Over the last year, much has been written about the wave of clinical transformations brought about by industries that are not necessarily in the business of providing health care. The articles speak to a revolution in health care. A Price Waterhouse Cooper (PwC) Health Research Institute (2018) report describes what is happening as a "seismic change." There is not a day that goes by that does not see the introduction of a new digital tool, new company, or new partnership to tackle the health care delivery system. According to Murphy and Jain (2018), "Anyone who has had to wrestle with the frustration of deciphering a hospital bill knows how far healthcare has to go before it reaches the levels of customer experience and user-friendly technology that we have come to expect in other areas of our lives."
DISRUPTORS AND INNOVATION
As I mentioned in my most recent column (Skiba, 2018), several trends point to a revolution in health care. Murphy and Jain (2018) noted five main disruptors (personalized medicine, consumerism, digital revolution, regulatory change, and the Amazon effect) and stated that patients are "among the most important players in healthcare's disruption story[horizontal ellipsis]. After years of contending with limited options regarding where, when, how and from whom they get their care, healthcare consumers now have choices. They can pick among a variety of delivery models, including telemedicine, home health, concierge care and online self-help."
This idea is echoed by Manis (2018), who wrote, "The health care industry is not being disrupted by digital technology[horizontal ellipsis]. [It] is being disrupted by consumer-centric organizations that offer services to meet society's needs and expectations[horizontal ellipsis]health care customers expect much more than access, quality and affordability. They expect an exceptional, retail-like experience: ease of use and immediacy of service - how, when and where it is most convenient for them, not us." Although it is true that many of these consumer-centric organizations use digital technologies, their commitment is to provide exceptional consumer services.
According to the PwC Health Research Institute (2018) report, four archetypes of health care delivery service have emerged: vertical integrators (e.g., CVS and Aetna partnership), employer activists (e.g., Amazon-Berkshire Hathaway-JP Morgan Chase Alliance), technology invaders (e.g., Apple, Google, Uber, and Lyft), and health retailers (e.g., Walmart, CVS Health, Albertson Companies/Rite Aid). Let's explore a few of these disruptions.
In early 2018, Apple, Inc., announced that it would begin to develop its own clinics to care for employees and their families. AC Wellness Network will offer concierge-like health care services and "believes that having trusting, accessible relationships with our patients, enabled by technology, promotes high-quality care and a unique patient experience" (https://www.acwellness.com/about). The AC Wellness Network will also be used to test new digital health care tools built upon the Apple Health Care toolkit platform and using Apple products such as the iPhone, Apple Watch, and iPad.
Another disruptor is the Amazon, Berkshire Hathaway, and JP Morgan Chase venture. According to Tracer and Son (2018), writing in Bloomberg Business, "The initial focus of the new company will be on technology solutions that will provide U.S. employees and their families with simplified, high-quality and transparent health care at a reasonable costs." Their plan is to leverage digital technology solutions and data analytics to provide effective and quality care.
Dr. Atul Gawanda, CEO of the Amazon, Berkshire Hathaway, and JP Morgan Chase venture, offered insights into the partnership at a recent conference of the American Health Insurance Plan. He is quoted as stating (Slabodkin, 2018), "System science and innovation is the next massive, major opportunity to advance human wellbeing in health" and that "patient-reported outcomes are fundamentally important." Gawanda highlighted the necessity of continuously collecting patient-generated health data to examine how patients are doing physically, cognitively, and emotionally in between health care visits, stating that digital health tools "are going to be really crucial to gathering the data" and emphasizing that tools must be easy to use. Describing himself as a strong supporter of low-tech tools such as checklists, Gawanda called for communication tools as well as artificial intelligence to "substitute for parts of that capability." This is particularly true, he stated, if we want to ensure that health care teams and patients are all participants in connected health.
Let's not forget that some health care organizations are also getting into the innovation business, with numerous hospitals opening innovation centers to create, test, and pilot innovations (Becker's Hospital Review, 2017). The University of Colorado Health (UC Health) recently announced it will open an innovation hub located within Catalyst Health-Tech Innovation Center in Denver. According to Dr. Richard Zane, chief innovation officer (Freund, 2018), "Artificial intelligence, big data, decision support, virtual health and wearables are rapidly disrupting health care as we know it. We are committed to being at the forefront of this change and partnering with other innovators to improve the quality, experience and safety of health care while helping control costs." In particular, UCHealth will explore the hospital room of the future, knowing it may well be in a person's home.
A recent forum posting, "The Health Innovation We Need" (Chokshi, 2018), also sparked my interest. As we know, innovation has become a buzzword in health care to describe the use of new technologies for clinicians and patients as well as disruptors such as new health care ventures and the use of augmented intelligence. Stating that some innovations are only small pilot studies or tools that do not fit clinical realities, Chokshi mentions electronic health records and their relationship with clinician burnout, asking "how do we get from flashes of health innovation to a steadier flame?" He believes we need to think less about innovation and more about imagination: "Reimagining how health care is delivered begins with a metamorphosis for primary care."
As noted by PwC Health Research Institute (2018), Jeff Arnold, CEO of Sharecare (https://www.sharecare.com), believes that any company that attempts to make a difference in the health care innovation must be fluent in three languages. "You have to be fluent in healthcare. You have to be fluent in technology, like analytics and artificial intelligence. And you have to be fluent in media, in driving discussions and having dialogues with patients to make them feel a certain way."
HOW SHOULD WE PREPARE OUR DOCTORAL STUDENTS?
So, looking toward the future, will we find nurse leaders spearheading disruptive innovations that transform health care? Will nurse leaders be among those who reimagine nursing care? If so, how should we prepare our doctoral students?
Yes, we prepare PhD students to become research scientists and test hypotheses. We prepare DNPs to be experts in specialized advanced nursing practice and to "focus heavily on practice that is innovative and evidence-based, reflecting the application of credible research findings" (American Association of Colleges of Nursing, 2006). But are we preparing our doctorally prepared nurses to work in innovation centers? Will they be part of the disruption to transform health care to become more consumer-centric? Do they have the skill set to reimagine the nursing care in acute care, primary care, and long-term care?
Do doctoral curricula emphasize concepts like innovation, disruption, systems thinking, human design thinking, Gartner's hype model, the Shark Fin Model (Kalis & Trulsen, n.d.; Oertel, 2015), and being fluent in three languages? Are nurses fluent in data analytics and artificial intelligence? Could our doctorally prepared nurses work with nursing professional organizations to draft a policy statement on augmented intelligence, such as the American Medical Association's (2018) recommendations on augmented intelligence?
Do we provide opportunities for doctoral nurses to foster and become a part of a culture of innovation? Should PhD students connect with an innovation center to conduct their research? Should DNPs do their capstone projects in innovation centers? Do you provide any opportunities to be creative and work with other professionals such as engineers, entrepreneurs, or computer or information scientists?
Just some food for thought as we examine doctoral education in this issue. As always, you can reach me at mailto:[email protected].
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