The unconference started off with a great keynote (=> slides) by Vlatka Hlupic on The Management Shift.

The audience related in particular to the core message

People + Purpose = Performance

which framed the subsequent discussion of the core challenges within the healthcare sector in New Zealand. CIIC participants decided to focus on two healthcare related problem statements:

Design and development of tools for effective self-care: With increasing numbers of people dealing with health issues that don’t go away, e.g. diabetes, we need to find innovative ways to help them keep as healthy and independent as possible. How do we engage people in self-care that is effective, and what are the tools that we can use to keep them engaged? Monitoring and education tools are good, but surely there are other tools we can develop to solve this problem of people needing supervision, coaching and clinical guidance from doctors and nurses who are already overworked and only accessible for short consultations.
– Dr Karen Day

How do we mobilise and align NZ’s policy, research, healthcare and commercial capabilities to deliver world-leading health outcomes, generate substantial economic returns, and attract, develop and retain talent?  (First step: simplify problem statement.)
– George Arnold

Rather than attempting to dive into potential solutions, participants felt it more appropriate to take a step back, and to take the time to come up with good description of key characteristics of the problem space. The following observations and questions summarise key parts of the discussion:

• Improvements in healthcare outcomes can not be measured exclusively in terms of individual patient outcomes, but must consider the wider context that generates potential health challenges.
  • Let communities define their own problems and challenges from their perspective, and use this definition as the yardstick for measuring outcomes.
  • There is a need to shift from measuring output to measuring outcomes.
  • The dichotomy of either conducting research or a pilot is self-limiting in terms of optimising outcomes.
  • The  culture of competitiveness in the medical profession and a fear of failure  stand in the way of improvements.

• How do we build trust between healthcare professionals, communities, and individuals?
  • There is significant tension between the traditional authoritative approach to diagnosis and treatment and increasingly knowledgeable patients who may have done significant online research into their specific health issues, and who may have compared notes with many other patients. Patients are increasingly becoming healthcare prosumers, with a corresponding shift in expectations for healthcare service delivery.
  • To what extent must healthcare professionals be prepared to be entirely open about the limits of their knowledge, and to engage in eye level dialogue with patients and their families?
  • The  culture of competitiveness in the medical profession and a fear of failure  creates a barrier to collaboration between healthcare service providers and patients and their communities.
  • The healthcare sector is highly interconnected with many other sectors and institutions.
  • Many clinicians want to be involved but may be too overworked to offer optimal contributions.
• Traditional communities have been weakened and destroyed whilst virtual communities are emerging and growing in relevance
  • A bottom-up and middle-out definition of community is required to obtain a  working definition that is meaningful to the people interacting with healthcare services.
  • Communities are important for local and global sharing of knowledge relating to health challenges and related to proactive preventive measures, and available services and treatment options.
• How do people want to use their medical records?
  • How easy is it for an individual to obtain complete access to their medical records?
  • Privacy breaches occur in the physical and in the online world, however the nature of digitised information and the monolithic architectures  of current healthcare data repositories have led to systemic risks that are poorly understood by most individuals and healthcare professionals.
  • Relevant knowledge is not limited to explicit information and medical records, but to a significant extent also includes the tacit knowledge and insights that patients and communities have about themselves and the tacit knowledge that specific healthcare professionals may accumulate over time.
  • Group dynamics come into play.

Some of the open questions will undoubtedly picked up and explored in greater depth in upcoming unconferences.

Towards the end of the day, participants tapped into the results of earlier CIIC events, and explored a set of values that may promote the necessary cultural shift in the healthcare sector and a corresponding shift towards outcome oriented metrics:

1. Zero waste = eliminating ecological externalities => concrete criteria for evaluating potential innovations
2. Minimising social inequality = eliminating social externalities => concrete criteria for evaluating potential innovations
3. Appreciating diversity = playing with variants and learning about variants => potential for innovation
4. Engaging in collaboration = playing and learning with others => potential for scale
5. Honesty = refraining from deceptive manipulation of knowledge and information => high quality input data for further critical analysis and validation
6. Transparent governance = making cultural knowledge accessible for validation => potential for trust and shared understanding
7. Protecting individual privacy = providing individuals with the ability to express themselves selectively => prevention of discrimination and exploitation