Things have changed. But not that much.
For a system that is supposed to be “helping people”, it sure can be cold and cruel. Especially to its own. Fall in line - or you can quickly become an outcast. So it's easy to see why many fall into survival mode, instead of choosing to add extra to their already full plates.
Scarcity, Fear of Change & Fixed Mindsets
In a world of abundance, healthcare usually operates from a place of scarcity and lack. Lack of resources, time, information, funding… yet always endless things to do. So the default is to ruthlessly prioritise, remove all distractions, and always, de-risk.
Risk, fear, and following processes are the heart of healthcare. Mostly with good reason, and the best intentions. You always want to try to ensure safe, controlled outcomes - for you, your colleagues and patients. Without curveballs or unnecessary additional chaos.
So to venture outside of the set state of things, and take a risk, is not only terrifying, but also actively discouraged at every turn. No wonder there's too often fear of change and the unknown within this system.
“Risk It for the Biscuit”
Any change statistically carries risk. There’s no way to eliminate it completely. All great progress in society, and medicine, has always come with a bucketload of it. And sacrifices.
But eventually, when you avoid change and risk for so long - the lack of it, can actually become the risk itself. In a world constantly moving, evolving and accelerating - remaining still puts you behind. The longer you want, the bigger that gap becomes. And the harder it will become to catch up.
There’s no easy way to figure out a safe way to navigate this balance of risk and change, but what is certain, is that if we don’t start figuring out how to do this - it’s not going to be pretty.
Optimism vs Pessimism
Another product of this system - is the mindset it creates. In health, you can find many sceptics and pragmatists. Which is, of course, essential in this field.
But with this often comes a closed-minded way of looking at things - dashing down creativity or “long shots” before they even get a glance.
Though healthy to have a level of pessimism and pragmatism, to innovate or change things, you need some optimism and belief that it's possible. But too often, in medicine and health, this key ingredient is missing
Whether You Think You Can, or Think You Can't ... You're Right
~ Henry Ford
Inheriting a Broken System and Culture
When you venture into medical school, you’re bright-eyed and bushy-tailed… thinking you’ll make a change and won’t ever be like those cruel, old school clinicians. You’ll be different, and treat people kindly. “We’ll be the generation that changes things” we all say...
But, systems, and cultures, are powerful things.
No one usually wants to be a dickhead. Or teach through fear and bullying. But when you are subject to criticism, coldness and (sometimes) cruelty day in and day out, it changes you. We all can’t help but become a product of our environments. And we are what we consume. Doctors and health professionals are only human after all.
Age vs Knowledge - The new paradigm
Now, younger generations know infinitely more than their elders about technology. And often, how this new world works.
It’s the first time in history (ok, I’m guessing), that there has been such a substantial gap in this direction between generational knowledge. Youngsters grew up living and breathing tech - and are now firmly in the driver's seat of new trends, tech and ways of working.
In a profession like health, with an incredibly rigid hierarchy and standing directly related to time, and linear progression - this must be seriously unsettling. Resulting in many rejecting that “juniors” or “new changes” could possibly be of “true” value.
Older clinicians, professionals and operators “like things done their way”. So usually - it’s their way or the highway. The number of doctors I know who use minimal to no technology - because their boss “refuses to” is...well… probably most.
Welcome to the inner workings of healthcare….
You Can’t Fix a Problem Using the Same Mindset Which Created It
This statement applies to most things in life. Yet, it seems overlooked in health.
There are many crazy knowledgeable experts who undoubtedly need to have a say, but the ones who have been around for decades - still seem to be disproportionately represented in rooms where decisions, and products are made.
Right now, the key decision-makers are those who live, breathe and designed the old one. So how can we possibly expect them to fix it in new, creative ways without some external inputs?
Redesign Is Reasonable… and Actually, Essential
Designing for health should not be building on top of old workflows, strategies and processes. But instead, often built bottom-up, or around old practices.
To truly optimise and move into the next era - with new technology, should come creating new processes. Not just jamming these new incredible innovations into old clunky workflows where they probably shouldn't fit.
