Navigating Healthcare Redesign: A Journey Towards Autonomy and Well-being

In this blog we will discuss why it is important to redesign healthcare and utilize health- and welfare technology to help people keep their autonomy and enable them to stay at home longer. We recently sat down with Kevin Doughty, visiting Professor of Digital Transformation of Care Services at the University of Cumbria in the UK, and Eetu Koski, CEO of the Evondos Group, who will share their expert views in this blog on the healthcare issues we are facing in the world today.

An aging population that wants to live a meaningful life

The healthcare sector is under immense pressure, people keep getting older worldwide, and chronical diseases are increasing among the population. People are living much longer than they did a few decades ago and the sector is facing complex challenges. The demand for healthcare is increasing and is growing much faster than the expansion of the workforce that is available to facilitate this. For example, in the Netherlands 1 out of 4 professionals will need to work in healthcare by 2040. Particularly in home care and elderly care, which are the fastest growing sectors. This is a very unlikely scenario. Furthermore, the focus from the disease itself must change towards how to lead a meaningful life, even with chronic diseases.

The current structure of the healthcare sector is not sustainable

If we continue to organize healthcare the way we are now, it will not be sustainable for the future or even desirable from the perspective of future clients. Smart healthcare technology, digitization and robotics could become a vital part of the healthcare system. Like medicine dispensers, video calling or remote patient monitoring. Transforming the healthcare sector is not an easy feat. Although we do find that one or more of the mentioned technologies are becoming part of new policies. In the Netherlands, and part of the Nordic countries, the focus is primarily on staff shortages. You could wonder if that is partly due to lack of implementation of healthcare technology. According to numerous scientific studies and practice-based analysis, this technology could solve a significant portion of the staff shortages. This requires strong change management, and professionals being receptive to using healthcare technology. Which is not always the case today.

Kevin, could you tell us more about the current situation in the UK?

Kevin Doughty: ‘’The UK is facing the same problems, with an aging population, a lack of resources for care, plus the shift towards technology and the barriers that lay in the way. The barriers can be cultural, educational or people simply believing they paid enough into the system to have unlimited amounts of support out of the system. Sadly, this is not the case. Nobody could have predicted how much need there is for healthcare. We are looking ahead at how we could provide more support for people who have far greater needs, without having to use the valuable resource of carers. The whole healthcare system is starting to realise we will need to use far more healthcare technology to tackle the needs of clients. Perhaps the issue is identifying all those needs that could be solved using technology. Medication compliance for instance, is very high on the list of needs.’’

What kind of technology is already being used in the UK?

Kevin: ‘’We’re currently transitioning from using community (or social-) lines, an analog technology that is over 50 years old which still works well. Many of the older population couldn’t afford a land line back in the day, nowadays they all can.  A large portion now own a mobile phone, which enables an always on technology, so monitoring can happen remotely, continuously, and virtually. This opens the door for the introduction of much more advanced technologies.’’

How is the (NHS) supporting this?

Kevin: ‘’There is a complex arrangement, which differs amongst the different regions in the UK. Essentially, a large portion of the money lies with the NHS, far more than any local authorities who have local healthcare responsibilities like employment of home carers and monitoring, supplementing, and supervising taking of medication. But it’s very wasteful when a carer travels 40 minutes just to supervise medicine being taken, and it doesn’t coincide with other reasons for visiting patients, like providing food.

The NHS is looking at efficiencies, like simplifying the process of medication. But also making it efficient from the perspective of clients; taking their medication on time, making sure they do not overdose, will they not forget to take their medication at all. The risk of not having a carer physically present is that the adherence to the prescription will go down. It’s probably no better than 50% in most cases.’’

Is there something we at Evondos could offer as a solution for these issues?

Eetu: ‘’Evondos is a medical device company, it all starts from patient safety, the main aspect of our work. We already have some ongoing projects in the UK in collaboration with some of the local universities. If you think of adherence, it has a huge impact, especially in cases of missed medications and hospitalization consequently. One of the questions our founder asked himself was: ‘’How can we enable independent living at home as long as possible? We see our role as a technology partner of care personnel taking care of daily routines and enabling them with more time for clients that need extra care and attention.

Visiting the same patient multiple times per day is a huge challenge for society, with the current available qualified personnel. We approached it in a way that the adherence using our technology is at a much higher percentage than the usual 50%, as clinical studies show an adherence of 99% when using the Evondos automated medicine dispensing system. Our solution is based on real life evidence which is critical for any medical device solution. ‘’

Kevin, is there a focus on people staying at home longer?

