Dr Richard Chivaka

Are synergies between government, the private sector, and industry possible towards delivering value-based healthcare?

In October 2019 Spark Health Africa CEO Dr Richard Chivaka was part of a panel discussion at the Asia Health Conference in New Delhi, India. The theme of the conference was “Serving the World’s Fastest Growing Region Through Healthcare Convergence”. This article summarizes his main points in the discussion. 

The question before us is so relevant given today’s efforts aimed at achieving better health for the majority of our people. It is a question that requires a different mindset among all the parties involved. In my view, it is possible to leverage synergies between governments, the private sector and industry to deliver value-based care. 

However, the point of departure is not the usual top- down approach that results in the parties to the efforts aimed at achieving better healthcare simply copying and pasting their respective ideas and strategies onto what would be considered a response strategy.

Where do we start? Empathy for the patient!

Empathy for the patient, who is a child, a mother, a father, a friend, a member of our community, a citizen of a country should be the starting point.

What is empathy?

The ability to be in someone else’s shoes. The ability to see the world from someone else’s perspective.

Why empathy?

If the potential synergies between governments, private sector and industry are to generate the anticipated value for patients, then the parties have to see the world from the patient’s perspective. Therefore, empathy allows us to understand and share the feelings of others in such a way that we effectively co-develop impactful healthcare solutions that meet the needs of individuals, families and communities.

What is the patient perspective?

Patients are members of our communities who aspire to have a peaceful, healthy and productive social life. As such, their perspective is one where healthcare services enable them to experience a state of “ease” in their social lives. This state of “ease” is seen in their ability to:

  • Spend more quality time with the families and friends
  • Have productive lives
  • Enjoy relationships
  • Live with dignity

The state of “ease” in an individual’s social life is interrupted when one’s body is infected, resulting in a state of “dis-ease”, commonly referred to as a disease. As such, the infected person and his/her family/friends experience the state of “dis-ease” because they are both infected and affected, respectively. Consequently, this leads to the disruption of the infected person’s and the affected people’s social equilibrium. In this case, social equilibrium is seen as the state of “ease”, and conversely, social disequilibrium is a state of “dis-ease”. 

When a person falls sick, that leads to them experiencing social disequilibrium, together with those around them. When this happens, a person counts on other members of society to assist in his/her recovery from this state of dis-ease in order to re-establish equilibrium in his/her social life. That is the real value that patients are looking for when they come to health facilities seeking treatment.

What is the required response by governments, private sector and industry?

If the potential synergies between governments, the private sector and industry are to deliver value- based care, there is a need for the parties to create a common agenda that is informed by the value that patients need. This requires that the parties enter into a SOCIAL COMPACT that is underpinned by a deep sense of empathy for the patient.

[Social compact is an implicit agreement among the members of a society to cooperate for social benefits, for example by sacrificing some individual freedom]

Why social compact?

Synergies require some trade-offs where parties involved voluntarily give up some of their freedoms and privileges for the greater social good. A social compact will therefore assist in regulating the actions and relations of governments, the private sector and industry in order to ensure that they collectively act in a way that will generate and deliver the required value for the patient. Therefore, a patient empathy-driven social compact is the foundation for a resilient framework that will bring to bear the collective competencies, assets and resources of governments, the private sector and industry in generating and delivering value-based care. 

Empathy allows each party to understand the relevant competencies, assets and resources that they should put on the table in this social compact framework. Every party to the social compact stands to benefit from such an arrangement as follows:

Governments

Achieving value-based care means that a country has more productive citizens who experience a state of “ease” in their social life. Every government wants that. It means more tax revenue from productive citizens, less money spent on curative healthcare activities and more money available for other sectors of the economy, improved peace and security for the country, etc. Further, for politicians it means fewer voters are dying!!!

Private Sector/Industry

The private sector gets more productivity out of healthy workers. Industry players can design equipment and technology based on user needs, that is they can adopt a user-centered design model which provides effective healthcare solutions at lower costs. In India, we have heard of technology designs that are generated by laboratories which are not being taken up by industry to the commercial stage. 

These exemplify cases where lack of user-centered design can result in resources being wasted in creating prototypes that don’t get to actually support value-based care. Putting patient empathy first in technology designs therefore creates a sustained market for products and services.

What’s next?

