Setting the stage for transformation

For reasons we will dive into later, we want to transform healthcare, so we need to form a team or community with the required skills and experience to embrace this topic. We want to get our heads around it.

Looking for digital changes and innovation in healthcare can be a daunting task, let alone a whole digital transformation. It’s a complex world that makes it hard to know where to begin and what to expect during a given time. We must embrace this complex world, whether we are from a medical, social, technical, consulting, or managerial discipline, and seek actionable ways to make the transformation happen.

We have to set the stage for the transformation team or community in which we will be playing our parts: on the supply side for care professionals, teams, and organizations to provision all kinds of healthcare, and on the demand side, the persons receiving treatments for their health and ever-increasing lifestyle improvements, so that they can participate in society.

Exploring this complexity, getting a common understanding across the disciplines, and knowing where to begin and how to proceed is the purpose of Transformation into Sustainable Healthcare (TiSH).

For starters, and because this model will reappear in almost every chapter, we will introduce TiSH as an acronym, name, and model. The acronym is clear, the name is to make it personal and keep everything on a human level, and the model represents a placeholder for complexity, as demonstrated in this first figure:

Figure 1.1 – The TiSH staircase for digital transformation in seven treads

The transformation objects at the foundation are People and Technology. The transformation itself is performed, tread by tread, as follows:

1. Learning digital Skills by individuals
2. Enabling the Capabilities of teams with technology
3. Ensuring enough Capacity for teams and their technology enablers
4. Providing quality data-driven Treatments to patients
5. Resulting in better-observed Health
6. Prevention via a healthier Lifestyle
7. The best outlook to Participate in society’s activities

The lower four treads refer to the care provider’s organization to deliver treatments, and the upper four treads are about the patient and their care network to work on their Health and Lifestyle and be able to Participate.

Note that each of these treads is already happening right now in some form without much technology, standardized work, or processing. In this book, we will discuss how to improve each tread with digital transformation and accelerate the move to the highest tread in a sustainable way. Here, we mean sustainable as in the use of human, technological, and environmental resources.

Our approach is to build the digital transformation, tread by tread, by doing the right things, in the right order, and at the right pace. In other words, the right systematic approach. With this, you can ask questions regarding which tread we stand on today, which treads are our objectives in the short, medium, and long term, and what we have to do to reach the new tread. Each time, a higher tread is built on the lower treads, putting the new tread on top. It’s like building a staircase with pallets as building blocks, as represented in Figure 1.1, or rectangles with rounded upper corners. What these building blocks consist of will be revealed in the coming chapters.

The TiSH staircase forms a frame of mind to model the complexity of the transformation as a scaffold to fit knowledge, such as models and methods, into the transformation. In a way, it’s used to build a model of models for the digital transformation of healthcare.

But first, let’s start with the question of why? Why digital transformation, and why modeling?

Digital transformation is needed because of demographic, medical, technological, and especially digital advancements. We will explain the urgency of it in more detail later, where we will discuss what developments are driving these developments. Common or cross-disciplinary understanding is needed, as was already put forward in 1990 by Peter Senge in The Fifth Discipline. Here, systems thinking is the driving force realized through the shared modeling of complex developments, with a lot of disciplines working together.

In particular, it involves an combined understanding of the pillars of developing technology, business enabling, and providing care – in short, Technology, Enabling, and Care, as demonstrated in Figure 1.2:

Figure 1.2 – Common understanding between technology, enabling, and care

For this understanding, generic and cross-disciplinary models can be used. We have to look for the Goldilocks zone of models for this cross-disciplinary understanding:

• Metaphors are too generic but suit initial recognition
• Single disciplinary models from their respective bodies of knowledge are too specific but are needed to detail and specify solutions
• Just right are generic models with some similarity with specialized models to be used in bridging these specialized models from two or more different disciplines

This book is our contribution to describing this fabric of understanding in such a way that the reader gets a foundation and toolbox for the journey of embracing the complexity of the digital transformation of healthcare. With this contribution, we invite all disciplines to join the transformation and secure enough transformation agents and resources to make it happen on the scale required.

We started our common understanding by using metaphors such as staircases and pallets as building blocks to build a sound foundation. These metaphors are very generic with no further explanation needed. However, having a common understanding is a bit more complex, as demonstrated in the tale of the village of blind people who encounter an elephant and try to describe it. Metaphors can be easily searched on the web. If you want to know more about these metaphors, you can look for them yourself in your further reading. Try searching for the phrase “elephant metaphor.”

Additionally, cross-disciplinary generic models can be found relatively easily on the internet, as they are widely accepted by many disciplines. We will discuss how to apply them to the digital transformation process, referring to other sources for more information and further reading on the model itself or other usages.

Also, we will use some specific models to be able to bind the disciplinary bodies of knowledge. These will be explained in more detail as they form the main threads of reasoning and exploration to design jointly transformational solutions. By combining models, we get new insights to reason about and explore these solutions. Also, it helps to translate from one viewpoint or discipline to another, helping the process of common understanding.

Digital twins

Next to this modeling for common understanding of healthcare, it is useful to build a digital twin, a real-time virtual representation of real-world entities, activities, and processes. We can distinguish three of these digital twins:

• The digital landscape itself
• The medical and social processes
• The avatar of a person

Let’s talk about the avatar, which is a digital representation of the patient. We will follow the avatar as we go through the different stages of transforming healthcare. The avatar will help us in understanding what’s in it for the patient. We cannot predict the future, but we do think that we will have a digital twin of ourselves soon: an avatar that holds all the data about our health (known as a quantified self) and tells our doctors what they need to know, a simulation of a person for clinical diagnostics based on input from, for example, scans, examinations, and medication.

This will help a clinician set precise diagnostics and define precise interventions without heavily impacting the patient. The avatar will help them to stay focused on the patient. And that’s what this book is all about: the patient or, even better, how to prevent an individual from ever becoming one.

With modeling, you can specify and quantify the healthcare in all aspects so that simulations can be designed to explore different scenarios of the transformation. Based on this, better solutions can be made.

We hope these digital twins will create feedback loops to self-direct the actions to the desired state of common understanding, sustainability, and health.