What Charles Darwin Can Teach Us About Digital Transformation in Health Care
It is not the most intellectual of the species that survives; it is not the strongest that survives; but the species that survives is the one that is able to best adapt and adjust to the changing environment in which it finds itself
Charles Darwin, Origin of Species, 1859
Survival of the Fittest
Charles Darwin, the pioneering evolutionary biologist, is well-known for introducing the concept of 'Survival of the Fittest.' His work on this topic began in 1835 when he set off on an expedition to the Galapagos Islands. At the time, the popular belief was that species were mostly fixed and unchanging. But as he observed populations of plants, birds and reptiles, he noticed something interesting. On each of the otherwise similar islands, populations of the same species that developed in isolation from each other had differences in their characteristics that likely came from a gradual transformation.
For the next 20 years, Darwin kept these ideas to himself and a few trusted colleagues. During that time, he tested different assumptions by collecting data and running experiments to build a case to support his theory. In 1859, he published his work in a book titled ‘Origin of Species.’ The work challenged popular notions and opened the door for future scientific breakthroughs that would come from seeing the world through this new perspective.
Darwin's theories and the journey he took to develop them offer valuable insights for understanding digital transformation. This connection, sometimes referred to as Digital Darwinism, suggests that like species, organizations must adapt to survive in changing environments.
But before we explore how these insights apply to health care, let’s start with a few basics.
Digital Transformation: What It Is and Isn’t
Digital transformation in health care involves a series of coordinated changes to culture, workforce, and processes - enabled by digital technologies – that results in meaningful changes to an organization’s business model, strategic direction or value proposition.
Digital transformation is often confused with simply changing the format or capture of information. Digitization is converting information from analog to digital (e.g., shifting medical records from paper to electronic). Digitalization is using digital technologies to change processes (e.g., capturing patient reported outcomes remotely instead of in-person). Source: Reinitz 2020
We digitize information.
We digitalize processes.
We digitally transform organizations.
The Landscape in Health Care is Rapidly Changing
Some of the key forces driving this change are:
Pressure from patients, payers and regulators to improve access, quality and the cost of care
Patients’ comfort with and demand for more convenient, digitally-enabled care such as telehealth, accelerated by the Covid-19 pandemic
Technological improvements such as remote patient monitoring and artificial intelligence
A rise in venture capital and private equity investments spurring new startups and business models
Existing organizations from other sectors expanding into health care such as the tech giants (e.g. Apple, Amazon, Google, Microsoft) and retailers (e.g. CVS, Walmart, Walgreens)
Source: Glaser & Shaw. NEJM Catalyst 2022
Lessons from Darwin’s Work
So lets look at how we can apply lessons from Darwin’s work to our digital transformation efforts.
Embrace Change
In the wild, the ability to adjust and adapt to the changing environment is key to survival. The same is true for health care organizations. Those that have the foresight and ability to change their approach to meet the shifting landscape in health care are the most likely to thrive over time.
Encourage Innovation by Testing and Learning
After his trip to the Galapagos, Darwin left with many new ideas, but he didn’t rush to share his thoughts with others. Instead, he took the time to identify his hypotheses, gather data and test his assumptions. He knew that without the right evidence, his ideas could be quickly dismissed rather than widely adopted. In health care, new technologies are emerging every day. But just because these capabilities exist does not mean they will all translate into improvements. Instead, organizations should focus on identifying their strategic objectives and then test assumptions on how these technologies may help them achieve those goals.
Design to Solve Problems for Your Users
Just as species adapt to better fit their environment, health care must evolve to meet the needs of its users. Patients want faster access to care and are increasingly looking for ways to incorporate healthy behaviors into their daily routines. But they often will forgo care rather than putting their lives on hold to wait extended periods of time only to spend just a few minutes with a clinician. At the same time, clinicians are continuously being asked to do more work with less resources. Clinician burnout is at an all-time high and many feel their time is allocated too much to administrative burdens and not enough to the reasons why they chose their profession in the first place. Successful efforts must understand their users and solve for their challenges.
Collaboration is Critical
Survival depends on collaboration within and sometimes across species. Health care is complex and therefore no single organization can do everything on its own. Successful transformation efforts will require partnerships and alignment between health care organizations, technology companies, and policymakers.
Transformation Takes Time
When Darwin traveled through what seemed like very similar islands in close proximity to each other, he noticed different characteristics within the same species that differed only based on their location. Some of these changes were subtle, while others were not. But they did not occur overnight. Instead, they took time and often were the sum of incremental changes that amounted to something bigger. Health care has been known to move slower than other industries so it’s no surprise that digital transformation will take time.
But transformation in other industries also takes time. Netflix took decades to shift from mailing DVDs to streaming others’ content online to predicting what a consumer might want to watch to developing their own content once they understood their audience. Uber was originally called UberCab and only offered black cars. It took more than 10 years to change local laws that would enable any person to use their car to transport someone else to their destination. Its business has grown globally and expanded to new verticals like food delivery (e.g., UberEats). Many describe the need for health care to be more like Netflix and Uber, but they often overlook the fact that these businesses took decades to transform their industries.
Summary
The health care landscape is rapidly changing. Digital transformation efforts will require a series of coordinated changes to culture, workforce, and processes across an organization. These changes may be enabled or accelerated by digital technologies but do not rely on technology alone. Organizations that are most likely to be successful will embrace change, encourage innovation by testing and learning, design to solve problems for their users, look for key partnerships that enable synergies and be prepared for a long journey ahead. Like Darwin's enduring impact on the scientific field, a thoughtful approach to digital transformation could change health care for the better.
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