Once a social compact underpinned by a deep sense of empathy for the patient is established, the next level of work should focus on the healthcare system itself. Based on the patient empathy- driven social compact, and the anticipated patient value, the healthcare system should be re- configured, and the health providers supported to start to do things differently.

Meta-level shifts

At a meta level, there is need for a paradigm shift in how the healthcare system is designed and operationalized. First, an acute focus on primary healthcare is imperative. Prevention is better than cure. The patient’s social equilibrium can be maintained with a focus on preventive measures as opposed to curative health services. Primary healthcare requires more investment in the frontline workers if universal health care and its anticipated value is to be realized. 

For example, the Indian government’s decision to provide health insurance through the Ayushman Bharat program to 500 million (about half of the population) that are considered poor, requires a shift away from curative to preventive aspects of the healthcare system. 

Second, the parties to the social compact have to organize themselves in such a way as to leverage the available resources within the country. For example, the use of assets from the various parties to the social compact should be done in such a way that a healthcare system does not have assets that are over-stretched in one part of the country and others that are underutilized elsewhere. 

During the first session today, an idea was floated that perhaps governments and the private sector/industry partners need to regard certain assets within the healthcare system as national assets, regardless of who bought/own them. That’s an example of the trade-offs required in a social compact; being willing to give up on one’s privileges/rights for the greater social good.

Operational level shifts

At the operational level, once the meta-level healthcare design and partner arrangements are sorted, the frontline workers themselves have to change their mindset. This entails changing behavioural and work practices from those that hinder the creation of value for the patient, to ones that create an ecosystem that transforms treatment centers (health facilities) into healing centers. 

Therefore, based on a deep sense of empathy for the patient, frontline workers collectively work to transform their behaviours and practices from:

  • Work groups, to well-functioning teams
  • A passive/reactive conflict-resolution mentality, to an opportunities-for-mutual-growth mindset
  • Assumptions-based decision-making, to data-based decision-making
  • Siloed service delivery approaches, to collaborative practices that offer holistic services
  • Regarding communities as simply beneficiaries of health services, to regarding them as part of the solution to healthcare challenges
  • Looking at a patient from a disease perspective, to regarding them as people who want to re-establish their social equilibrium – a state of ease
  • A deficit mental mode, to an asset-based mental mode
  • Entirely human touch service delivery models, to technology supported human touch service delivery models
  • Regarding hospitals as treatment centers, to seeing them as healing centers. This requires that healthcare providers radiate positive energy throughout the hospital so that when a patient comes into the healthcare system, they enter into a placid environment. The lifestyle of the healthcare providers and the relationships which they have among themselves, are key ingredients in providing the highest level of positive vibration. Poor relations and lifestyles pollute the energy field of the healthcare centers (healing center), resulting in patients failing to get value-based care.
  • An acute focus on clinical indicators of success, to patient-defined social equilibrium indicators of success. This requires that the clinical indicators and metrics of success (e.g. drug regimen adherence rate) ultimately lead to the attainment of social equilibrium indicators of success (e.g. the quality of the patient’s healing journey, more quality time spent with family & friends, etc.).

The mind-set shift among frontline health workers starts with changes to individual and group behaviours, which lead to changes in the way they interact with each other during the course of service delivery. These behavioural changes influence the health delivery practices in a more effective, efficient and sustainable way. 

For example, when a group of workers changes from being a mere work group to a well-functioning team, that changes the way they see each other (empathy) and the way they bring to bear the benefits of collective thought. This in turn creates and supports the opportunities for integrated services, leading to fewer hassles that a patient has to endure in the course of receiving healthcare services. Ultimately, the healing journey of the patient is enhanced, resulting in ease of social life.

Conclusion

In conclusion, if the anticipated benefits of synergies between governments, the private sector and industry in delivering value-based care are to be realized, we need a culture change at both the strategic and operational levels of the healthcare system. In doing this, the centrality of the patient in creating the architecture of the framework (I argue for a social compact) that unites the power of governments, the private sector and industry, cannot be overemphasized. 

Empathy for the patient should be the basis for creating the social compact at the highest level of any healthcare system. Further, at the operational level, again empathy for the patient should inform efforts aimed at the mind-set shift of frontline workers as they work in the context of the social compact, to deliver value-based care. 

Therefore, it is possible to deliver value-based care by leveraging the synergies between governments, the private sector and industry on the condition that there is a culture change in the way the parties come together, leading to the way in which the frontline workers practically deliver health services. 

Our starting point? Empathy for the patient!

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