So, I promised you a stupidly long list, and I really don’t like to disappoint… so, here we go again with round 2.
In case you missed Part 1 - you can catch up here.
Also, big thanks to all the legends who reached out sharing your thoughts, feels, struggles & successes. The best part of this really is the great chats I get to have with all of you. And can’t wait until we can all be in a room together in person again soon (ok, I’m optimistic alright).
But first… Not on the list yet? Want to get more of these with a hoard of other passionate healthtech peeps? Hit that pretty purple button 👇
The Other Stuff…
7) System Set-Up: Government, Hospitals and Tech
Public systems are not conducive to innovation… 🌱
At least, in their current state.
Stay with me. I’m not saying that public healthcare is a bad thing and we’re truly blessed in Australia. But by having a “good” health system, it’s meant we’ve avoided truly dismal structures and situations of the US, which pushed them to adapt and innovate.
As time has progressed, our system set-up has continued on the “mass production line” path, largely geared towards bandaid fixes (vs plugging holes with preventative care), fast turn over and 10-minute medicine. And incentivising this.
In true capitalist style, we try to achieve more with less. Less time, doctors, funding, technology, reimbursement… but by increasing output today and not properly addressing things or investing in tomorrow, we’ve dug ourselves into quite the hole.
The Only Way to Improve Outcomes Is to Change the Systems
The economic argument is clear. As well as the psychological, physiological and professional. We need to invest in rejigging the system - shifting focus with the right people, technology, resourcing and workflows. Stripping it back and addressing it bottom-up - in both the public and private realms.
Not saying this is easy… it’s a damn nightmare. But if not now, when?
8) Bureaucracy & Big Egos
It’s not a technology problem, but a people problem.
And when it comes to implementing changes in systems (government and hospitals) as well as with vendors, we often find a little thing called bureaucracy.
For some reason, people enjoy playing by old rules, holding power and their position, as well as operating from the capitalist compete vs collaborate standpoint. Not to mention the “us” vs “them” mindset which seems to be steadfast.
Maintaining the status quo is (apparently) the name of the game
Until we see people willing to give some ground, collaborate and take some leaps of faith into a modern world, these stubborn obstacles are going to stay stuck and make it extra hard… and people are just going to try move around them.
It’s ironic how many arguments there are right now about the fragmentation of healthcare from these “new models” coming through…
Really, it’s always been an issue (at least in my lifetime). Yes, it has progressively worsened, but it’s not technology to blame for that. With the increasingly mobile nature of patients and professionals and access and availability of information, the mass production healthcare model has not aged well. Many people no longer having that ongoing family doctor relationship.
It’s now so bad that many have lost faith in the system completely…. both patients and professionals. Across all generations
So Where Are These Continuity Problems? ⛓
1) Investment - Whenever there is a system, project or people introduced, often its short term, underresourced, and not properly funded. If you want anything to succeed, you need to properly invest time, energy, and funds. Looking at you gov.
2) Project Funding Cycles & Pilots - Often short-lived, not refreshed, and if they are, it takes so long that people are hanging on the edge waiting to hear their fate. Wasting time, resources and trust. And results disappearing into the abyss never to be seen again. I’m not an expert here, but this needs a revamp.
3) Technical Systems - Often implemented, but either only in a single area, or with shortcuts. When are we going to learn, shortcuts only lead to more cost in the end or flat-out failure. Also, not saying it’s always the case, but big companies who are experts often are for a reason. Why do we always throw money to design “our own systems” yet still undercut the resourcing then end up even worse off?
4) Treatment Systems & Incentivisation - Our system incentivises quick fixes, often discouraging the whole person focus or lifestyle measures. Good doctors have to charge obscenely out of pocket making it inaccessible to many whilst those who don’t are victim of the Medicare claiming hamsterwheel. We need a shake up of how this is funded.
5) Continuity of Care - Gone are the days of the one GP managing you and your family. Or being able to get help with multiple concerns from one place. Yes, some people and conditions don’t need it. For others its imperative, but made near impossible from an access, timeliness and financial perspective. We need new models to make this work and properly support those who need it.
Did no one learn anything from basic finance and principles of long-term investing?
More continuity. Less waste… Invest in the long game for the best returns 💰
Time is our most precious commodity ⏰
And as we’ve touched on - it’s particularly tough in healthcare.
Everything demands more of it, yet those at the centre of things (early-stage companies, patients and professionals) don’t have time to spare.
Trials and tests for clinical validation, regulation and approval demand crazy amounts. To get a product to market there’s a lot of hoops you need to jump through to make it patient and/or physician fit & friendly. Not to mention get them onboard.
