The “Triple Aim” of healthcare — access, quality and efficiency — is now widely recognized as an “and” not an “or” proposition. Better quality care is often more efficient, not more expensive. It is not a question of trade-offs but of mutually reinforcing goals.
We need to apply that same wisdom to the design and adoption of digital health: Designing digital health-enabling solutions into patients’ and carers’ lives, not as alternatives to traditional care, but as a complementary resource, augmenting and improving the efficiency of the human capital involved in health and care. The industry should be embracing a new Digital & Human Capital approach where multi-disciplinary teams, including digital resources and colleagues, collaborate to deliver more efficient, better quality care and a better experience for all. This approach is at the core of how IPsoft is leveraging its expertise in AI and cognitive technologies as we launch our Amelia Healthcare practice and address the growing need for digital resources throughout the healthcare industry.
Healthcare workforce – lifted up or burnt-out?
Healthcare, we are told time and again, lags far behind other industries in the adoption of digital technologies. Its attempts to cope with demand-driven challenges to access, quality and efficiency have led to increased pressure on the industry’s human workforce, leading to widely reported feelings of burnout:
- Many health systems are facing cost and access pressures in their hospital-based Urgent and Emergency Care systems, with a reported 240% increase in costs over the last decade, and are trying to proactively manage this demand by shifting to primary care or pre-primary care models.
- At the same time, chronic conditions are an accelerating population health epidemic: In the U.S. they account for 86% of healthcare costs and, globally, 70% of all deaths. In some developed countries, almost a quarter of the population is now found to have more than one chronic illness. Most systems are trying to address this situation with more proactive-care management models — detecting, enrolling and navigating patients in well being and condition management plans, mostly delivered in ambulatory care settings.
- An aging population also has increased the need for effective and well-coordinated domiciliary care services and care homes, which also require an increased community, primary and social care workforce, and the mobilization at scale of informal carers (e.g. relatives and friends).
However, health systems have struggled to scale and sustain this shift of care into primary care and community care models, even where evidence of clinical impact is strong in large part because of workforce capacity and affordability gaps. This was the case with the Australia Diabetes Care Project, a three-year pilot program which designed and analyzed a new model of health care delivery for adults with type 1 and type 2 diabetes, and has not been rolled out to date, mainly because of affordability concerns about the resource model, despite promising results in terms of improvement in health outcomes. Primary care workforce shortages are a growing crisis for many health systems or regions. For example, in the UK, the Royal College of Nursing forecasts a shortage of over 40,000 nurses, with one in nine posts currently vacant. Similar trends are reported across the world, including in many emerging markets, and will worsen as more nurses retire in the next 5-10 years. Most of these new models of care require active engagement with patients to enroll them (initial assessment and testing, enrollment, coaching, care-plan generation), help them navigate their care plans (call/recalls, etc.), and coordinate the proactive, timely and appropriate mobilization of relevant health care resources (tests, visits, check-ups). This has required new care navigation and coordination roles which have frequently been either economically unaffordable or impossible to deliver at scale, given the existing shortages in nurses and other community care resources.
Other service industries have dealt with similar issues by embracing digital-enabled innovations to simultaneously drive increases in labor productivity, service quality, and customer experience (such as in banking and the airline industry). These benefits have so far eluded healthcare, which has seen the lowest labor productivity gains of any sector. Between 1999 and 2014, for example, US labor productivity increased by only 6% in healthcare but by 18% in other service industries and 78% in manufacturing. Healthcare also has recorded the lowest adoption of digital capabilities, lagging other sectors in terms of digital assets, usage and labor. In fact, rather than welcoming digital solutions as enablers, the healthcare workforce has complained about the increasing workload imposed by the implementation of systems (some clinicians now spend 50% of their time entering data in systems) and regulators and professional associations have often resisted their implementation on quality, safety or privacy grounds.
As a result, rather than being lifted-up, empowered and enabled by digital solutions, the healthcare workforce feels overwhelmed and there is alarming evidence of burn-out. For example, in New Zealand, prevalence of high work-related burnout was observed at 42%, and in China, high rates of nursing burnout were closely associated with an expressed intention of almost a quarter of nurses to leave their current role.
