The five essential elements of healthcare transformation
Cancer care needs an overhaul. Here are five ways to do it
The challenges facing healthcare today could demand a comprehensive rethink of how cancer care systems are organised and operate. That is the view of many who work in the field, including Rifat Atun, Professor of Global Health Systems at Harvard University, who suggests this rethink should consist of five elements.
1. Move from intention to action
“We talk a lot about what needs to be done,” Professor Atun says. But ambitious words fail to translate into action. Instead, we need a mindset of learning and experimentation.
“There are no off-the-shelf solutions, because the societies we have today are very different to societies of the past,” he says. Policymakers and providers need to try new ways of doing things. “We need to implement, learn, modify and continue to improve.”
2. Take an integrated approach
Professor Atun says that policymakers need to think about the whole system of care, because any system is only as good as its weakest link. So tackling cancer needs effective action at every point on the care continuum – from comprehensive screening to early diagnosis and fast referral. This should be followed by effective treatment, both in hospitals and through an increased role for primary care. And then to follow-up care with regular check-ups to actively monitor for potential re-emergence. Palliative care is an integral part of the care continuum for those who need it, and also essential for people whose cancer is terminal, in order to give them dignity and manage their suffering.
3. Create inclusive partnerships
The third element is the need to foster inclusive partnerships for what Professor Atun describes as a “whole of society” approach to cancer. “We have to bring together public- and private-sector actors, not-for-profit foundations and civil society and patients’ groups to think through the issues collectively and co-design solutions in a way that capitalises on each group’s capabilities.”
4. Invest wisely
The fourth plank is to promote investment in health. There are immense pressures on healthcare finances, and cancer costs are rising. Professor Atun highlights the mismatch between current funding and the burden of cancer. It is, in part, he says, the result of a failure to keep pace with the demographic transition under way in many nations as populations age and the epidemiological transition that accompanies the rising burden of chronic disease and cancer. Innovative new diagnostics and treatments also offer huge benefits for patient outcomes, but these can be expensive.
The key, argues Professor Atun, is to stop thinking about health spend as a cost and see it instead as an investment – especially when it comes to high-value preventative measures and early intervention. “It is one of the best investments you can make,” he says. This is an investment that promotes human health, reduces expenditure on costly late-stage treatments, boosts economic productivity by supporting labour-market participation, and also offers opportunities for new jobs in healthcare.
5. Innovate at scale
The fifth element of reform is to spread innovation at scale. Providing equitable access to existing solutions is a huge challenge globally, with significant inequalities both between and within countries. So, we need a completely new approach to the design and delivery of care.
“The institutional logic needs to change,” says Atun. “We are stuck in the past. There needs to be a new way of thinking in how we approach problems and design solutions rather than more of the same, which clearly is not delivering results.”
That should involve a different role for private-sector partners – including pharmaceutical companies. “I see it as the transition from producing medicines, which is very important of course, to also being a partner in changing the systems through which those medicines are delivered,” says Professor Atun. “We have lots of delivery of innovations, but not enough innovation in delivery.”
The challenge facing cancer care systems is substantial, but it is not insurmountable. “Clearly, business as usual will not work,” Professor Atun concludes. “We need to take a step back, reflect, and really think about innovation through partnerships. That’s going to be key.”