Doctors are the most time-poor people you’ll ever meet. Endlessly stretched. Trying to fit extra tests, trials and training into their schedules.
So how, and why, would they fit in extra time to look at tech without it being built into their schedules? Or remunerated? Or ensuring that we’re not wasting their time with yet another “nice idea” with terrible UX and no understanding of the true problems?
We need to make more viable ways for doctor & professional involvement from a system side.
Timelines & Sales Cycles in Health Are Something Else
Usually, for enterprises, it’s an almost lifelong agreement with wild switching implementation costs. Investment returns, hurdles and appetite are also extended (see part 1). Not to mention the time needed to upskill people properly and get them in the game or onboard.
Naturally, it will take time to adapt, create these processes and get actual change. But also, we need to stop expecting things to accelerate through shortcuts or sheer will.
And provide the practical investment and system restructure to appropriately support innovation & adoption - for all parties.
Let’s stop expecting shortcuts and quick and easy returns.
Trust is the most valuable commodity.
But unfortunately, in the health sector, a lot of it has been lost.
Patients no longer trust the system, the government, and often, even their doctors.
We’re also seeing it in clinicians - after being burned by the system a few too many times, they too fall into cynical and highly suspicious mindsets.
Don’t get me wrong, this is a gross generalisation and certainly not always the case. But, sadly that trust barrier in the general public is very real.
This is why Big Tech, with strong delivery records and brands, are sadly seen by many as more trustworthy than traditional institutions… and making traction.
It’s messed up (and not like they have the best track record with privacy) but at the end of the day, they deliver the key service they promise - often exceeding expectations. With a quality experience to boot.
Trust can be rebuilt. But it’s a tough and lengthy process.
And harder to regain than build from scratch
12) Collaboration & Co-Design… or Lack Thereof
To make this work, we need to work together (shocking).
Every big health provider, consultancy and tech company has put out an article (or 10) on this in the past 12 months… but where’s the action?
For any successful product development or design processes, you need research, user/ customer testing, and reiteration in a continuous cycle. Yet most still don’t do this.
Why? It’s hard.
You need buy-in from the right people and environment, but until it happens more as opposed to one-off focus groups post-development or surveying small subgroups, we’ll continue getting sub-par products.
Other Areas This Applies To... Policy, Regulation, System Design & Resource Allocation
Too often, instructions are created by the 1% who often have little to no exposure, training or insight into the area. Let’s take the pandemic - It took far too long for health professionals voices to be heard, and this is too often the case.
Doctors and patients are left to play with the cards they have been dealt. Which isn’t cool. We need a more collaborative approach with more co-design with key stakeholders in this process to address these issues from the top down.
13) Appropriate Clinician & Clinical Access
To succeed in health, you often need buy-in from clinical practitioners and decision-makers.
But there are hefty brick walls blocking many from getting there.
Even those in the trenches have a hard time getting in… and uptake. Resulting in endless wastes of time, energy & resources chasing tails and the death of many companies. Or worse… prolonged deaths of things that could have been easily ended with validation.
We need more pathways for people to clearly find ins to appropriate clinicians, clinical settings and data.
And for clinicians to be given the time and pathways empowering them in this healthtech sphere. Obviously, in a highly regulated way to stop abuse, influx overloaded… but these clinical pathways are key for progress.
Why is it so damn hard to find anything and see what’s actually happening? 👀
There is no easy way to see what’s going on, find what you need, or where to go in ANY area of health. Patients trying to navigate the system, physicians getting things done, researchers seeking studies, entrepreneurs trying to navigate and nail opportunities… it’s all a battle with no clear paths or answers.
If we can’t clearly see things or even get a glimpse of the whole picture, how can we properly diagnose or treat the problem?
Yes, experimentation is all a part of the game, but the current state of things is frankly insane.
We need to create some more visibility & clarity in the sector - shedding light on the too often hidden pathways, problems, and opportunities to enhance everyone’s experiences & success.
TL;DR - we need more of it
Education is easily one of the biggest problems in every area of healthcare - including health literacy, professional training, understanding systems, navigation, processes and business operations.
Last year accelerated technology into the space, and whilst uptake sped up, the education gap on how it works (and/or how it can work), remains. If not actually worsened - with practitioners, patients, developers, companies, front line workers, administrators, investors, and even the institutions & bodies trying to play catch up and setting the standards and procedures.
Digital literacy is often taken for granted.
People might want to use tech or adopt it, but if they aren’t ready, able to understand it, or know how - it can be an effort in vain.
