The excellent article by M. Iacucci and colleagues “Endoscopy in inflammatory bowel disease during COVID-19 pandemic and post-pandemic period” in The Lancet Gastroenterology, highlights the importance of developing strategies for the post-COVID-19 healthcare ecosystem. Although the article focuses on the particular clinical scenario (Inflammatory Bowel Disease), it provides a lot of food for thought about designing, prototyping and scaling-up approaches fit for the new set of realities.
The pandemic is a wicked strategic problem. As H. Rittel and M. Webber described in their 1973 Policy Sciences article, wicked problems are different because the current processes cannot resolve them. Designing healthcare to address the #Covid19 pandemic and its aftermath fits in this category. There are many interdependent, changing, and ambiguous variables within and beyond the healthcare sector. Therefore, there are no off-shelf solutions to mitigate the demand on clinical services or to address yet unforeseen and far-reaching consequences of the pandemic and its socio-economic sequellae on the health of the population.
In one of the previous posts, I have emphasised that #pathology and #laboratorymedicine industry and profession needs to redefine its role in the #healthcare ecosystem. To highlight the paradigm shift required, taking into account the evolution of the medical laboratory systems in the United Kingdom, I have introduced the term Pathology3.0. The argument behind Pathology 3.0 is that the profession should migrate from its traditional, transactional business model based on the volume and quality of analytics. It should move away from the constraints of the current penny-wise, pound-fullish, insulated cost-center-based financial model. Finally, it should proactively endorse the forthcoming drive for vertical and horizontal integration of health and care. #Pathology30 is about delivering high-quality, innovative #laboratorymedicine solutions and adding-value to clinical operations of our service users and improving the lives of our patients. Also, I have learned that a similar vision for our industry, branded as Clinical Lab 2.0, is being discussed on the other side of the Atlantic.
The #COVID19 pandemic gives us both reason and opportunity to accelerate this transformation. I believe that there will be numerous opportunities, especially if we look into addressing issues across the clinical pathways, boundaries of individual organizations and segments of care. But #pathologists and #laboratory professionals will need to start asking the right questions, without fear of upsetting the applecart. Also, we will need to endorse and rely on service improvement methods based on the iterative approach and active experimentation and start feeling more comfortable in volatile and uncertain environments. This will be the topic of the forthcoming series of articles.
At the most immediate aspect, as illustrated in the figure
from the paper by M. Iacucci and colleagues, ubiquitous #testing will become a new norm, and this can be extrapolated for other clinical interactions. But the key question is that of operationalization: how shall we do it at scale, on time, causing least distress to the patients and clinical users, equitably and with the minimal financial footprint? Shall we do it in large testing hubs, near-patient/near-clinician or combination of both? Shall we introduce innovative sampling methods and bring sampling closer to patients’ homes?
Can we be even more ambitious? Can we leverage #pathology and #laboratorymedicine as well as #telemedicine and #AI to redesign outpatient pathways and follow-up of chronic conditions and help to deliver care closer to home and more safely and conveniently? As Michelangelo said: “…the greatest danger for most of us is not that our aim is too high and we miss it, but that it is too low and we reach it.”