The Collective Roundtable: Talking Health

MATTHEW  My background is in design and for the past five years, I have been part of the global team leading IDEO’s health portfolio. The majority of my work is focused on the systems, organizations, and experiences that enable patient care. 

IDEO’s health portfolio spans the full care continuum, from last-mile care—healthcare services and experiences in traditional clinical settings—to first-mile health, which designs for the non-clinical factors that enable healthier, more equitable futures.  

The work I get the privilege to work on in health is impactful because it makes a meaningful difference to a whole myriad of different humans. 

CHRIS  I spent many years working in government, which is where I got interested in digital transformation. I then worked my way around the NHS system, leading the development of products, platforms, and services. 

At Public Digital, I work at the intersection of traditional policy/programs and exceptional digital delivery. In terms of our health focus areas, we work with providers and care providers, but we do most of our work with public institutions, specifically NHS England. This year, we’re also focused on supporting the Prevention Agenda, which is a big government priority. And we’ve got quite a strong play in local government where social care sits. 

My first product job was on a service called 111, the U.K.’s national number for urgent care. That moment where you’re actually designing for people who have an urgent healthcare need or are in crisis, and you’re able to support them — talk about public purpose! I was hooked. 

LOUISE  As a design consultancy, Gehl is always working with the urban environment and public realm, but we’re really interested in exploring how that can also be a more intentional place to drive prevention in health. 

I have a background in anthropology and urban development planning. Coming into health, what really interested me was that it requires long-term thinking. That’s definitely my driving force, as well as what you mentioned, Matthew and Chris, about getting close to people and understanding barriers and motivations. 

Gehl does work around food and food environments in cities: what people have access to, how they experience their environments, and how that ultimately impacts their behavior and routines around food. We also do work around early childhood. How can we be more intentional in designing positive urban environments that are good for early childhood development? 

In recent years, we’ve also had a much stronger interest in mental well-being. We completed a project around how moments of awe can have positive mental health impacts, such as reducing stress levels. The urban environment is always at the center of our work, but we acknowledge there’s a lot of bridge-building that needs to happen in terms of bringing together different sectors that are not traditionally in conversation. 

ED  At Lexington, we focus on public affairs, government engagement, and communications in Healthcare. That takes a variety of forms. For example: working with pharmaceutical or diagnostic companies to help them engage better with governments around science policy, research development, or clinical trials; helping design and create solutions for localized or disease-specific problems, like redesigning how a patient pathway needs to work when you have transformative new medicines, diagnostics or innovations.

On the communication side, we help our clients deliver and communicate what is often quite complex scientific life sciences and R&D policy in a way that is accessible.

Lexington does a lot of work in the U.K. and across Europe, but we’ve also done some great work in the last six months in the U.S., Asia, and the Middle East, expanding our reach and applying our expertise to global challenges. 

At the start of my career, I worked for a politician who became the Secretary of State for Health. What appealed to me about health was not just the human factor but also how it impacts all different facets of policy, government, and beyond. It has wide-reaching complexity and we have to balance competing — and sometimes contradictory — priorities in a way that helps people.

MATTHEW  Recently, I went to ViVE, the digital health conference. AI is the latest “hot topic.” Everyone has built themselves a hammer and is running around trying to hit everything. When you run around with a solution, everything’s a problem. Rather than start with the hammer, let’s start with the problem to be solved. It might not be a hammer that you need; it might be something else.

CHRIS  You can go to any health conference in the U.K. and you’ll see the same thing. There’s been a “let a thousand flowers bloom” approach to AI innovation and a lack of standardization of how those tools fit into existing clinical workflows.

We’re in the middle of a hype cycle around AI. Health is one of the greatest places of potential for AI because of its large structured data sets. Imaging is the obvious example. [Google] DeepMind’s protein folding work is all based on extremely large, well-structured models, which is what you need for AI to work well. If you pull unstructured data in, the results are less reliable. 

All of a sudden, the conversation is flipped from “Let’s redesign our services to meet our strategic objectives” to “What are we doing about AI?” which, for me, is the wrong focus. There’s also a real design challenge of AI explainability and transparency that I don’t think has been cracked yet but is going to attract a lot of attention over the coming years. 

ED  When you look at how AI is viewed in government, there’s a real sense that AI is the efficiency lever. 

AI does have the potential to change things like drug discovery and how we bring innovations to market. Two of the most famous drugs discovered in the last 20–30, years, Viagra, originally a blood pressure drug, and Ozempic, originally a diabetes drug, were repurposed based on real-world evidence that showed they had a massive impact on erectile dysfunction and weight loss [respectively], two things that are relatively easy to quantify and measure impact on. 

AI unlocks doors and ways of looking at problems that otherwise would take years of human observation. It will help companies, particularly in the life sciences sector, commercialize, conduct clinical trials, and ultimately do drug discovery in a different way. 

MATTHEW  Many healthcare companies are coming to us asking about AI for efficiency. What we want to be talking about is: How can we use it to drive growth? It’s very easy to point it toward the bottom line, but the benefit, the differentiation, is at the top line. Secondly, how can we use AI to enhance the human-to-human element? 

We did some work last year in pathology. It’s one of the few areas that hasn’t digitized because there hasn’t really been a reason to. Pathologists love their microscopes. But AI offers the ability to more intentionally target the things that pathologists do. We met with a pathologist who told us, “I can tell what 90% of the things that come across my desk are straight away; the other 10% is where things get really interesting.” That’s when you get to go deep into a case and understand what’s going on. Allowing someone to focus on that is beneficial to both the individual and the scientific community.

