Why is trust essential to innovation?

By Pritpal S Tamber

Innovation means change. Doing or achieving something in a new, improved way inevitably means changing what was done before. And yet one of the most often-repeated observations in health care is that “doctors are resistant to change”.

In my TEDMED talk I examined what I believe underlies doctors’ behavior and why I think their so-called resistance is a lazy interpretation of a more complex problem.

In essence, doctors are taught to doubt, as this is what helps them make the right decision for their patients. This same behavior also makes them build mechanisms to ensure that the system they work in is safe and effective. I call these mechanisms the “web of trust”.

Innovations disrupt the web of trust, which causes discomfort for doctors. This manifests as resistance. Innovators need to better understand the role of trust in health care (or why doctors doubt) in order to build trust into their innovations. Few, if any, do, which is why I think most current innovations in health care are bound to fail.

But health care is about more than doctors. The burden of disease is changing from episodic things that were treated in hospital to chronic things that are part of our daily lives. As a result citizens want more understanding and control of their daily health, which is why we’re seeing more and more innovation outside the traditional boundaries of health care institutions.

It would be a mistake, though, to see the citizen space in isolation. Instead, it’s part of a continuum that extends into primary and then specialist care. This means that whatever tools a consumer uses to manage his or her health needs to be trusted by the clinicians that may ultimately be called upon. Without that trust, care will be fragmented and perhaps ineffectual.

Other industries have learnt how to create these new, distributed forms of trust. In the hotel industry, for instance, AirBnB has enabled ordinary people to rent their spare rooms to strangers. Their website is specifically designed to provide the kind of information people look for when deciding whether to trust someone, either as a host or a guest. Although there is a specific technology that has made all this possible (peer-to-peer platforms, often abbreviated to P2P), it’s about more than just technology. It’s about society embracing opportunity made possible by new forms of trust.

With more and more citizens taking charge of their health, traditional health care needs to understand and embrace a new, distributed form of trust. It’s only with such trust in place will radical innovations that tackle today’s seemingly intractable health challenges be possible. Riffing off P2P, I call this new form of trust, “We2C” – how we, the people, can lead and engage clinicians in a productive manner underpinned by trust.

Follow Pritpal S Tamber at @pstamber where he will be further developing We2C.

Pritpal S Tamber is a TEDMED 2013 speaker, its Clinical Editor, a physician, and the founder of Optimizing Clinical Knowledge, a consultancy based in the UK.

The Themes of TEDMED 2013

By Pritpal S. Tamber

Regular readers of my blog will know that this week is TEDMED, the US-based event that looks – with a multidisciplinary lens – at the future of health and medicine. I’m TEDMED’s Clinical Editor, one of the four-person Core Editorial Team that recommends topics and speakers to the Curator, the ever-curious Jay Walker. I thought I’d use my Heathrow-to-Dulles time to reflect on some of the themes of the programme that we’ve put together.

Let’s start with an obvious one: big data. I have bemoaned the overuse of this term in the past but our focus is less on the bombastic (ie poorly thought-through) and more on the societal shifts that will be needed to create truly valuable knowledge. We’re generating data all the time but where is it? How do we get to it? And if we believe that pooling our data can create valuable insights, how do we make that happen? I’m sure that one of our speakers will ask yet again whose data is it anyway, an echo of a thought I heard perhaps a decade ago but was beautifully stated as a civil rights issue at last year’s event.

Power is a theme close to my heart (so much so that I have been convinced to do a talk). The days of monolithic decision-makers presiding over the future are rightly ending thanks to how the Internet has made it possible for more people to see and question information. But it’s not all about the Internet. Communities are self-organising, taking back the right to define their existence, a right (perhaps) unintentionally taken from them by the drive to make life cheaper. One speaker, notably from the commercial sector, will consider the impact of health care’s business model on the desire to do good. There will even be reflections on the assumptions we make when we shape knowledge, given that “knowledge is power”.

As befits an event that hopes to stimulate new thinking (see my previous post to understand TEDMED’s aims), we’ll be inviting the community to consider whether the two-step model of wellness and illness is all there is to it. And while we’re questioning things in two we’ll consider whether it’s really only about care givers and care receivers; is there a third community we’re not seeing?

Seeing, or not, is a theme for a session in which we explore whether how we approach things limits our ability to understand them. We’ll see a new way to image the heart made possible by super-computing. And, less literally, we’ll consider whether there is more to the consultation than just “seeing” a patient. We’ll even ask whether how we see Phase III trials is limiting our ability to unlock the potential of existing treatments.

So much of health care is about communication. I always like to remind people that communication is not what is said but what is received. In health care we’ve known for some time that any meaningful impact on health will come from better societal organisation, but does that really get through to those in charge of organising society, the politicians. We’ll hear from one speaker who heard loud and clear. On a more micro level, one speaker will also ask whether we even know what the language of health care is – quite a fundamental question in an industry with communication at its core.

Technology seems to evolve faster and faster these days and one speaker will describe how they’re imaging the future while they’re still dreaming up the tools to create it – and how they’ve secured some pretty serious funding and endorsement to go on that journey. Another will ask the community whether it really makes sense for the medical profession to try to define the future of health care when it’s really not shaped to cope with onslaught of change. And staying with “coping” one speaker will ask whether the profession is coping at all, or whether it’s time to look in the mirror and have a rethink.

Most of these issues are huge. Many would be the subjects of weeklong conferences. At TEDMED, we intentionally set out to give the community a “TED ache”, to make their heads hurt with so many great topics and insights. The aim is to get a conversation going, to stimulate creativity, to seed new and unexpected collaborations.

As I said when I first joined TEDMED, “I hope that we’ll catalyse courageous reinvention, big ideas, and new thinking”. And I hope that you enjoy the fruits of our labour, whether you’re at the event, at one of the simulcast locations in 80 countries, or watching after the event online. We look forward to getting your feedback.

And so, without further ado, it’s time for TEDMED…

Pritpal Tamber is TEDMED’s Consulting Clinical Editor and a TEDMED 2013 speaker. This post also appears on his blog at www.optimisingclinicalknowledge.com.