Service and experience design: Enabling Patients & Carers, simultaneously
One reason for the lag of digital adoption in healthcare is that these solutions have often been designed and perceived as siloed and competing alternatives to the mainstream healthcare delivery and engagement models, often focused on serving one stakeholder group only (e.g. wearables and apps to empower the patient, or data capture systems to inform the health system administrators), without sufficient simultaneous consideration to their implications for doctors and nurses.
To be effective, such digital-enabled innovations need to be designed into the lives of patients and carers and improve the experience and performance of both stakeholder groups simultaneously. We need to learn from the lessons of the wider digital economy: Airbnb would not have achieved its penetration level if its solution had only focused on the demand side of the ecosystem. Instead, Airbnb designed tools and business models that are convenient to both homeowners and renters.
Digital & Human Capital: Working together to free the human skills
We can solve the workforce shortages and burnout issues, and the pressures on the “Triple Aim” of quality, access and affordability in health, by mobilizing digital labor – designed into an extended Digital & Human workforce, and working collaboratively to enhance both the patients’ and the carers’ experiences. This is a central pillar of IPsoft’s new healthcare practice, where we can leverage our products and services to bring this new collaborative approach to reality.
Artificial Intelligence-enabled cognitive virtual agents, such as IPsoft’s Amelia, are now able to engage in conversational style in voice or chat modes, effectively recognize human intent from natural language expressions and address their requests by dynamically implementing end-to-end processes and accessing (as humans would) expert systems and other colleagues.
Novel combinations of human and virtual capital can help address most of the challenges we have observed in healthcare, increasing efficiency, access and quality of care delivery and its experience by all:
- Virtual primary care agents can be designed to handle frequent, routine interactions such as requests for appointments or information queries about test results or availability or immunizations – freeing up receptionists, nurses and doctors to spend more time engaging in patient care.
- Digital care navigators can be available 24×7 to patients enrolled in chronic condition care plans, regularly reminding them of upcoming tests and appointments, coordinating recurring tasks such as ordering prescription refills and being available to provide information about their care plan, always as part of a multi-disciplinary care team. This creates more time for the rest of the care team to engage in more patient home visits or multi-disciplinary case calls.
- Conversational care assistants can enable visiting nurses, domiciliary care workers, and informal carers by offering convenient, conversational voice or chat interfaces to information, decision support, or administrative reporting resources. This can improve the productivity and enhance the capability of this increasingly important workforce, as well as provide an intuitive conversational interface for the patients or their relatives to request services, get personalized information and provide updates to their care team.
Human-like cognitive virtual agents, designed and trained to join the healthcare workforce as new colleagues in an extended team, can provide an always-available resource to handle frequent, repetitive and routine cognitive tasks and interactions in a conversational, empathetic style.
In turn, this can free up their human colleagues from the burden of repetitive tasks, and allow them to focus on the interactions they enjoy most and which humans do best: collaboration, creativity, and deep interpersonal engagement.
 Greene J Price Transparency in the Emergency Department. Annals of Emergency Medicine Volume 64, Issue 1, A13 – A15
 Imison C, Curry N, Holder H, et al. Shifting the balance of care: Great expectations. Nuffield Trust Research summary March 2017
 Mendis S Global Status Report on Noncommunicable Diseases. World Health Organization 2014
 Barnett, K et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet, Volume 380, Issue 9836, 37 – 43
 https://www.rcn.org.uk/news-and-events/news/worst-case-scenario-shortage-of-42000-nurses ; https://www.theguardian.com/society/2017/may/13/royal-college-nursing-nhs-recruitment-crisis
 Singhal S and Coe E The next imperatives for US healthcare. McKinsey & Co. 2016
 Sinsky C, Colligan L, Li L, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. 2016; 165:753–760
 Chambers, C N L et. al. Burnout Prevalence in New Zealand’s Public Hospital Senior Medical Workforce: A Cross-Sectional Mixed Methods Study. BMJ Open 6.11 (2016): e013947.
 Jiang H, Ma L, Gao C, et al Satisfaction, burnout and intention to stay of emergency nurses in Shanghai Emerg Med J Published Online First: 04 May 2017.