LOUISE  I think to your point about pathology, Matthew, what are we asking AI to solve and what can it leave space or time for us to do differently? We did a project around youth and their emotional responses to different urban environments. It was a combination of looking for tone of voice and the way they spoke about things. With AI, we could do that across a huge data set instead of looking at individual responses. It was a deeper analysis of motivations and emotional layers. 

CHRIS  There’s something here around the relational vs. transactional aspects of healthcare. We’re working with various children’s services, and there’s been a rush to establish a front-door process where queries go through various triage algorithms and get farmed out to different parts of local authorities. We’re actually trying to flip that around and get greater human expertise earlier up the chain. When you’re advising someone with a social service need, you can avoid a lot of issues by having conversations earlier so they’re not bouncing around the system. 

 It’s choosing the right tool for the right moment and not automating away the moments where human contact will deliver a better outcome.

ED  The population is aging and that’s going to transform how we have to deliver healthcare. We’re going to have double the number of people over the age of 80 than we had 25 years ago. That will have massive implications for health systems — on spending, design, how you develop and deliver things, how care is implemented, and, frankly, cost.

The biggest problem that exists across pretty much all healthcare systems is the short-term nature of dealing with that. It’s a bit of a vicious circle, in the sense that these demographic challenges lead to funding challenges which lead to health systems being so concerned about how they keep lights on … which further compounds that problem. 

I think that’s why AI is such an attractive idea to governments and health systems; it’s seen as a silver bullet in the same way that prevention is. But prevention only works if you create a model that you’re prepared to fund for several years. 

LOUISE  Another issue — which is well known but not enough action is taken on — is the implementation gap between research and practice. It’s translating some of these insights from research into how we design our prevention policies, strategies, and who’s doing what. 

CHRIS  There’s also an assumption that upfront design can solve everything and that a policy can be so clever, it will solve all the problems. You can’t kill complexity with cleverness. The only way of navigating these problems is to take what we refer to as a “test and learn” approach. Starting small, experimenting, testing, learning, and scaling — that’s the way to drive change in complex systems.

MATTHEW  It’s all about choices — understanding how they impact and affect complex systems, and then adjusting. When organizations talk to us about resilience for the future, it’s more about behaviors and mindsets than building the perfect system.

MATTHEW  Louise, you’re on the edge of the health universe looking in. What’s top of your mind? 

LOUISE  I’m thinking, Where is the money to make serious investments in this space? Is prevention really seen as part of the health sector? And how do we make the case for that? 

MATTHEW  How might we refocus prevention? In the U.K., the public health system is focused on just dealing with what walks in through the door, the acute issues, before you even get into chronic issues or into preventing them. 

ED  There are two things that you need to reorientate the system. The first is money and the second is political bravery. Prevention will save money in the long term, but it requires the system to spend money in the short term to put measures in place, invest in education, etc. 

The benefits you’ll see from investing in a preventative system will not happen within one or even three years. They might happen outside of an electoral cycle. So you need people to look long term. 

CHRIS  Everyone talks about prevention and agrees that it’s a good thing — until it gets down to signing off on the budget. There’s a massive role for digital to play in prevention. The NHS “Couch to 5K” app is one of the most successful apps of all time. There are huge numbers of digital engagement in the NHS these days. Having data in the system allows you to be targeted and run campaigns in specific parts of neighborhoods to target specific health conditions. 

I’m most interested in how you reduce the marginal cost of this kind of prevention. There has been a long history of NHS screening programs, but, historically, they’ve been pretty dysfunctional. By turning these into more efficient Internet-era services, you catch things early and ultimately save much more in the long run. 

Similarly, with vaccination, there was a huge success story with the COVID vaccine in terms of building the infrastructure for tracking, administering, and managing the supply chain. Using digital infrastructure allows us to see benefits in the long run. But there isn’t an easy solution to money problems. It’s going to take tough conversations. 

ED When I think about things I’m excited about, AI is genuinely one of them, if used properly, with all the caveats we’ve mentioned. With the advances in treatments and diagnostics, there are massive societal impacts.

A trend that we don’t focus on enough is the role of the health systems in driving sustainability and carbon emissions. Depending on the country, health systems are 4–5% of total carbon emissions. I think there will be much more of a trend towards sustainability in healthcare, which we’ll see permeate at local, national, and industry levels. 

MATTHEW  Planetary health and human health have been held in separate silos, but at the end of the day, when you live in a healthy planetary environment, health outcomes improve. And I’m excited for that!  

LOUISE  On sustainability, we are seeing big foundations recognizing that overlap with some substantial investments. 

I’m also interested in national policy rethinking proximity in the healthcare system. How can we think about more localized solutions? How can these be more accessible and integrated into people’s everyday lives? What are the local conditions for making that attractive? 

MATTHEW  I think we’re heading towards a moment whereby the case for change becomes so acute that we do need to get everyone together to rethink the way we’re going, as our old ways become increasingly unviable and unfeasible. What will force us to sit down and take a revolutionary look at the way that we provision healthcare and the way that people live healthier lives? 

CHRIS  There’s quite a bit of reform planned by our current U.K. government and I’m excited to see how that pans out. Hopefully, it will be an opportunity to land some of the things we’ve all been talking about here!