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Posts Tagged ‘social care’

In 1969, the supersonic aircraft Concorde was the first commercial airliner to replace the traditional and burdensome mechanical and hydro-mechanical flight control systems with the more sophisticated and secure fly-by-wire system. In essence, in a fly-by-wire aircraft the pilot moves the joystick sending messages to a central computer that, once the order has been processed and checked against the rest of the information received from sensors installed along the aircraft, sends an order to the appropriate part of the aircraft, e.g. the engine or the wings.

When fly-by-wire was first introduced, pilots complained that they were not “sensing” the aircraft; they were losing the feeling of how the aircraft was responding. Nowadays more sophisticated algorithms have introduced a feed-back to the pilots, enabling them to “feel the aircraft” like in the old days.

Socio-health care is in the process of going through the same kind of revolution with the same kind of professionals’ complaints. e-Care is introducing a new paradigm into the care process. Many practitioners feel that through long-distance technology, telemedicine for instance, they are losing touch with their patients. Is that true?

Obviously I don’t think so. Haven’t we been using telephone calls as a substitute for face to face meetings since early in the last century? Is not a telephone call effective for solving a myriad of problems that, in the nineteenth century could have resulted even in a war due to the slowness of the response? Think about it: the tools that e-Care puts in our hands are here to solve in minutes what in the old care process would have taken, and still takes, days. Those days are precious when at the other end of the line there is a suffering human being.

e-Care, health or social, is here to help the patient. This is something we should never forget. It is also a tool to help the practitioner to work in a more efficient way. It means the practitioner has to adapt to a new care process, forgetting the old ways in which the patient waited patiently in the waiting room to be seen by the all mighty care professional. That same professional who would explain, in the best of cases in an incomprehensible manner, what was going on.

Today, the patient will demand a clear explanation. A demand full of questions fed by the knowledge, good or bad, acquired on the web. Today the patient will not be patiently waiting, but will be impatiently expecting your to-the-point answers at the other end of the ICT system.

But also today, as a professional you have at your fingertips, or better at your “mouse tips”, more information than you ever dreamed of having. And the combination of general information, together with the much better and accurate information about your patient, puts you on a professional level that your predecessors in the field were never able to achieve.

Do not miss the opportunity, go e-Care! The sooner the better for your patients, and also for you.

Anuncios

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Why is it so difficult to convince older people to adopt gadgets and new behavioural patterns that are meant to make their lives healthier and richer? A person who has not ever read will find it difficult to enjoy reading when turning 65. Behaviour is one of the most difficult things to change; ask any smoker or drinker. And it gets more difficult as we age. Habits form our core identity. As we age we tend to rely more and more on our way of doing things and tend to confront any change with the utmost suspicion.

This behavioural inertia is also ingrained in society. Almost every socio-health care system is based on a pattern of attending social and health problems. Care systems are traditionally designed to repair our ailments. If you have a problem we will take care of you. Don´t bother us if you just feel that probably you will have a problem in the near future; we don’t have time for it!

The combination of both behavioural patterns, personal and social, results in a rejection to adopting anything that means to change our old ways. Change then comes forcefully, meaning we have to change because there is no other way. Any change is, then, a public proclamation of some kind of unavoidable evolution in our system. If I am using a walking stick, it means that I am now frail. I am telling everybody that now I am frail, everybody assumes I am going downhill. Outcome: I will not use that dammed walking stick even if I fall!

If walking sticks became fashionable, as they were in the last century, my ailments would be stealthy; I would be using the walking stick just like everybody else, only I really need it.

If care systems insist on putting all their efforts into solving problems – tackling mainly acute problems-, there is no chance that we can incorporate new habits into the population. I know that for years there has been talk about the need to introduce prevention into our care systems. I know also that very little has been done. If you are in doubt, compare the amount that any system is investing in obesity induced illnesses and the amount spent on preventing obesity. I recognize also that the opening of a new acute hospital makes headlines with a nice picture of the Minister of Health, while a program for changing eating habits in children in an out of the way school does not make even a tiny article on page 45 of the local newspaper. Nevertheless, we all know that prevention is the only way to face a brighter future.

Prevention means that, as soon as possible in the person’s life, the system will help to change habits in order to avoid future complications. With that in mind, we will be able to introduce say, healthy eating apps that will be assimilated into our everyday life. The person will rely on the app when feeling at loss for ideas for tomorrow’s lunch. The odd search will become a habit, and the app will start recording what food is chosen, and letting the person know when he/she is eating more meat than necessary.