Its already cluttered and complicated. You do not want to add to this. In fact - this is why so many health professionals HATE technology. They have had to deal with very subpar experiences and snake oil salesmen. Wasting their scarce time, energy and resources.
Healthcare needs to go back to basics… and basic design principles.
Less is more.
And sometimes you just need to start with one simple thing to get the ball rolling.
The Beauty in Basics, Blended Thinking & Innovating Outside In
This is not the popular answer - but take a look at the current legacy software providers and my health record *shudders*. There are so many features, layers and sections to navigate - that no one likes, or is even using them. It’s simply - impractical.
The solution? Innovating outside in or bringing in new ways of thinking
“You can’t just recreate the whole health system” I hear you say… Obviously.
But the longer we delay it, and insist on trying to push old ways of working that will, frankly, never work, the worse the problem gets.
A classic example is Eucalyptus and Ro. They both started with a single vertical and problem, with a splash of a creative spin. Many classify it as “not serious” healthcare. Which, to be fair, they weren’t. Then, they built upon it. And in the process, building solid systems, trust, and brand to boot. Many questioned it - but now it's become clear that they are here to stay. Not to mention, by carving this path from outside the “traditional” system and methods - they’ve pathed the way, and acceptance, for a whole new type of innovator in the space.
A Missing Piece of the Puzzle…Feedback and Co-design
The reason so many health professionals loath the technologies and innovations that come their way - is the lack of co-design and understanding of things from the user, or health professionals’ perspective.
This is something that is preached a lot, but in reality, execution is hard. But a BIG necessary piece of the puzzle. The problem? That accessibility piece.
We already know healthcare doesn’t like outsiders. Clinicians can be darn hard to reach, and are often so busy they literally often barely have time to pee. But to really get things moving, we’re going to have to work together to find ways to build in accessibility. And remunerate them. Giving them time, space and prioritization to actually participate. It’s often not that they don’t want to.
PS - One, one-off focus group does not constitute proper feedback or co-design.
So Then, How Do Get This Change Going?
Isn’t this the ultimate question? There are big steps being taken - which is great.
But the real answer is to start conversations, make more space for open-mindedness and collaboration, and try to create practical stepping stones to facilitate this change.
Right now there is such a big gap in culture, knowledge and understanding in and around the industry, and specifically technology - as a whole. Which is only getting wider. So in order to succeed - we need to bring everyone on the journey. Starting to bridge some of these gaps, and create a culture of safety for people to explore, engage and participate. Instead of letting it remain the untamed wild west, with every man fending for themselves.
How exactly do we do this?
Education, Open-Mindedness and Gradual Culture Change.
Oh, and Giving More People a Seat at the Table…
These are, arguably, the most powerful tools in existence.
There’s an infinite realm of possibilities. But at the end of the day, like everything, whether it all happens or not, comes back to people. And whether we create opportunities for learning, sharing and education. To enable bridges to be built. Concepts to be clearly communicated in ways others understand. And for true adoption, collaboration and co-creation to begin.
It’s Just the First Innings
We’re still in the very early days of health tech and innovation. At least, in the scheme of things. And we’ll no doubt look back and laugh at what we thought was “cutting edge” and condemn our practices.
Probably similar to how Apple was first scoffed at and told that no one would ever buy a home computer… We all know how that worked out *she says writing on her MacBook*.
And, as long as we keep an open mind, build those bridges and actually start working together - there’s a whole universe of opportunities.
After all - the magic is in the mix.
So what are you waiting for? Go out there and build some bridges.
✨ What do you think? I’d love to know and respond to all emails and comments! Hit reply or drop a comment below
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Thats all folks
Catch you soon (Maybe IRL? - Check out the Syndey and Melbourne events here!)
👋 Emily
Favorite read of the year 💪🏼 Hit so many nails on the head.. although so many sad truths to swallow
Emily, I cannot tell you how inspirational of a read this is. Thank you. Yisha