Our life is by nature filled with emergencies and unforeseen events that require immediate attention. We are at the heart of a revolution that is changing the way we live and work, including how we think about and operate emergency care. This revolution is transforming treatment and diagnostics, the relationship between health professionals and patients and is altering the setup and management of health systems. At the heart of this massive shift are the fourth industrial revolution and the project economy, respectively addressing the “what” and the “how” of reimagining emergency care.
The fourth industrial revolution is a range of new technologies that fuse the physical, digital and biological worlds, while the project economy, a term coined by Dr. Antonio Nieto-Rodriguez, a world-leading expert in project management, refers to the paradigm shift where projects are displacing and replacing operations as the economic powerhouse of our time.
At a time of exponential advances in AI, robotics and big data, projects involving the changing of organisations are disrupting operations that traditionally involve the running of organisations. Projects are increasingly at the heart of organisational transformation, faster product and solutions development, and agile technological adoption. Unfortunately, in many countries, healthcare systems in general and emergency care suffer from strict demarcation lines of responsibilities, institutionalised limits on care provision and silo mentality. This is a well-known problem as emergency care provision is multi-disciplinary, hence in need of breaking up the silos and building collaboration to address patient needs.
The silo/collaboration dichotomy is mainly the result of historical developments and focus on running emergency care organisations rather than also changing them. If running is the lifeline of emergency care but change is critical to take advantage of the opportunities of the fourth industrial revolution, how can we combine the two in the services of emergency care? Welcome to the project economy.
Medicine, as a professional domain, dates back to the early 19th century. Emergency care traces back to the French Revolution (1789–1799), however, it developed in its current form only in the 1960s, making it the most recently developed field in medicine. Before the 1960s, staff in emergency care hospitals usually worked in rotation with family doctors, physicians, general surgeons, and other specialists.
At its core, emergency care involves the rapid assessment, treatment, and triage of critically ill patients (hence the focus on the running of emergency organisations). With ongoing medical system reforms around the world and the implementation of hierarchical diagnostic and treatment systems, emergency care is busy with operating its function and naturally struggles with changing the organisation.
The Covid pandemic showed that it is necessary to move the front of first aid forward, conduct multi-disciplinary cooperation, provide treatment to all types of critically ill patients, handle public health emergencies, and foster hierarchical diagnosis and treatment. In many cases, the timely, orderly and efficient application of the latest technologies to the early treatment of critically ill patients matters most.
Against this backdrop, what are the opportunities to re-imagine emergency care? We divide them into four broad categories:
Inefficiencies and process optimisation
The first opportunity is eliminating inefficiencies (i.e., crowding), process optimisation and early treatment to elevate the organisational and individual capacity for early identification, appropriate treatment, and life support. Here the competencies and leadership skills of emergency medical professionals are vital: it is critical to nurture the capacity for rapid response, effectiveness, and service attitude, and equip medical professionals with the necessary leadership skills regardless of job roles and titles.
Managing emotions and inter-departmental logistics, delegation and practice efficiency, when and how to say ‘no’ to a patient, managing difficult patients, establishing boundaries, shaping patient satisfaction, effective and when necessary incisive communication with staff and patients are much-needed leadership skills in emergency care.
Seamless data flow
Reimagining emergency care needs technology, particularly big data and the Internet of Things (IoT). IoT adoption is critical, as the need for timely diagnosis and treatment of patients continues to grow. IoT is a system of interrelated computing devices, mechanical and digital machines, objects, animals or people that are provided with unique identifiers and the ability to transfer data over a network without requiring human or human-to-computer interaction. In IoT a “thing” can be a patient with a heart monitor implant, an ambulance with built-in sensors to alert the hospital, or any other object that can be assigned an internet protocol address and can transfer data over a network.
Technology can help tap available resources and collect information on patients, helping emergency staff in real-time. If no specialists or general practitioners are on site, a patient’s critical information can be wirelessly transmitted to experts delivering remote guidance that may be critical to saving lives. Remote monitoring also enables hospitals to grasp patients’ condition at the earliest, create emergency plans in advance, allowing a seamless connection between out-of-hospital emergency and in-hospital treatment. In addition, the collection, processing, storage, and sharing of out-of-hospital emergency data can elevate treatment efficiency and service excellence.
Data and Decisions
Big data can fully analyse and develop insights into medical information to support decision-making. One important application is cloud technology for emergency and critical care information management. A cloud platform can collect diagnostic, examination, and treatment-related patient data from databases (i.e., emergency logbooks, picture archives, hospital information and communication system, microbial detection and management systems, or a pathology information system).
The data can then be cleaned, classified, extracted, and investigated using the platform and can serve as the basis for a teaching management system, including a multidisciplinary triage management system, a critical care score and grading management system, and an early warning system for emergencies. This can greatly improve teaching efficiency and the ability to diagnose and treat. As we know, insights are a beautiful thing but need to be used by emergency care personnel well equipped to make a wide range of decisions, from daily running of the organisation to decisions involving the changing of the organisation, and what or how it operates, such as the decision to equip the emergency care entity with data-driven decision-making capabilities in the first place.
Precision Emergency Medicine
Precision medicine is an emerging approach to treatment and prevention. It considers individual variability in genes, environment, and lifestyle. It is intended to enable doctors and researchers to predict more accurately treatment and prevention strategies for a particular disease for different groups of people, as opposed to the average person.
Emergency care represents the first critical link in the diagnosis-treatment of critical illnesses and infectious diseases, and individualised, accurate assessment and prevention of disease susceptibility requires fourth industrial revolution technology adoption. Acute infectious diseases are most common in emergency care, but due to their complexity, require timely detection technology, and multidimensional clinical information integration technology to diagnose and treat.
The above are only some examples of how technology can enable growth in emergency care. AI is crucial to develop capabilities in prediction, analysis, and response. When AI engines and applications execute instructions, they can learn from big data through image/speech recognition, human-to-computer interaction and physical sensing. AI can also assist to anticipate potential risks and threats, assess the situation and predict the required medical services.
What is now required in emergency care (as well as in many other fields) is the human willingness and ability to be “organisationally and mentally ambidextrous” as opposed to “structurally ambidextrous” (i.e, separate structures for different types of activities). Organisational ambidexterity means being able to run current capabilities (operations) while exploring the new ideas (change via projects) while mental ambidexterity allows emergency care personnel to make daily choices between normal operations and adaptation-oriented activities (change) in the context of their day-to-day work. Changing the organisation includes innovation, transformation, agility and value creation in the long term.
Emergency care operates in disruptive change, hence driving this change is paramount. In the project economy, projects are the means to explore new ground and new competencies, focus on medium to long term, deliver strategic objectives and operate in entrepreneurial ways based on collaboration, not silos to change and transform emergency care. Striking the right balance between running operations and change is key.
Tools such as the Project Canvas can guide professionals in each stage of a project, before, during and after its launch. It is a one-page strategic template inspired by the work of Alex Osterwalder and Yves Pigneur for the business model canvas and is based on any project’s purpose, people and the creation of value.
We are at the dawn of reimagining emergency care, placing emphasis on expertise rather than location, and adopting technology to elevate human life and expand our capabilities. The health sector is among the most exposed to technological evolution and the magic word in maximising the benefits of tech innovation in emergency care is “change”. Welcome to reimagining emergency care: from idea to run.
Dr. Selina Neri is the Professor of Leadership and Corporate Governance at Hult Ashridge.
This article appears in the Daily Dose 2023. Read the full issue online today.
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