Compare this process with today’s. Today, I would go to the doctor when I felt sick, he will spot that I am eating a very unhealthy diet and recommend a complete overhaul of my eating habits. He may recommend an app to help me keep track of what I eat. I will struggle to follow the diet and will not use the app. My mind is telling me that I have been eating a lot of meat ever since I was young and I have enjoyed every minute of it. I will keep it that way till the grave, even if it means the grave closes nearer.

I think that the only way to success is to be able to induce a behavioural change in our target population. We know that behavioural changes are easier the younger the person is. We should then aim at incorporating as soon as possible into daily life those elements that will contribute in the future to a longer and healthier life. Get your walking stick today; do not wait for when you really need it. Or in a more up-to-date fashion, start getting acquainted with apps and other ICT gadgets today, before you really need them and feel old and battered.

From the developer/entrepreneur point of view, your customers are the social-health care systems; convince them that only by prevention will they have spare resources to attend the ageing society; change their behavioural pattern from solving acute problems to preventing problems. I know it is a long and burdensome process but it is the only way that your products will make it to the market, to those who need them.

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If the number of projects focusing on eHealth is any indication, the market must be huge. The recently published brochure “Research and Innovation in the field of ICT for Health and Wellbeing: an overview” lists 97 on-going or recently finished projects funded by the European Commission. By this measure eHealth apps should now be treated as an uncountable.

It has been said too many times that the ageing of the population will put an unmanageable strain on the social and healthcare sectors. It is (almost) public knowledge that only home-care delivery can somehow tackle the coming situation. If you still have any doubts, a recent article in The Economist can, in a nutshell, reassure you about the existence of a growing demand.

In order to respond to the challenge posed by the growing demand, we need to change the way care is delivered. Regarding social care, maybe only some small adjustments will be needed but, for healthcare, a drastic reengineering of the process is necessary.

Assessing the market by simply counting the number of prospective clients is not a valuable marketing approach. We already know that the number of older people living alone at home will increase. The problem is not the number of prospective clients. The problem is twofold: a) how can we reach that population? and b) what business model will bring eHealth into public domain?

The business model has to be ingrained within the care process. Unless distance care can deliver standards similar to face to face care, eHealth will remain the poor relative to traditional healthcare. To attain those standards the redesigning of the care process has to accommodate: a) the idiosyncrasies of the care professionals; b) the legal implications of distance care; and last but not least c) the trust of the care recipient.

Once the care process has been reengineered, then we could focus on designing the business model. For that, the main issue is who pays for what. Because today, most systems link care acts and payment, while home delivery is meant to reduce care acts, switching the burden from the care giver to the care receiver. Again, the alternative funding mode, per-capita payment, is directed to a single organization, while eHealth will switch the burden from healthcare to social-care. So the eHealth business model has to take into account that the healthcare giver is more successful when a) the care receiver does more towards his or her wellbeing, and b) social-care organizations are more active. Summing up, designing a business model that rewards the success of the organization by measuring how it activates other entities (care-recipient and/or social-care) is not easy.

If we successfully solve the business model conundrum, reaching out to our primary customers (care recipients) should be a piece of cake. Anybody will be willing to use a system that reduces the burdensome features of face to face care, e.g. time consumed in transportation and waiting to be seen. Anybody, – and the number of bodies is only increasing -, will grasp the advantages of permanent monitoring, easy access to advice and other advantages that eHealth can deliver. The point is, is eHealth ready to deliver?

Going through a check list of the situation today against the bare needs listed above, the answer is an unqualified NO.

