Disrupting healthcare without hurting it

[Music]

so this is my story

i’m a pediatric doctor that got tired of

seeing patients in hospital

because for majority of them it was

mostly too late

and largely preventable but how could i

blame them

when we know we’ve designed a system

that doesn’t work for most people

kind of like alice trying to fit through

that one door to get into wonderland

and let’s not sugarcoat it healthcare is

broken

and nowhere is this more obvious than in

mental health we all have stories of how

ourselves or the people that we care

about has been affected by mental health

or more tragically lost to suicide

you see mental health is common one in

two of you will face at some time

and of those who first have symptoms to

when you finally seek help

the lag time is eight years

and yet only 20 percent of those who

seek help felt that they got the help

that they need

so even though even during medical

school i was really passionate about

tackling inequality

and a half outcomes i think it appealed

to that sense of fairness that has

guided a lot of the decisions in my life

and when you work in the system you

quickly see the factors that perpetuate

these outcomes such as certain

population groups struggling to get

early access to care

so even though i wasn’t technically

trained in mental health it was really

clear to me that if i was to innovate in

this space

it would make the biggest impact in

people’s lives

and that if i wanted to make an impact

at scale

technology was the only vehicle to do

this

and of course as a millennial it boggles

my mind that there is so much

convenience and control

that we have in our lives due to

technology

from being able to transfer money from

one bank account to another

from being able to hell a ride from

point a to b

and it would be as simple as a few taps

on your smartphone

but then when you think about how i

worked in healthcare

and i felt like i was stuck in the 1960s

still

using faxes and pages and for those of

you who are younger you probably have to

google that

um it didn’t make sense and the patient

really has to battle to get access to

their own health information

and not just to think about how and when

they’re going to get the care that they

need so the common link between all

these

innovations i’ve listed as they’re

considered disruptive

disruptive innovation is any innovation

that creates a new market

that eventually disrupts an existing

market because of the superior value

that it creates

and then that also displaces the

established marking leading firms and

the expected norms of how to do things

but yet when you read the headlines of

these disruptive

disruptive innovations they seem to be

filled with destruction

take for example in america in 2012

when amazon’s online sales started to

take off

employment numbers and department stores

plunged by 250 000 people

and as we get more and more used to

lower prices you’re going to expect more

of those brick and mortar stores to

close down

so is it possible that we can have

disruptive innovation in healthcare

without destruction maybe

in order to understand how to transform

a health system we first must understand

what type of system it is so healthcare

is a complex

adaptive system other examples of

complex system is the earth’s climate

your human brain and the reason these

systems are complex is because any

change to the system

leads to unintended consequences that

are difficult to predict

and in some cases even produce the

opposite of the desired outcome

and all of this is due to the

synergistic effects of the multiple

autonomous

inputs interacting with each other big

words i know

but let me give you a real life example

so if a surgeon is incentivized with a

pay for performance model

you expect that more surgeries would be

performed which is great

unless the reason more surgeries were

being performed was because shortcuts

were being taken

mistakes were being made and then the

patient has to come back to the

hospitals to have those short

mistakes be rectified

and perversely the surgeon then gets

paid again

so the theory is a system is made out of

nodes that are autonomous inputs

such as your health provider and your

patient and my hypothesis is

that if you create superior value and

connections between those nodes

you’re going to be able to disrupt

without being destructive

so a year ago i took a break from

clinical medicine to co-found

a tech startup called clearhead

clearhead is an

online one-stop-shop platform for mental

health and well-being that’s provided

directly to all new zealanders for free

and our vision is that we would improve

access to care

through the use of ai helping you figure

out what your mental health issue is

and then finding the help that you need

and we knew then

that the only way we could improve

access enough to meet the sheer demand

that’s out there is to use artificial

intelligence

we need to augment our limited

healthcare workforce because they do

take time to train

and build up and what about the

opportunity of technology to guide you

to the help that you need

rather than having to figure out this

confusing maze that our health system is

but if you want different outcomes you

need to make sure that the people

working the system

are going to do things differently and

the only way you’re going to achieve

that

is if you design with them something

that will make their life

easier not harder to do the right thing

so this is how we stumbled into the idea

of co-design

co-design simply means that all the key

stakeholders are involved in the design

and decision making of the solution that

you’re trying to build

and this is quite different from the

tick box consultation that often occurs

in healthcare where someone has a great

idea

from the top and then they ask for input

when it’s too late to make any sort of

significant changes

but fundamental to this process is the

need to make sure it’s centered around

the user

as they say nothing about us without us

and so we didn’t start off with

pre-formed solutions

we came with interviews to lots of those

with lived experience

to understand the problems that they

face as well as the outcomes

that they want to achieve so we saw them

not as hospital bed numbers

we saw them as people who had thoughts

on how the system should work for them

not the other way around and this is

important

97 of our current mental health funding

goes to the top three percent of those

with the most severe disorders

imagine if you rocked up to emergency

department with a broken arm and of the

100 people that came through

97 of you got turned away what sort of

uproar would that cause

and yet when our current government’s

goal is to increase access to the next

20 percent

i would argue that it’s still asking the

wrong question

and therefore going to lead you to the

wrong outcome which is which is that

