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