Digitech adoption by healthcare providers – gentle seduction works best

This emerged from a panel discussion between top innovators and healthcare providers at the International Finance Corporation’s conference entitled, “Developing Resilient Health Systems in Emerging Markets,” held in Cape Town last week.

With healthcare professionals overloaded, staff in short supply and entrenched ways of working, resistance to revolutionary streamlining technology which improves patient outcomes is predictable.

The panel discussion, entitled, “Planning Sustainable Health Service Digital Transformation,” embraced the International Finance Corporation’s, (IFC’s), digital health lead, Klaus Boehncke, Discovery Health’s Chief Digital Officer, Ana Endres, Healthforce and Kena Health’s telemedicine innovator, Saul Kornik and the IFC’s Senior Investment Officer (Health and Education), Giles Newmarch.

They were discussing how best to develop a strategic, aspirational and pragmatic approach that leverages digital technologies to deliver higher-quality healthcare more efficiently.

Endres said Discovery’s user research showed that despite initial resistance, doctors did recognize the value of digital health.

“It’s a lot to take in with these devices. They don’t want to stray from their MO. But when we show them a dashboard of population health management and which patients have failed to do what they’re supposed to do and how they can, at the touch of a button follow up (on a script, for example), they’re likely to engage. We have a duty to continuously push healthcare practices and the system to transform itself and become the most efficient it can. There are so many solutions to reduce overall healthcare costs,” she said.

Change management crucial

Endres said change management was crucial to enable technology to improve patient-centric care and create a paradigm shift. Many surgeons took strain during Covid with DHMS claims dropping significantly over the first eight months of 2022, but returning to pre-Covid levels in the last four months of last year.

Kornik, who provides on-demand telemedicine for over three million user consults via 200 000 consultants in 500 clinical settings, agreed that change management was ‘critical.”

“Digital health has a lot of different forms. In business-to-business you need to understand whether it’s a tool or your actual business where, if you strip the software out, your business will fail. In a lot of our work, we become the business of the software. When you get nurses to call the telemedicine doctor, it becomes the business.”

Kornik said some nurse leaders were afraid of the legal implications of using digital technology – which made a change management, people-centered approach vital.

“We incorporate the thinking of healthcare professionals in our tool design, but doctors don’t know everything – though some think they do. Some don’t even realize they need this technology. It needs to be intuitively useable. Incentive alignment is critical when launching something in a business-to-business model. If a clinician’s incentives are not aligned to the use of the tech, they’ll reject it.”

He cited the stethoscope, saying it took a century before doctors began using it routinely.

Doctors stubbornly held onto their patients, often resisting anything that appeared as if it might disrupt or potentially impact their incomes.

“My two-year-old son was sick recently, so I took him to our GP who gave him ear drops and told us to come back in three days. It didn’t improve and after three days he prescribed another med, telling us to come back in another three days. We could have carried on forever like that, without a solution. He’ll never refer us to a pediatrician when he can collect R500 every three days. So, with digital, there’s massive fragmentation. You have to sell to each individual provider who wants to hold onto that patient. That’s how they make a living. You must incentivise them,” he said.

Kornick said the ‘trick’ was to occupy a significant part of the value chain (for example, making Discovery Health a partner), and add value without getting knocked out.

Endres said Discovery used the Vitality incentive model with doctors, increasing remuneration for positive digital health engagement.

On the member side, chronic patients were targeted for regular check-ups and pathology testing, earning points for rewards.

Discovery’s approach

Over the last decade, Discovery had used a structured approach, appointing one team to curate and identify the correct technology, another to manage the road maps of integration and a third set of enablers for system development.

“As new care models came in telehealth and telemetry, we’ve shifted and integrated with third-party solutions of all kinds. We focus on, rather than develop features, and then integrate seamlessly with those providers. There’s a lot of emphasis on data and insight to pool and nudge the right solution to the right patient at the right time and orchestrate that journey, she added.

Klaus Boehncke, whose company is called LEK Consulting, said regardless of whether healthcare professionals were in First or Third-world countries, resistance to technology was universal.

Illustrating barriers to tech implementation, he cited his company’s attempts to introduce a medication management system in two hospitals in Australia’s Northern Territories.

A cautionary tale

The doctors at one hospital described the system as ‘terrible, super complicated,’ and alleged that it was killing patients.

“I noted their feedback and we went to the second smaller hospital where we’d introduced the system, expecting the same response. However, they said the system was fantastic, and that they’d never seen a better one. We asked the government about the different responses before realizing that in the second hospital, we’d put in a trainer for four months with medical doctors looking over his shoulder. So, the only difference was change-management.”

The irony was that the resistant hospital was politically influential – and the government scrapped the system.

“You should budget at least 20% of outlay on change management and getting that right,” Boehncke warned, adding that the subsequent deep analysis in Australia showed that with paper-based systems, for every re-admitted patient, there were six medical errors and a 60% error rate for IV's.

He backed his co-panelists, saying that once you’d achieved tech adoption, you could reward and retain users financially or with Vitality-type points, "and then look at training and education as we did in Australia.”

Boehncke added, “the stats are mind-blowing. It’s a bit like Google Maps – once they’ve been, (gently), introduced, they’ll always want to use it. The motto must be, ‘reward, train and delight’,” he added.

Top-down leadership was key in building digital systems for patient management and extended quality care for far longer.

“It’s a long period of transformation to get a full digital workflow, wherever you are globally, but you must look at your business so digital can become your business. It’s an integral part of how you manage as a service provider to your patients and staff. Create a platform they love to use. I’ve had nurses say they wouldn’t want to work anywhere else because it guarantees the quality of care for their patients,” he added.