Training is the missing piece of the puzzle. And to move forward - we need to address these humungous gaps to make sure the players are trained so we can actually adopt, improve and accelerate the game.
16) Creativity, Crossing Disciplines & Unconventional Mixes
Healthcare traditionally has left little room for creativity - operating within rigid rules, and following tried and true procedures. Often with good reason. But when it comes to solving the bigger problems, you need to step outside of the lines and try new things.
HotDoc’s Co-Founder Ben Hurst left clinical medicine as he felt it limited his ability to be creative, leaving to become a writer before eventually founding the tech company.
Still in health, where everything is overstretched and under-resourced, it’s hard to get the space or support needed to spark and/or pursue these things.
"We cannot solve our problems with the same thinking we used when we created them" ~ Albert Einstein
Often healthcare excludes those that aren’t in the inner sanctum without clinical training. Creating more blind spots and bias.
Yes, a clinical lens is essential, but increasingly, big successes are coming from those who take a stab from other industries or combine efforts, bringing unique perspectives to the mix.
Take These Emerging Startups Crossing Disciplines
Arli’s founder, Sally Krebs, used her lived experience caring for her mother to craft what was needed from the patient & carer perspective to create a holistic approach to addiction
Medtasker combined a clinician with a tech-xpert creating a killer combo to tackle the crazy big (and tough) problem of communication and task management in hospitals
Harrison.ai’s founder Aengus Tran finished his MD and instead of practising clinically, focused on his company (common in the US)
Eucalyptus, like Hims applied a marketing, eCommerce and customer experience lens to healthcare
The magic really is in the mix ✨
Disclaimer - this is not to say that this is only one way. And there are many millions of pathways, it just goes to show the power of doing things differently
⬆️ Do yourself a favour and read this thread on how we might look to tackle the commercialisation issue in innovation ft a mix of policy & initiatives
We need to encourage and embrace more creativity, and accept that the only way we can fix things is by doing this together, crossing disciplines and concepts, and including more people from outside the clinical sphere too.
17) Risk Aversion
Startups are inherently risky 🚨
Healthcare is the opposite and practically allergic to it.
Understandably - It’s literally life or death. Or can be…
Trust in technology takes on a whole other meaning when you introduce people’s lives to the mix. Accuracy and lack of bugs are imperative. Just like our lack of trust in self-driving vehicles, despite the improvement in fatalities, unless it’s perfect, we’d rather leave the responsibility in the hands of humans. It’s easier to stomach human error and not worth the risk when lives are on the line.
But this does not apply to all areas. And until we create frameworks to appropriately enable some “safe” calculated risks (or at least some changes) across an appropriate spectrum, we’re going to slowly drown and see the demise of our system.
You don’t drown by falling into the water, you drown by staying there ~ Edwin Louis Cole
So we need to find ways to take chances and strides forward in safe, collaborative ways, and ultimately move the needle.
Nothing in Healthcare Is Ever Certain, and Every Treatment Has Potential Side Effects
So what’s worse? Doing nothing and watching it deteriorate…
Or testing and trialling possible cures which may help millions?
It’s time to take some leaps forward.
Sometimes you’ve got to risk it for the biscuit (within reason of course).
It’s One Thing to Sit Here and Talk About the Problems...
But How Do We Go About Fixing Them❓
It’s going to take a seriously big group effort. With more creativity, collaboration and co-design including all parties - to make this happen. Breaking out of our archaic processes and paternalistic thinking to rebuild a better future. Not just the continuous echo chamber we’re used to… having everyone playing a part.
Change can be scary. And no one said that it’s going to be easy. Or without failures.
But the only way to succeed is to come together and try.
There’s also heaps of good happening, killer progress and cool stuff…
But that’s for another time.
Thoughts? Feelings? Comments? - Hit reply and let me know or drop a comment below
Catch you soon
I think it's worth noting that although the US is great for health tech, it's terrible for the health outcomes of the average citizen. Put another way, despite all the innovation that's happening in the US it lags horribly behind the rest of the developed world in healthcare spending per person and outcomes.
This recent article really drive the point: https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly
"The top-performing countries [for healthcare] overall are Norway, the Netherlands, and **Australia**. The United States ranks last overall,"
So, yes if you want to work in health tech go to the US, but I'd think long and hard about changing the Australian system to emulate the US, because it would likey lead to worse outcomes for Australia as a whole. And at the end of the day, isn't it all about outcomes?
“ It’s not a technology problem, but a people problem”; someone else said this too.