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We are familiar with too many good ideas that never make it to the market and less frequently, brilliant marketing strategies selling a flop. A proper balance between the product and the business plan rarely occurs. That is probably why there are few companies like Zara or HM; only the chosen few can find the Holy Grail. But we all struggle to do our best and come up with the right balance that puts our product or services in the right spot in the market. The belief that that is achievable is what bring us together every time there is a gathering like this one. And the reason for this exposition is because we, the partners of AiB, believe that we are on the right track. First, let me go through briefly how the ideas that my colleagues have already explained can become a sellable thing. To start with, you may have gathered already that AiB has two heads, kind of like a Hydra.  The difference is that this one has only two heads, its breath is not poisonous but sweet, and its blood, instead of being deadly, heals. One of the heads of our friendly beast represents a service. AiB has been designed as a care service with the objective of detecting the risk of falls in the individual being cared for by a care service provider. Corresponding to that view, AiB as a service offers a complete software-hardware package that allows the care provider to screen the population under its care for a set of signs that will prompt the system to raise alarms. If this is the case, care professionals will perform a pre-evaluation of the person to double-check if the user should be included in the risk-prevention programme or if this is a false positive. Once the inclusion is decided upon, a multidisciplinary team will perform a complete check-up of the user and decide upon a personalized care plan for the user to follow. The care plan is a comprehensive set of neurological and physical exercises included in the system library, as well as any other action that the care professional decides, such as pharmacological therapy or dietetic recommendations. The system will request certain information by the user, mainly about environmental conditions, and prompt remedial actions to counter its risks. Once the personalized care plan is designed and introduced in the user terminal, the user will be asked to follow it by means of an agenda, reminders and so forth. Continuous follow-up of his or her performance will be recorded by the system, triggering alarms to the care professionals in case of deviation from the care plan or changes in the vital signs of the user. These events will allow the care professional to modify the personalized care plan accordingly. It will be obvious by now that AiB as a service is directed to socio-health organizations that can take advantage of the system to reduce the rate of falls in the population they cover, with a clear saving in the overall cost of care, which I am not going to go into since we all are aware of the cost of a hip replacement, for instance. The second nice head of our Hydra corresponds to the product that we envisage to earmark for the individual. In a nutshell, AiB as a product is a self-contained package for individual use by those concerned with their health, probably because they have already fallen or have seen their relatives fall. So it is for people who are aware of the personal cost of a fall in terms of days and/or health lost. The AiB product comprises a self-evaluation that will prompt a care plan, although obviously not at the level of the service care plan. The care plan includes a set of remedial actions that can be made in the environment, as well as physical and neurological exercises. A system of alarms will suggest the user refer to a care professional when deterioration in the performance of the user is detected. How does this translate into a business model? We have chosen the Business Model Canvas because it is as good or as bad as any other model but has the advantage of being simple and clear cut. I will concentrate on only two of the boxes of our model. First the customer segment, in the Canvas jargon. As you can see, we are targeting two completely different markets:  the professional care market and the individual, with basically the same body of knowledge.  Again our friendly Hydra comes to mind with two heads but only one body, and guarding against the perils of falls instead of the entrance to the Underworld. Second, the key activities. We have discussed a lot among the partners on how to proceed from here. We have been able to produce a thing, system and product for the prevention of falls, without killing each other.  A thing that is the sum of the efforts of very different organizations, from health care, to users, to ICT companies, to process designers, even an economist (myself). The result cannot be broken into parts so that each one takes its bit and markets it independently. So we arrived to a solution that has been in use for many years: the European Economic Interest Grouping. This legal figure is governed under European Community (EC) Council Regulation 2137/85. It allows us to continue collaborating while preserving the individuality of the members and separating the AiB undertaking from the other business of the partners. The use of the EEIG will allow the AiB partners to go on to the next step of industrializing our output. That will be our way forward. I am sorry I could not attend the event in person, but if you have any questions, feel free to ask either my colleagues present or contact me at the e-mail address shown on the screen. Thank you very much for your attention.

You can also whach the presentation at http://youtu.be/QZtK6AyvfN0

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Efficacy in the provision of care coupled with efficient use of scarce resources is the goal of any social and health care system. Or is it?

Governments feel hijacked by their constituencies. They feel the need to provide quick answers to problems that, in most cases, their constituencies are not even aware of. Politicians feel the need to do something, and that something has to be readily visible. If you were an average  politician, what would you prefer? A front page picture in the paper of the inauguration of a hospital, or a long interview in the middle pages explaining how you have bet on primary care? You can fill in the blank ________________.

And yet, we all use a lot more primary care services than those of an acute hospital, no matter if we are young or old. We rely for our well-being on proximity services: social and health primary care. Only on extreme occasions do we use an acute setting.

Furthermore, primary care is focused on prevention, as opposed to remedial actions provided by acute hospitals. To top it off, prevention is recognized as the basic pillar of efficacy in care and efficiency in the use of resources.

And then, why is it that prevention is the black swan of care? I can only think of one answer and it is not a pretty one: our politicians need quick fixes and they have neither the knowledge nor the willingness to confront complicated problems.

Can we do something about this? I would like to think that we can. The constituents, or in other words the professionals and users of the socio-health system, should make their voices heard loud and clear: we would like a system that helps us to prevent ailments, not a system that only takes care of us when it is too late.

