Time to Care

I’ve spoken about my own experience of burnout as a doctor and it was something that was on my mind when preparing my recent keynote speech at Radical Health Helsinki. As a busy GP I was drowning in an unmanageable workload, undersupported, under resourced, and unable to give my patients the services and treatment they needed. Much of this was a function of TIME. I simply didn’t have the time I needed to do the work in front of me with the tools I had. Having taken the time to recover and use my medical background to build a successful career in health tech, I hear from friends and colleagues that the system is still pushing everyone to work at the top of their licence, at a more furious pace. So why is this?

In part it is because Healthcare demand exceeds supply. In the UK waiting lists for treatment are at an all time high in England and Scotland It’s reported that we need to recruit 50,000 staff to meet the OECD average . A staggering 42% of GPs plan to quit in the next 5 years . At a recent medtech event for medical students that I spoke at, I was surprised to hear that nearly 50% of the class did not plan to enter clinical practice. Shockingly, surveys indicate this figure is around 25% for US medical students, with 58% seeing their current studies as a stepping-stone towards a broader career in healthcare that will not involve directly treating patients.

It’s not limited to the UK; it’s a global problem. In France, the average age of a doctor is 51, with 30% of doctors > 60yrs of age. In Finland, where I recently spoke about this issue at Radical Health, an additional 200,000 health & social care workers will be needed by 2030, with at least 10% coming from abroad . Belgium who hold the EU presidency, have focussed on healthcare workforce strategy as a priority.

Healthcare experts take a long time to train so when staff are leaving, retiring earlier, reducing their hours, and striking, we can’t just recruit more to fill the gaps. We need to support them and stop them wanting to leave in such numbers. How might we do that? We find them more TIME.

Is tech a solution?

A lot of hope is pinned on technology but what role can  technology like AI, wearables, remote care and monitoring take in saving time? And how can we allay fears that tech equals a lack of compassion, instead using tech to deepen the care that human healthcare staff can give to patients?It is a question that is being discussed a lot, with the Topol Review into preparing the healthcare workforce to deliver the digital future stating (2019) “wherever possible the adoption of new technologies should enable staff to gain more time to care, promoting deeper interaction with patients.”

More recently, the NHS Long Term Workforce Plan (2023) echoed this point stating the importance of “Ensuring staff have the right skills to take advantage of new technology that frees up clinicians’ time to care.” However, while there is evidence that time can be saved, we are less clear on what is done with that time.

The reports

It’s at this point that I’m going to direct you to the HEALTH FOUNDATION in the UK. They’re a charitable foundation who focus on improving health, reducing inequality, supporting radical innovation, and generating evidence. In the past year they have published three reports looking at this area, and posed three questions:

1) What do technology and AI mean for the future of work in health care?

2) Which technologies offer the biggest opportunities to save time in the NHS?

3) How would clinicians use time freed up by technology?

The first used labour marketing modelling to understand how Healthcare might be different from other workplaces. Given the importance of human care delivery, technology is more likely to change the balance of tasks and work roles. They offer a framework to help plan this, looking at how technology can support, strengthen, substitute or supersede work based on the capability to match or exceed performance. All of this requires deep, active engagement with staff, management, and policy makers, who can then share their needs with developers.

Moulds A, Horton T. Fisher R. What do technology and AI mean for the future of work in health care? The Health Foundation; 2023 (https://www.health.org.uk/publications/long-reads/what-do-technology-and-ai-mean-for-the-future-of-work-in-health-care).

The second report looked at which technologies represented the greatest opportunity for time saving in the NHS. They surveyed 560 staff across the UK across 8 different professional bodies, and supplemented with expert interviews. What this showed is that the greatest interest was in core tools such as Electronic Health Records (EHRs) and interprofessional communication platforms. Administrative support was seen as low-hanging fruit. However, the strongest request was for optimising existing tech and removing IT and infrastructure barriers, over new technology. They were optimistic about AI over the coming 5 years, mainly in assisted documentation and interpretation of imaging and lab tests. The success of implementation was felt to be more likely when staff are directly engaged in identifying problems and developing solutions.

The final report holds the most interesting findings. How would clinicians use time freed up by technology? A literature review estimated that less than 1% of the existing literature on technology’s impact on healthcare staff time looked at how time is used. From their survey data they found that only 27% of time would be spent on direct clinical activity, with the remainder being used for training, research, quality improvement, and staff wellbeing.  These proportions vary by staff type, years of service, and amount of time freed, meaning that employers and staff need to work closely on how to best utilise any time savings. 

My call to action to you

So, given the findings of these 3 reports, what should we do? It depends very much on who you are, and what role you play in the system.

For the BUILDERS, we need to take care over our claims. Grand claims, especially those that emphasise time savings, need to be well evidenced or moderated. As the value proposition is described, take particular care when directing the buyers towards reusing the time saved for more patient contact.

We need to develop solutions that support time with patients and protect it. This requires careful attention to the care process and patient journey, thoughtful user experience and human-centred design, and not forgetting to help healthcare workers care for themselves and plan their professional development. 

None of this is possible without engaging the stakeholders from the very beginning.

For the BUYERS, don’t assume that time saved is entirely available for patient care. As the Health Foundation reports show, only a quarter of freed time may be available for this purpose. Plan accordingly. 

Should productivity improvements be your goal, remember that shorter hours have been shown to be effective. Yes, even in healthcare

At all times, engage with your stakeholders, frontline staff, patients, and their families. Their time is not entirely yours to spend.

And for the USERS? The patients and families, the pharmacists, nurses, and doctors? You need to engage with the builders and the buyers. When they come to you, work with them. If they don’t, hunt them down and force them to. 

When time is freed up, protect it. Save some for your patients, but remember it can be spent on quality and depth of encounter. 

Do not forget to save some of it for yourself.

We face a choice

Without care, there is a good chance that HealthTech could make our situation worse. If the focus is purely on the economic buyer’s needs at the expense of the users or ultimate beneficiaries, the products and services developed will simply increase the volume of work we are doing. Worse still, this work will now be of higher complexity and challenge, as we are driven to work ‘at the top our our licence.’ We’ll be building digital whips BUT if we do things the right way, things could look very different. 

We could spend the time we’ve saved on deeper, higher quality, human interaction. We would be able to provide the personal and professional support our healthcare workers need to survive and thrive. We’d be able to better engage in preventive and precision healthcare, because both of these require (say it with me) TIME. If we win back time to care, we have an obligation to preserve it for that.

At its heart, medicine is about storytelling. For the patient, it’s telling of their personal story, and that of their illness. For the clinician, it’s hearing these stories and weaving in that of the disease.

Hippocrates, said“it is much more important to know what sort of person has a disease than what sort of a disease a person has.’ To tell a story, to hear it, to understand a person and their illness, takes time. If we want to protect our workforce, help our patients, and deliver the best care possible, we have to find a way to give that time back and protect it.

If you have a health tech idea that you would like to develop, get in touch to find out how our Product Strategy and Visioning service can help