In part 1, we looked at how having ‘top-down’ thinking means that golden opportunities to transform ‘disease-care’ into healthcare are being missed. Now, we will be looking in some example at how ‘bottom-up’ thinking and ‘thinking local and acting globally’ works in practice.
The UMMC Telehealth Network
Rather than transporting patients from rural ‘critical access hospitals’ to UMMC, the clinical director of nursing at University of Mississippi Medical Centre (UMMC), Kristi Henderson, devised a solution whereby UMMC’s medical expertise could be shared with the critical access hospitals through the use of a telehealth system. This would reduce patient transfers and make it possible to treat more people in local hospitals, where costs were significantly lower than at UMMC.
The pilot study worked exceptionally well, and over the following decade, the program expanded until it was operating throughout the state. Henderson didn’t stop there, though. Today, Iora Health provides multiple specialty services at over two hundred hospitals, service centres, schools, and prisons throughout Mississippi.
Ten years into the project, patient satisfaction stood at 93.4%, and local hospital administrator satisfaction at 87.5%. Over seven years, Iora Health improved its patients’ overall health, reduced hospitalisations by 35% to 40%, and lowered total health care costs by 15% to 20%.
Mighty Oaks From Little Acorns Grow
When it comes to intrapreneurship in healthcare, the impact of ‘thinking local and acting global’ mindset has been proven to be truly game-changing. In 2015, Kristi Henderson was invited to testify before two US Senate committees as to how the Iora Health model could be replicated across the country. This thinking does not, of course, only apply to the US. A similar study in Australia mirrors both the problems and the outcomes.
Home Monitoring of Chronic Conditions
CSIRO wanted to explore whether telehealth could be used to home-monitor aged care patients with chronic diseases, to reduce the load on the health system, improve health outcomes and reduce costs. Funded jointly by the Australian Government Telehealth Pilots Program and CSIRO, the company delivered a clinical trial across five states, with a total of 287 participants. Patients received telehealth and vital signs devices that monitored their conditions for twelve months. Health workers were able to assess changes in their patients’ health remotely, which allowed for early intervention and increased self-management of the patients’ conditions. This had the effect of reducing hospital stays and improving quality of life.
The trial showed savings of 24% to the healthcare system through a reduction in frequency and cost of GP and specialist visits, as well as a reduction in the number of procedures. There was also a 53% decrease in hospital admissions and a 76% reduction in length of stay. With an estimated daily cost of $2,051 per hospital bed, this saving, in particular, is significant. Patients also reported a reduction in anxiety and depression and a greater understanding of their conditions. This is reflected in the >40% reduction in the mortality rate of patients participating in the trial.
As we can see from both of these studies, global thinking is there right from the outset. Those who create successful initiatives are ambitious and forward-looking. They recognise the need to generate profits and reduce costs, as well as to improve patient care. Increased recognition from the top of healthcare organisations of the innovations that spring up from the ground-level is the change that is needed to create an environment in which the improvements and cost savings would genuinely be able to transform the current crumbling system into one that saves millions – of lives and dollars.