Thursday, June 27, 2024
“We should not downscale healthcare from A+ to a B, but adjust it from A+ to another A+," said prof. dr. Jan Kemer during the Medical Delta Café on Tuesday, June 25th. Four professors reflected from their own expertise and perspective on how the future of healthcare should be organized: sustainable, affordable and green.
The Medical Delta Café 'More with Less: Where innovations help implement sustainable healthcare' immediately followed the Round Table meeting of the Sustainable Healthcare Thesis Lab of LDE Center for Sustainability and Medical Delta. A short report on this event can be found here. The Pattern Book with the results can be downloaded here.
Special envoy 'Appropriate Care' prof.dr. Jan Kremer (Radboudumc) kicked off the café with a presentation on appropriate care. Kremer stated that there have never been as many healthcare workers as there are today. “Instead of talking about the staff shortage in healthcare, you can also ask the question: are our expectations too high? The system is now designed in such a way that it mainly leads to providing even more care. Appropriate care can be part of the answer to the challenges of an aging population: appropriate to people's life stage, with less focus on rewarding the amount of care provided.”
Jam with each other - like a jazz band does.There are many local and regional examples that show that a future-proof healthcare system is possible when we work together - including healthcare professionals, government and citizens, Kremer discussed. “My advice is: stop making big plans and start working together. Reflect and learn. We do not need conductors, we should seek balance. Listen to each other, respond to each other, in short: jam with each other - like a jazz band does.”
Unnecessary eardrum tubes
Placing eardrum tubes has no proven benefit. Yet it is still done every day by hospitals. “Why?”, Prof. Dr. Maroeska Rovers (Radboudumc) wondered at the beginning of her research career. This question also arose when she later worked in the hospital and regularly witnessed new innovative tools appearing, without any immediate use or need for them, including expensive and polluting surgical robots. “Therefore, start with the end users: healthcare professionals and patients. What is their need? Do they see the added value and need?”
Rovers sees an increasing 'medicalization'. “We are pulling everything into healthcare. The same thing happens with technology. A lot of technology and innovation is added to healthcare, ‘on top of’ and not 'instead of'.
At the same time, essential discussions remain beneath the surface, she shared with the audience. “We are still talking about exceptional cases such as mad cow disease. While there is no long-term ethical discussion on the enormous health risks of climate change and the polluting effects of healthcare.” According to Rovers, that is also why we should say 'no, unless' more often instead of automatically saying 'yes'.”
Behavior change
As a surgeon, Prof. Dr. Nicole Bouvy (Maastricht UMC+) noticed that many colleagues are operating too much. “There are perverse incentives in the system to place those eardrum tubes mentioned earlier. But what I have discovered above all is that it is about behaviour.” Bouvy mentioned appendectomy as an example. “Whereas a lot of material was reused twenty years ago, it is now thrown away. In Bosnia they still work like we did back then, and the same operation produces 200 grams of waste there, while in the Netherlands it is 7 kilos of waste.”
In Bosnia, the same operation produces 200 grams of waste, while in the Netherlands it is 7 kilos.The most sustainable operation is an unnecessary operation that is not performed. Bouvy therefore advocates better patient selection. “During an analysis of sustainability aspects of gallbladder operations, we discovered that an operation has no effect for 20 to 25% of patients or can even negatively affect their health, for example due to complications. As surgeons we can select patients that will benefit from surgery more accurately, supported with AI.”
As another example, she discussed the fear of infections due to dirty air particles in an operating room. “There is more air circulation in an operating room than in a cleanroom of ASML. While the risk of infections via air flows is minimal. We need to think about how we make that kind of awareness common. Behavioural change is the key to more sustainable healthcare.”
Ethics and philosophy as part of the solution
Medical ethicist Prof. Dr. Martine de Vries (LUMC) reflected on the ethical issues raised by the speakers. “Far-reaching medicalization and technology as a solution for everything: we go along with it, without asking essential, ethical-philosophical questions such as: 'what is the goal of our healthcare?'.”
According to De Vries, it requires a different way of thinking: a paradigm shift. This also concerns the usefulness of unbridled technological developments in healthcare. “What value does technology add, and what do we lose with it? Make ethical, philosophical and social aspects part of healthcare innovation from the start.”
“As scientists, we always rely on cognitive aspects, while more is needed to convince people,” Kremer said during the closing discussion. We have to look for what motivates people to think and act differently and also respond to emotions, was the general consensus among speakers and audience.
Accept that life is finite.
Behavioral issues are also about acceptance, Kremer said. “Life is finite, we cannot always make everyone better and we should wonder if we want that at every stage of life. Appropriate care also means talking about what people want and can do.”
This also applies to the title of the Medical Delta Café, De Vries concluded. “I dare to attack the title 'More with Less'. Because we don't need 'more' at all. In the end it comes down to: what do we really need.”
Please visit our guides for making healthcare more sustainable (Dutch).
Overhandiging Pattern Book
De deelnemende masterstudenten aan de 'Sustainable Healthcare Thesis Lab'
Foto's: Eelkje Colmjon
