The case for a radical innovation fund in healthcare

As our healthcare system spirals ever deeper into crisis, nobody seems to have any answers. Yet many people - who are courageous enough to challenge the status quo - know of powerful solutions that are sadly impossible to implement. Why is it so hard to change the system and what is the solution??

I illustrate the problem with three case studies, in the fields of patient safety, compassionate care, and holistic approaches to healing. All three cases offer dramatic improvement in patient outcomes, major cost-savings, and more satisfying work for health professionals. All have been resisted by the ‘system’. In order to make progress, we need to understand what the system is and how to create the conditions to bypass these limitations. That is why I am proposing a radical health innovation fund.

Case1: Patient safety

The famous Harvard Medical Practice Study (1991) into healthcare error, showing that more than one-in-ten patients are accidentally harmed in the course of care designed to help them, was subsequently replicated in New Zealand. 12.5% of patients admitted to NZ hospitals were harmed in the course of their care, either before or during the hospital admission. Roughly one third of the errors were highly preventable, a third moderately preventable, and one third non preventable.

The ‘Cost of medical injury in New Zealand: a retrospective cohort study’ in 2002, examining records from 13 public hospitals (J Health Serv Res Policy.?2002 Jul:7 Suppl 1:S29-34). They report,

“850 adverse events were identified in the NZQHS which cost an average of $NZ 10,264 per patient. For New Zealand, adverse events are estimated to cost the medical system $NZ 870 million, of which $NZ 590 million went toward treating preventable adverse events. The results suggest that up to 30% of public hospital expenditure goes toward treating an adverse event.”

The ‘Medication-related patient harm in New Zealand hospitals’ study in 2017 showed that “28% of patients were harmed by medication errors” either during the hospital stay (65%), or in errors causing the admission to hospital (NZMJ 11 August 2017, Vol 130 No 1460).

In 2006 I was a member of the national Quality Improvement Committee and also the NZ representative on the World Health Organization Patient Safety Solutions Committee. I was the co-author of a report to the Minister of Health setting out a business case for investment in electronic drug prescribing and dispensing in hospital, to replace the paper drug charts and manual drug handling.

Our research predicted that we could save 200 lives per year (which compares with the 300 lives lost each year in road accidents). We identified off-the-shelf systems for electronic prescribing and dispensing and these technologies were proven in hospital-wide pilot trials (also making life easier for health professionals). The business case relied on the huge cost-savings from automating drug stock control, where the existing manual systems allowed many drugs to go out of date, missing or stolen. The potential cost-savings in patient care were huge, considering the data above, but the business case did not rely on predicted improvements in patient care.

Nearly twenty years on, we are still using handwritten drug prescriptions in almost all public hospitals and there are huge numbers of preventable errors. They include prescription errors: wrong drug, wrong dose, wrong route, forgotten allergy; and huge numbers of administration errors: wrong patient, wrong drug, wrong dose, wrong time, wrong route.

Why does this scandalous situation persist? Would we board a plane knowing that 28% of passengers will be injured on each flight? I could make the same case about the failure to implement many other proven patient safety solutions.

I have eventually concluded that the problem is the fragmented nature of hospital management and the focus on short-term budget issues rather than long-term system function. Patient safety solutions require investment in technology and training. While the costs may fall within the budget of one general manager (IT), the eventual cost-savings accrue invisibly in the budget of another general manager (clinical services) in reduced bed days and costs per patient.

In order to solve this problem, we need system-based leadership and accountability over longer time frames, both of which are missing in our current management systems and and extreme budget restraints. It should be noted that doctors are equally guilty of fragmented management of patients, divided as they are into many independent medical specialties.

Case 2: Compassionate care

While the inclusion of compassionate care in my arguments might seem odd, the research is compelling. Compassionate care can significantly enhance patient outcomes, reduce patient demand, dramatically reduce costs, and give greater meaning and satisfaction to the work of health professionals.

I was an international campaigner for compassionate care for more than a decade, visiting many countries and cultures. I uncovered research that showed that patient treated with compassion have less pain, heal surgical wounds more quickly, have better functional recovery after trauma surgery, recover more quickly from infections, live longer in the presence of terminal illness (with better quality of life), and that diabetics treated with compassion had 42% fewer hospital admission - among many other studies. Compassionate care also saves time.

Bertakis in the USA (J Am Board Fam Med 2011;24:229–239) in 2011 studied the extent to which individual patients in primary care received compassion, patient-centred care.?

He divided the group into two equal sized populations who received more than, or less than, the median level of patient-centred care. Using insurance company data, he then measured the annual expenditure in healthcare for each patient, including both primary care and hospital care. Those patients who received less than the median amount of patient-centred care in primary care had total annual health expenditure 50% higher than those who received above-median patient-centred care.

I published all my findings in my book, ‘Time to Care’ in 2012, which launched our international movement, “Hearts in Healthcare”, and was translated into several languages. Subsequently, a professor of medicine in the USA, Stephen Trzeciak, hit the headlines with his book ‘Compassionomics’ quoting all the same studies.

I have been invited by the executive teams of more than half of the district health boards in NZ to make presentations and run workshops with staff, all of which was received enthusiastically. Yet, not one single health board has a sustained program of compassionate care despite the compelling evidence that it could save money, achieve better patient outcomes, and prevent burnout in many health professional. The same is true in many public health boards and corporations that I consulted, in different countries.

