This interdisciplinary course focuses on sustainable innovation, introducing entrepreneurial students to the realities of problem identification and solution design within the complex world of healthcare.
The Healthcare Dilemma Part 1
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From the course by Duke University
Healthcare Innovation and Entrepreneurship
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From the lesson
Innovating in Healthcare
How do physicians see and interpret the patient? Can physicians observe without judging? Are there more cost effective ways of disease prevention and treatment? What role does innovation play? How can an entrepreneurial approach improve healthcare?
Meet the Instructors
Marilyn M. Lombardi, Ph.D.Associate Clinical Professor
School of Nursing
Bob Barnes, PhDInstructor
Biomedical Engineering
Imagine a health care system that is better, cheaper, and more accessible than
the one we have now. With fewer medication errors, lower
hospital readmission rates. Less invasive ways of diagnosing
diseases. And better ways of personalizing
treatment. This is our opportunity.
Hello again, this is Marilyn Lombardi. And thank you for joining me.
On your screen right in front of you, you're going to see a slide with the
entire root of our week's journey on it. As you can see, we've arrived at the
second station on our journey, this stop entitled the health care dilemma.
In this video, we'll do the important work of setting the stage by placing our
focus on innovation, within the complex context of modern health care systems.
That to a very large extend determine, how we provide care, how we receive care,
how we pay for care. Now before I get started, I'd like to
talk about what you're going to hear in this short video.
I'll be setting the stage for innovation by talking about the challenges.
The challenges that our health care systems present to us.
And this well help us develop a shared context for learning and applying the
tools, that we're going to need to see the system from a different perspective.
As I go through the litany of challenges that face us in the health care arena
today, they can be daunting. They can be paralyzing.
I just want you to remember that these are not problems.
Rather, from the innovator's standpoint, these are opportunities.
And the bigger, more complex the challenges, the greater the
opportunities. So, I want to get started.
Talking about our perspective in this course.
Inevitably, your instructors who happen to be living in the United States, I'm
here sitting a short walk away from one of the great research hospitals, Duke
University Medical Center, and I have a particular perspective.
That is in relationship with my environment.
You have your own perspective. And the marvelous thing about these
massive open online courses, is that the perspectives of the people who are
listening to this video right now, are so varied, so diverse, from so many
different geographical regions. That we have the makings here, of an
exchange of information that's pretty unprecedented.
So, once again I encourage you to share with people in the discussion forums how
different your health care system might be from one described here.
So, I must, this is the caveat, I must warn you that there is going to be a
bias. Simply because of the partial vision of
your instructors, the partial experience of your instructors.
And we'll talk a bit about how we need teams of people, bringing multiple
perspectives to bear on solving problems of this nature and of this dimension.
Of this size. That being said, I will begin by talking
a bit about the United States and many of you will have heard these statistics
before because the media coverage on this kind of data has been pretty wide spread
in the United States. So, for those of us living here we spend
per capita more than any other country. On health care.
That translates to 17.3% of our GDP last year alone, and that's up from 7% in
1970, what are we getting for our money? Well, this really shocked people when it
came out in 2000. The World Health Organization, did a
comparative study based on its own criteria about what it means to perform
well as a health care system. And in terms of performance, the key
indicators were things like. Do you leave people in catastrophic
straints because of medical expenses? Does your system offer quality in its
care? Affordability in its care?
And a whole string of other key performance metrics.
When they compared through this framework.
Nation, to nation, to nation. They ranked the United States as 37th
among nations. And, you have the citation here, that you
can look at and peruse on your own. Having said that.
Then we start thinking about, well what are the more recent statistics saying
about the United States. Are we continuing this trend of being
what some say a fourth rate power when it comes to providing quality healthcare?
Well, I look around me and I see dedicated staff, extraordinary lengths
that are gone to, marvelous medicine being done, marvelous research.
And great, great performance when it comes to quality care in my environment
here in Darum, North Carolina. Yet, when we look at the statistics for
the United States, we've got an infant mortality rate compared with the rest of
the nations in the world of 39th, an adult female mortality rate of 43rd,
adult male mortality 42nd. And life expectancy, 36th.
Now I could say, let's concentrate on that problem.
There must be industrialized countries, who are doing a better job than we are
and of course there have been recent investigative reports to suggest that may
be the case, but this is a controversial and debatable subject.
And the question before us is, is this exclusively a problem with the United
States? Of course not.
Given the fact that there are low and middle income countries in which the, the
issues, the challenges, are different and difficult.
So what we've got, are global trends in healthcare costs that are absolutely
staggering when you consider that today, 56 billion people pay out of their own
pockets, for over half of their health care costs.
And this is in low and middle income countries.
That translates into 100 million people per year, who fall further into poverty,
or fall into poverty to begin with each year, because they must pay for
catastrophic care. And we have a reference here that you can
refer to, Primary Health Care Now More Than Ever.
The World Health Organization World Report of 2008.
And finally, just to give you an incline of what's down the road, in diabetes care
alone, 490,000,000,000 billion, that's in US dollars, billion dollars.
Is expected to have to be spent in the year 2030, to care for people aged 20
through 79 for diabetes care alone. So, what we've got here.
Is the elephant in the room. Healthcare, the relationship between
quality and cost, the, the, the necessity, of improving quality without
forgetting the need to decrease cost make things more affordable.
The effort to increase efficiency. While at the same time, not sacrificing
safety. All of this, you know, delicate balancing
act, makes health care and the health care systems we have before us, one of
the more staggering systemic issues. Before human beings as a whole.
So, when you talk about innovators, who have taken the time to look at the
healthcare situation, probably the first one in the United States that we start to
think of is a fellow named Clayton Christensen who is the reigning expert
on. The dilemma of innovation within
industries. Now, he's looked at manufacturing
industries, like computing like steel manufacturing.
And he had come at a certain point to the healthcare industry, set his sights on
it, wrote a book about it. And his conclusions are[LAUGH] frankly,
kind of interesting. As you see on your slide, here's a quote
from his acknowledgments in the beginning of his book, The Innovator's Prescription
on the Health Care System. Making health care affordable and
accessible is a challenge of monstrous proportions.
Hence my elephant in the room. Far beyond the most entractable of the
problems I had previously tried to study. Essentially, then, the healthcare
industry is simple. Is excuse me.
Quite the opposite. Is complex, compared with the simplicity
of other industries. The relative simplicity.
It is according to Clayton Christensen unfathomable, interdependent in it's
technological and economic complexity. The entire enterprise is a challenge.
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