Web 2.0 and the future of health care

Paul Hodgkin Patient Opinion

Digitization Wave 1Reduced the cost of systematising information

The information universe • Evidence based care• Cochrane, NICE, protocols, QOF

Simple electronic care records

Digitisation wave 2: networks and democratised voice

Democratised bill boards

Photo courtesy flickr.com

It’s cheap and easy to find ‘people like me’

So what might web 2.0 mean for health?

‘Voice’ will become as powerful a driver of as ‘exit’

Patient-led change

Voice can lead to structured, public conversations betweencommitted and passionate micro-audiences

Numberof peopleusing a service who feel:

Finding the thoughtfully passionate

Indifferent/ Concerned Passionatepleased

Known

Thoughtfully passionate people (whom we can now find)

Patient-led change

Open source hygiene

‘Sous-veillance’ as well as surveillance

‘Shroud wavers on speed’

‘Loose a million pounds’ campaign in Liverpool

Why is the web so disruptive?

Networks are citizen-centric

Networks can give increasing returns

ReturnExamples:

ProtocolsPolicies Coordination across organisationsTargets and incentivesNumber of partners in a care pathway

Decreasing returns to scaleAka ‘one more heave’ and ‘lessons must be learnt’

Number of people involved in system

ReturnDecreasing return systems are tightly coupled

Prize consistency and coordinationAverse to variation and riskHierarchical, mechanisticExtrinsically motivated, enforced

Decreasing returns to scaleAka ‘one more heave’ and ‘lessons must be learnt’

Number of people involved in system

Return

ExamplesYouTubeeBayWikipediaGoogle ?Cases Journal

Increasing returns to scale

Number of people involved in system

Return

Increasing return systems are digitalloosely coupledintrinsically motivatednetwork, horizontalvariable, stochastic, uncontrolled

Increasing returns to scale

Number of people involved in system

ReturnTurnover/employee

Number of people involved in system

10 100 1k 10k 100k 1m 10m 100m

x Patient Opinion

X Disney

X Microsoft

x YouTube

x Google

X NHS

Per

sona

l car

e

Systematic care

Hig

h

HighLow

Low

70/80sFeminismPost modernism

90s/00s1st wave digitisationEBMProtocolsManagerial control

10s/20sVoice more than exitPatient-led change

Per

sona

l car

e

Systematic care

Hig

h

High

Low

Low

50s/60sDr Finlayknows best

Thank You

Paul Hodgkin

Gift economies on the web

Policy

Evidence

Protocols, process, performance

Patients – professional behaviour

1 million people per day

1 in10,000 ‘nudge’ the system

200,000 service improvements per year

Cases study

Policy

Evidence

Protocols, process interventions

Patients – professional behaviour

Web 2.0 will change health care by:

• The democratisation of voice

• Reputations

• Gift economies