Compassionate healthcare should spread like wildfire. The desire to care is the motivation that brought most of us into healthcare. So why is it not adopted? The medical culture is deeply immersed in materialistic science that ignores the fact that patient are conscious beings. Doctors are taught to be ‘clinically detached’ and to promote technical excellence above human skills. Manager prioritise production, efficiency and hurried care. Few managers have the leadership skills or courage to tackle the bullying and burnout that is endemic in healthcare. Health professionals are overworked and stressed and feel as if they don’t have time to care.

What is the solution? Changing the management priorities and finding courageous leaders who are willing to role-model compassionate action. If we gave equal value to caring and connection as we did to technical skills, then we would have very different leadership priorities. Bullying must be eliminated; that means sacking senior members of staff who cannot improve their behaviour, even with support, becuase they do incalculable harm. Senior leaders must role-model compassion and caring.

Waitakere Hospital in west Auckland was becoming an international centre for compassionate healthcare and achieved radical culture change in a short time through the determined leadership of both managers and clinical leaders. This just and caring culture also allowed major innovations in patient safety, including becoming pioneers in open disclosure and apology after accidental patient harm.

However, such centres of innovation are highly vulnerable unless protected. A new CEO at the health board removed all of the inspirational leaders at Waitakere Hospital in the name of ‘efficiency’ by merging the management with a larger hospital. The hospital foundation, which had funded compassionate care projects, collapsed and our dreams were gone. Th positive culture remained for a long time but gradually eroded.

Case 3. Mind-body care

In 2020 I quit my long career in anaesthesia to become a trauma therapist using the breakthrough Havening Techniques?. Havening is based on a detailed scientific theory about how trauma is stored in the brain and the details of a molecular reaction which can erase trauma within minutes, triggered by specific forms of soothing touch (Harnessing Electroceuticals to Treat Disorders Arising From Traumatic Stress: Theoretical Considerations Using A Psychosensory Model. Explore. Volume 15, Issue 3,?May–June 2019, Pages 222-229).?

The theory includes all of the physiological pathways, neural connection, anatomical locations, neurotransmitters, receptors and intracellular mechanisms. The detailed theory gives us precise diagnostic tools and the ability to track rapid changes in the client’s physiology and stress reactions. This has become my full-time work.

Havening allows us to erase major trauma in a single session of therapy. For instance, a client who was violently raped might have suffered ten years of chronic anxiety, depression, social phobia, fear of men, and damaged self-worth. All these effects can be completely erased in single session of therapy (as attested by many counsellors, psychologists and doctors who have become my clients).

Trauma is the leading cause of chronic anxiety, depression, phobias, panic disorders, PTSD, and addictions. All are potentially curable and I have witnessed hundreds of clients transform their lives. Two randomised trials have demonstrated large effect sizes with a single session of Havening, including a large reduction in cortisol (a stress hormone).

When we encode a traumatic event, we also encode many physical symptoms when can then become chronic, even though the physical cause of the illness is healed. I have seen many clients recover from chronic pain, weakness, disability, cognitive impairment, seizures, irritable bowel syndrome and a host of other ‘functional’ illnesses. All these changes are predicted by the scientific theory.

I have treated many clients who were on chronic disability payments or undergoing prolonged rehabilitation (under ACC) who have made rapid recovery. They have all had to pay for my private care because ACC will not fund my work. Havening has the potential to save ACC hundreds of millions of dollars a year because every ACC client, by definition, is traumatised.

One client with Type 2 Diabetes reduced her longterm blood glucose (HbA1c) by 40% with no change in diet or medication - to the astonishment of the diabetic clinic. Her major traumas were released in three sessions of Havening and as a result, her cortisol levels fell. The results are predictable; the first job of cortisol is to instruct the liver to release glucose into the blood stream. Imagine if we replicated this result in other diabetic patients?

I put together a research team including two doctors, an ACC accredited psychologist and an ACC counsellor and applied to the ACC Innovation Fund. We were turned down. The ‘experts’ on the innovation panel are not willing to believe in a treatment that is so different from conventional medical treatment.

How do we get ourselves out of this mess?

I have presented three innovations that could save billions of healthcare dollars and improve outcomes. But the ‘system’ resists all of them. We cannot make progress unless we fund radical innovation and create protected spaces for trials of whole-system change.

The necessary conditions for real change are:

• An independent radical innovation fund
• Decisions of funding made by a panel of lay people and scientists, which excludes the usual ‘medical experts’ (who will suppress real innovation)
• The measurement of whole-system outcomes (not individual disease outcomes)
• Trials that enable innovative funding models in primary care - such as long patients appointments with GP’s, and funding of novel interventions such as Havening
• Trials that involve radical innovation in hospital management supporting whole-system improvements and longer-term outcomes, such as investment in compassionate care, health professional wellbeing, and patient safety
• A fully funded, independent journal of health innovation where peer reviewers are scientists who are independent of pharmaceutical corporations, medical group-think and vested interests

Thus we could image a whole-system trial in primary care where patients from a population are randomly assigned to their usual GP or an innovative primary care centre employing mind-body approaches. We could measure health outcomes, hospital admissions, and costs of care.

We could imagine a public hospital where the leadership is replaced with those who understand whole systems, culture change, and create accountability for whole-system outcomes, not the budget of individual divisions. They can trial whole-system approaches to compassionate care, health professional wellbeing, and patient safety. Their productivity, clinical costs, patient outcomes, staffing costs, and wellbeing measures could be compared with a similar size hospital with an equivalent demographic

It’s estimated that our last major structural health reform cost us $500million plus the loss of institutional knowledge and personal relationships that foster effective organisations. It’s tragic that this money was spent with no apparent benefit, leaving our healthcare system in an ever-more parlous state.

What we need is reform in the care itself, not the structure of care. Nothing will change until we create the conditions for radical innovation.