Written on 04 Dec 2020.
Healthcare managers, specialists and decision-makers work in a complex and fast-changing context. How can they develop and expand a global vision of their activities? What major trends do they need to comprehend? These questions are at the heart of the new EDHEC Executive MBA Healthcare Innovation & Technology (EMBA HIT) programme, created in partnership with the world-renowned Compiègne University of Technology (UTC). Start exploring these questions and more with François Langevin, Biomedical Researcher at UTC, Head of the Health Technology MS programme, and Co-Director of EMBA HIT.
François Langevin: It is important for healthcare leaders and managers to take a step back and develop a global vision of the context in which they work. Healthcare is not an isolated field: it includes economic, social, demographic, and environmental factors, and its techniques borrow from many different disciplines.
Access to water or sanitation for example, are still far from being universal. Maternal and children’s health depend on poverty, hunger, and women’s access to education. Recently, we have also been able to observe the relationship between COVID-19 and economic insecurity.
That is why, in the EMBA HIT curriculum, the Understanding the Global Healthcare System module enables managers and decision-makers to get a transverse and global overview.
It is key, because it enables healthcare professionals to approach situations as a whole and to aggregate information from different experts, in order to develop a strategic vision. In addition to assimilating different specialised expertise that do not usually communicate, innovation arises from connecting two thoughts nobody had associated before to generate new ideas.
For example, health and social problems, as well as nutrition issues, are intrinsically related. But they are still treated separately. Yet, it is difficult to treat patients if you do not understand their context. The manager of a dialysis center was telling me recently that it was sometimes impossible to set up dialysis systems in a patient’s house because of the poor conditions, the lack of space and the absence of a caregiver. To overcome these obstacles, we must think differently and decompartmentalize.
The population of developed countries is aging, which results in an increase in chronic pathologies, poly-pathologies, and handicaps. More generally, there is a continuum between health and healthcare mechanisms, but the way society creates pathologies is also a major issue, whether it is through food or the stress induced by work or urban life.
In the South, most infectious pathologies are receding significantly – like malaria or HIV. On the other hand, pathologies that used to be specific to Western countries are developing fast: cardio-vascular pathologies, cancers, diabetes… This transition can be explained by the changes brought about by urban transformation, as the urban population now exceeds the rural population worldwide.
We identify three categories of healthcare systems: the Bismarck model, based on the co-management of social insurance by employers and their employees; the Beveridge model, more universal and financed by taxes; and private insurance systems, like in the United States. In France, for example, we implemented the Bismarck model in 1918 through Alsace. In the United Kingdom, they set up the Beveridge model after World War II. But today, all these models tend to blend together.
No. Healthcare and regulation systems evolve differently, although there are some common trends – like hospital payment being massively based on diagnostic-related groups (DRG). Other common trends have emerged across Europe, with a more active participation of the patient in the healthcare system, and the growing use of “episodes of care”. The “walking patient” figure is gaining prominence with the development of ambulatory procedures, and a focus on patient responsibility has become key: citizens are encouraged to take their health into their own hands, by balancing their eating habits and limiting addictions. Developing an international vision is a must, because companies in the healthcare industry rarely operate on strictly national markets, except in the United States or in China.
As an industry and market, its main specificity is that it is not based on the two classic economic pillars of supply and demand. In most countries, healthcare systems are regulated, so they are based on three pillars made up of patients, healthcare organisations, and regulators. Understanding these mechanisms and their consequences, as well as considering the logic and role of companies, is key.
The medical and medico-social landscape is complex. It includes public, private, or non-profit hospitals, different follow-up care and rehabilitation structures, more or less medicalised institutions for the elderly, dialysis centers, non-profit organizations… The social and handicap sectors are also very fragmented, with a diversity of players.
The industry itself gathers many different players, too. There are the leaders of medical machinery, like General Electric, Siemens, Philips, Medtronic or Cann; the big instrumentation or pharmacy experts, like Roche, Johnson & Johnson or Novartis; but also the tech giants like Apple, IBM, Google, Samsung, etc, who are all interested in healthcare. We also cannot forget the many small- or medium-sized businesses and start-ups that have emerged over the past few years.
The relationships between all these healthcare players are not regular customer-provider or seller-buyer relationships. An innovative company, for example, needs support from opinion leaders, and hospitals willing to reference and test their products. It gives rise to unique partnerships and ecosystems, made up of stakeholders with diverse expertise and networks.
Hospitals are businesses in many ways. Human resources are based on Taylorism: in radiology for instance, there are a dozen different specialties – it is impossible to have a vascular radiology operation done by a pediatric radiologist. In terms of organisation, the Toyota Production System and the lean management theory are omnipresent. Hospital processes also follow an industrial logic: in a medium-sized hospital with about 15 operation rooms and 200 people working around the clock, from the stretcher bearer to the surgeon, everything must be managed like in a production line. Besides, the current hospital financing model, based on DRG, implies that all treatments and procedures are “sold” like products.
Finally, just like in other industries, the healthcare and hospital sector is defined by many mergers and acquisitions, based on the argument of economy of scale. This trend sometimes seems excessive: in France, for example, 90 hospital mergers have happened between 1997 and 2012. Some hospitals have become big superstructures and migrated on the outskirts of cities, just like these suburban malls you can only reach by car or bus. Going against this centralizing flow, the return of some of these healthcare services at local scale, closer to the people who need them, is a major issue today.
Of course not. Hospitals are not businesses like any other, because what they provide is healthcare. Many hospital workers are strongly opposed to the business approach to healthcare. We observed it in France, when nurses and nurses’ aides joined social movements such as the Gilets Jaunes. The truth is probably at the junction of both ideas: despite shared characteristics with regular businesses, hospitals must keep a human dimension and their purpose must remain, above all, of societal nature.
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