majority of the people

still don’t have access to the care that

they need

but if instead you ask the question of

what will it take

for 100 of the people who need help to

get it and then you work backwards

you’ll realize the solution you have to

come up with has to be transformative

it cannot be more of the same

and when you finally get that working

prototype done

and you test it out in the real world

you have to keep refining it until it

works

and so there’s absolutely no room for

ego because you cannot believe that you

get it right the first time

in fact in the space of a year my tiny

team of six all of us under the age of

30

had to build completely from scratch

seven software platforms

just based on all the iterative feedback

that we got

and i’m really proud to say that none of

them work more than 40 hours a week

to achieve this because you know we

practice what we preach

and when i say to you co-design what is

it that’s the image in your head

is it an image of an exclusively invited

small team

what if i told you our process was one

that was ongoing

and it’s an open invitation that’s

involved more than 500 people to date

all across new zealand and just

clinicians alone

200 of them this picture represents one

of the many groups that we co-designed

with

groups that included mental health users

psychiatrists

non-governmental organizations and many

more

but if you want to involve people in

healthcare you have to be flexible

around the process because you know most

of us

are bloody overworked and so

a lot of the co-design process for us

was sometimes in groups

sometimes one-on-one many a video

conferences

and you can even tag team into the

process but if you choose to do that

you need to make sure that you have a

consistent team that is

across the whole process taking the

holistic view across the system

and then making sure that all the

different stakeholders understand how

their design input comes together

so having heard what i’ve said you could

probably assume that oh

they just build a digital tool but

actually we know gold standard for

improving someone’s mental health

is the human to human connection but

often there’s a lot of barriers that

prevent people from reaching that point

and so because of co-design we clearly

understood what the barriers were and

how we were going to solve

them so for example our ai chatbot

mimics a doctor’s consult

so in your own time in the privacy of

your own home you work through the

mental health issues you have

and then equipped with better

information you are then more likely to

go seek help from your doctor

which previously the stigma would have

stopped you from doing so

then of course there’s the social

license of using ai

there’s so much backlash right now with

the big tech companies on how they’re

exploiting your data

without your permission or your consent

around and then applying all these

algorithms that have

huge consequences clearhead explicitly

states that you own your own data

we don’t sell it and we keep it safe and

encrypted

and because we do that we build the

trust of our users

and because they co-design with us they

define how they want the

ai algorithms to be applied to their

data and in order to help them

but of course beyond trust we have to

show that

we deliver on the results that we

promise and so this is my favorite user

feedback

the chatbot confirmed what i had

suspected but didn’t want to face

i’m now seeking therapy for the issues

it raised

and it was so gratifying for us to have

this feedback come back

just a few months after we launched to

know that we’re already solving the

problem we had set out to solve

or that we’ve only been live for six

months and spread completely through

word of mouth

and we already have users from all

across the country

and reaching people with the worst

mental health outcomes

and i genuinely believe that co-design

was the only way we could have achieved

this because of the local champions we

build

and of course with anything in medicine

you need to make sure that it’s

objectively evaluated

so we’re currently running a research

trial with the university of otago

to have that

so here’s the moral of the story that

all you need is mass participation

well no you must still have experts in

the space

to be able to lead and facilitate this

process

otherwise you know the results you’re

going to get as well [ __ ]

take for example the new zealand flag

referendum

10 000 flag design submitted 2.2 million

votes

and 26 million dollars later 57

of those who voted chose to retain the

existing new zealand flag

and a part of the critique is that yes

it is our democratic right you know to

delve deep within ourselves and figure

out what the flag meant to us

but unless you have flag experts or

designers

to be able to satisfactorily channel the

sentiment of the masses

it’s no wonder the status quo was more

palatable than the alternatives

who knows maybe in an alternate universe

where they’ll be flying laser kiwi flag

with pride

but my other lesson is that it’s not

great ideas that we’re missing

in order to change the world it’s the

courage

to do so when i reflect upon the last

one year

the amazing grassroots support we have

from our users and our clinician

it was so gratifying right but then it

was frustrating

as hell actually when i had to deal with

the decision makers of our health system

where it felt like it was talking to a

brick wall

that i was constantly banging my head

against a brick wall because in general

they were really risk adverse

and just wanted to fund more of the same

because it was familiar

so my call to action to you is this

exercise your democratic right

vote into power those who are willing to

take calculated risk

to support innovation which will then

equip us to better deal with the

challenges of our time

we need to live in a society where we

allow for experimentation

and not penalize people to the media or

to the short-termism of how we vote

i really love that in 2015 finland

introduced into their prime minister’s

office

a department that ran social experiments

like the universal basic income

these carefully designed society-wide

policy trials

allows finland to understand how they

could run their society better

and it also gives permission to those

finnish civil servants to test

ideas without being afraid of the

repercussions

i wonder what our world would look like

if all our governments had experimental

departments

in order to deal with the challenges we

face

maybe then alice didn’t have to shrink

herself

to fit into that one door and that we

would have innovative technologies

in our health system to enable the

analysis of the world to come through

the door they want to

and my final word is this mental illness

is a normal part of our society and the

least we can do

is to for those who are seeking help

dignity

when doing so thank you