Innovation in healthcare is impossible when it’s not patient driven

During the period I developed and subsequently managed a portal for managers of care homes for the elderly,, I posted an organigram (see below) that I had used at my own care home since around the year 2000.

Instead of a hierarchical structure, it represents a flat circular one, with the patient in the middle and management in the outer circle. Each inner layer initiates requests towards the outer layers. Each outer layer tries to cater for the requests coming from inner layers.

Basically, it turns your traditional hierarchy upside down, with managers being summoned by patients and employees.

The organigram was the most downloaded file on the platform, by far.

Now about 20 years later, we still work this way at our care home, so you can hardly call it an experiment.

There are two basic principles that you need to have in mind:

  • The patient must have an opportunity to steer their treatment.
  • Employees have to be given the right means (and responsibilities) to do their job optimally.

Does it actually work?

Without any doubt. Several surveys confirm that most patients are very happy with the friendly service of the staff. The degree of employee absenteeism is low and retainment isn’t a problem we have encountered in the last decade.

Meanwhile, iit has also enabled me to pursue another passion of mine: helping small and large companies improve healthcare delivery.

How can healthcare delivery be improved?

Being knee-deep in several innovation tracks for over 10 years, one of the main conclusions is that a lot of companies still build solutions for problems that do not exist.

Coming up with new concepts and solutions is so much more meaningful if they originate from real problems. In healthcare, nurses have some of the toughest and most stressful jobs, and, to make it worse, they have to work with sub-optimal tools a lot of the time.

If you take some time to hear them out, they will overwhelm you with opportunities for how healthcare delivery could be improved. I’m happy to see leaders actively promoting the inclusion of nurses  – with the hashtag #NursesIncluded – after successfully promoting the inclusion of patients.

I’m also delighted to see that caregivers are finding ways to exchange information and collaborate. A good example is the hashtag #BeNurse on Twitter for Belgian nurses.

But back to our care home, we’ve already adopted this approach. Nurses and care-aids tell us how an application should be built and what digital items, processes, forms and others should be improved, altered or completely redesigned. 

A product of digital innovation should fit the workflow and not the other way around.

You then realise innovation in healthcare should have exactly the same flow as the organigram we’ve been using at the care home for about 20 years. The patient is still in the middle, driving the service, but the caregiver is given a more central role. The same principles apply: each inner layer initiates requests towards outer layers and each outer layer tries to serve the requests coming from inner layers.

This is based on three basic principles:

  • The patient drives the service.
  • The caregiver has the opportunity to co-steer the service and treatment.
  • The management’s focus is to provide caregivers with the right tools (and responsibilities) to do their jobs optimally.


When the five principles above are respected, you create an environment where staff satisfaction levels are much higher than average. And this results in a much better service towards patients. If your staff is happy, so will your customers.

If you focus on a patient-driven service and on a caregiver-driven approach in your operational services and innovation trajectories, you even get an extra bonus: easy recruitment. Because who doesn’t want to work in an environment where management actively helps you do the job you love and prioritises giving you the right tools to do so?

I don’t believe in “patient-centric” organisations because, when applied in a siloed way, this is a flawed concept. I will talk about this at the HIMSS Liège conference in Belgium in April, but, essentially, good luck with your patient-centric approach if you neglect the central role of caregivers. Maybe a patient-driven organisation should offer caregivers a more central role?

This might end up in a chicken or egg situation, which I would short-circuit by focusing on three movements that need to happen, preferably simultaneously:

  • Top-down pull
  • Bottom-up push
  • Top-down implementation.

Management needs to convey they’re open for (change-) business, caregivers need to be aware tthat hey can change things, and then they have to be brave and determined to implement changes.

That brings me to outer layers beyond the organisation, namely industry plus government and policy. They should also play a role model and lead the way. In a perfect world, they would listen carefully and try to facilitate change and improvement, inspired by the inner layers. And it’s our duty to keep pushing them.

Improving healthcare delivery starts with openness and engaging patients and caregivers.

Bart Collet is the founder of Belgium-based Hyperadvancer and a consultant for HIMSS Liège. Healthcare IT News is a HIMSS Media publication.

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