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The new philosopher’s stone of our times is a balanced budget. Apparently, if our Governments reach that goal, all our problems will be solved: full employment will be reached; social and health services for all will be at hand; the education system will make our children achieve high marks in the famous PISA test; and, above all, our retirement will be assured.

Accordingly, European governments have gone into a frenzy of budget cuts meant to make it easier to achieve social nirvana. According to oxforddictionaries.com, “cut” means to reduce the amount or quantity of. This activity is geared at making state participation in the overall GDP of the country smaller.  This is not a bad thing. There could only be a problem if, parallel to the budget cuts in the public sector, the economy shrinks, so that the tax base shrinks too. If that happens, the economy falls into a vicious circle where the more the government cuts its budget, the more the GDP shrinks and the smaller the tax base is. I don’t want to sound pessimistic, but the present situation in Europe looks very much like this.

Governments have taken the easy way. It is easier and requires less thinking (not the main characteristic of most European politicians) to cut a budget than to come up with alternative saving plans. Saving means having a vision, designing a plan and implementing it. This is a process that requires building for the future rather than concentrating on short term results. In the worst case scenario, results could be achieved after the next elections, anathema for the non-leaders of today.

It is about saving, not cutting. Saving means reforming the process by which our welfare state continues providing the services that have made European countries the envy of the world. It is about integrating services while avoiding duplications, for instance bringing together social and health care services that could lead to reinforcing each other, instead of working back to back. It is about integrating all educational levels, from kindergarten to vocational training to university. And so forth and so on.

All of which means having a vision that, unfortunately, our so-called leaders lack completely.

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Last year an official at the Ministry of Health from the UK, addressing a conference on business developments in technology for disabled and older people said, “I see more pilots in this gathering than in British Airways”. And yes, he hit the nail on the head. For some reason, most developments financed under the AALJP, or for that matter under any other EU program directed at ameliorating the living conditions of older people, have foundered and have never gotten off the ground.

Why is it that most of those ideas that have been found valuable, not only by their promoters but also by the EU agencies in charge of selecting them, have not made it to the market? Why haven’t they become success stories?

The obvious answer can be found in their faulty business models. Answering the typical questions of “What is the real need?”, “How big is the need?” or “Why should this particular product or service come on the market” do not serve our purpose of achieving a successful business model.

“What is the real need?” and “How big is the need?” focuses obviously on needs, and let me say that one thing is “need” and a very different thing is “demand”. People are ready to pay for their demands, whether these correspond to their needs or not. In the marketplace only products or services that meet a demand will have a chance of success, regardless of the real needs of the population to which the product or service is directed.

“Why should it come to the market?” surreptitiously means that there is already a product or service, and we will look to the market for the possible demand. It is a top-bottom driven question. Our investigation should be bottom-up driven. What we should be doing is to ask first what the market demands are and, only then, investigate how to meet the demand with a product or service.

There is a second problem. Most of us assume that the public purse is going to foot the bill of a product or service directed at the older population. This is based on the belief that we can demonstrate that, for society as a whole, our solution is cost effective. What we really mean is that our product or service will save health care services, social care services, families and individuals huge amounts of money and/or time.

But really, who is going to pay? The health care service, the private health insurer, the municipality in charge of social care, the family, the individual, an NGO, who? Because the truth of the matter is that each of the previous possible payers has an independent budget. Why should, for instance, a health care service foot the entire bill for something that is going to save money for the social care services of a municipality that may even be governed by a different political party?

Out of the previous list of possible payers, there is only one that is going to benefit in full from our product or service: the individual. He or she is the only one paying the bills anyway, through direct payment, indirectly via taxes that finance public services, or by premiums that pay for private insurance care schemes.

There is another group that could benefit from a product or service designed to meet the needs of older and disabled people. It is the vast array of providers that cater for them. We are referring to shops, restaurants, entertainment, transportation, and the like. This group, mostly SMEs, could profit by establishing a special bond with the world’s ageing population.

The point is that, given that individuals are the end users of our services and products, we have to be brave and recognise that they will have to pay for it directly or indirectly. If, on top of that, a broad base of providers can benefit from the result of our investigation, we will have the support of other actors interested in paying for their use. Put together the interest and demands of those two big target groups and you will have a success story. That will be the moment to address a simple question “How much would you pay for this?” Needs and cost for the end users and providers, kept in balance, should be at the core of our development strategy and of our business model.

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