‘’Staying at home longer is what most people want if they can. The alternative is moving to a residential or elderly home, which is much more costly for society and people lose a lot of autonomy. Yes, people are safe and secure and there are more staff available to help them whenever they need it. But they don’t get to choose when they leave their homes, at what times they eat, what they eat or who visits them at their home. That’s the key thing about being at home in your own surroundings, there are many people in the UK that have lived in the same home for over fifty years, all their memories are there. Nobody wants to give that up so easily. If people could, they would live longer in their own homes and age well.’’

What must happen or change to achieve this?

Kevin: ‘’That is the million-pound question, they need a new model. It’s about dispersed care, it’s no longer about delivering care to people at home living many kilometers away. It’s about delivering care closer to home. We also need to manage the long-term conditions with medication, there is a need for polypharmacy. And when you think of a condition like diabetes, you need to monitor the long-term effects, you don’t see the difference from day to day. Not until a client has missed a lot of doses of their medication, and the glucose levels get too high. Which results in a client getting the known symptoms, and in the worst cases hospitalization. A late diagnosis can lead to amputations and blindness, all because the original condition couldn’t be managed properly with medication.’’

Eetu, could you please reflect on that, how is Evondos helping nurses to adjust the technology in their work?

Eetu: ‘We are experienced with identifying the needs of daily medication management. Many organisations want to do their own objective studies to see the value of the solution and the actual impact and what it delivers. We have a large body of evidence from municipalities and care organisations that our solution delivers on its promise. It’s freeing up the nurses’ time, improving medicine adherence, and it isn’t hard to implement or get used to working with. We feel we have a big societal promise to keep, with our impact on the nursing personnel and of course on the clients being able to stay in their homes for a longer period of time.

Kevin, are nurses receptive to new technology in the UK?

‘’There is a barrier introducing any new technology. One of the common reactions is ‘’There goes my job’’. The supervision of medication is not usually performed by nurses but by friends, close relatives or home carers who have got lots of other things to do with their time. Additionally, home carers aren’t qualified to tell the difference between two different medications. We are reliant on a workforce that is stressed out, overworked, and probably underpaid as well.

Family members, on the other hand, like the idea of technology because it relieves some of the stress on them.  I think health technology ticks all the right boxes. And once you have empowered healthcare staff to start accepting a certain technology, they will look at other applications and devices as well. Once that happens, I think we will move towards a far better place.’’

What is your personal experience with nurses fearing for their jobs?

Kevin: ‘’I know several nurses who don’t like to pass over responsibility, even though there aren’t enough nurses, and they don’t have enough time. ‘’ 

Eetu ‘’ Usually the first question is, ‘what is going to happen to my job? Because a robot is replacing me’, when in fact the robot or device is making their job easier and assisting instead or replacing them. We had a small pilot in Stockholm with 25 robots for 6 months, the driving time savings were approximately 3000 working hours, and the care time savings close to 6000 hours. When we ended the pilot, the nurses said, ‘We don’t want the devices to be taken away because we feel so relieved.’ 

It takes time to understand what changes within your job when you introduce new technology and the way it is managed. Organisations must be willing to invest time and capacity getting used to it and implement it on a large scale, that’s when you really start to see the benefits.’’

What are some obstacles in the UK?

Kevin: ''Many clients receive a blister of medications for the whole week, but it doesn’t give them a reminder or signal when it’s time to take the medication and it doesn’t give automatic reporting. Which in many cases results in clients forgetting their medication moments and medication being wasted by throwing it away or flushing it down the toilet. It happens. If no one is aware of this, I don’t think the NHS and the country itself can survive in that way.

Of course there are lots of health technologies available. It’s important to aim for high levels of compliance, like the technology that Evondos provides, and choose the best option to introduce to clients. Awareness is the biggest problem around the world, people don’t know what can be done safely, efficiently, and effectively. We need a big awareness program before we can start telling people how to choose the right technology. ‘’

Last question, what are your hopes for the future?

Kevin: ‘’Firstly, I hope we recognise the people who are non-adherent to their medication. I think they would likely be non-adherent to any other types of technology and therapeutic approaches, like apps, we introduce to this group of people as well. By looking closely at people who will benefit the most, I think we will not only save a lot of money trying to fix the issue of non-adherence, but we will overcome many of the obstacles across the widest range of (long-term) conditions. This will be a spur to the whole health technology market and will help lots of people to age well. ‘’ 

Eetu: ‘’We are facing big issues when it comes to the aging population and the healthcare system not being able to facilitate everybody properly.

I hope within 10 years we will live in a world more accepting of technology. So that people can enjoy it in the comfort of their own home for as long as possible. But there is a lot of work to do before we get there. ‘’