Having recently completed deeper research into the changes on the horizon for surgery, we are now sharing more detail of the views gained so that others can add further comments.
Earlier this year Future Agenda ran a series of events and deeper research into the changes on the horizon for surgery. Building on insights gained from the 2015 discussions about the future of health, future of data and future of work, this project sought to explore global and regional shifts taking place in and around the operating theatre and to understand some of the potential implications. Having recently completed the core of this work and having shared headline insights, we are now adding more detail on some of the views gained so that others can add further comments.
Drivers of Change
As we explored the topic of surgery with varied experts it was evident that this is a multi-faceted arena, one where technology, and especially digitization, is clearly creating new opportunities but one where there are also major influences from changes in funding, different social attitudes to healthcare and also shifts within the hospital and operating room hierarchies.
Six Key Shifts
While we identified a wide range of potential shifts for surgery, in our view there we seven that particularly stood out either for the nature of the change that they would bring or for the impact that this would have. These are:
Already in a number of development labs are examples of 3D printing being used with organic materials not just metals and plastics. As this technology is adapted and adopted we can see in-theatre printing of biomaterials bringing multiple opportunities for the 3D building of biological tissue and bespoke organs. We may soon be able to create replacement parts that are made from our ‘own’ cells as the capability emerges in hospitals adjacent to / in the operating room and so enables wider revolutions in surgery such as supply of precise, personalised surgical components and the printing of organs on demand.
Equipped with greater understanding of the individual’s genetic disposition and new intervention technologies, we will be able to proactively edit genes and undertake minimally invasive surgery to reduce the need for major surgery in later years. Technologies such as CRISPR may mean that surgery is prevented or minimised via early intervention. Coupled with more predictive analysis across the system and spiralling costs of healthcare, preventative healthcare gains wider support and traction in key areas and the combination of new technology development with the need to improve system efficiency accelerates introduction in many countries.
Surgeon as Supervisor
There is much talk about how AI will impact healthcare as well as more pervasive use of robotics. However, few believe that surgeons will be replaced any time soon. Rather increased automation, augmented reality and artificial intelligence will all combine to take over more expert surgical actions - leaving the surgeon to stand back and be available in case of an emergency very much like airline pilots. Surgeons develop deeper expertise but actually undertake fewer operations themselves. They support and guide the teams and the technology but their status changes from captain and operator to coach
Led by solutions increasingly developed in India, Africa and Asia, remote and real-time patient monitoring enables early, de-centralised surgery to be undertaken more widely and at lower cost. As such, small, local walk-in surgery centres become popular for light interventions. They reduce major hospital demand and provide cost savings for the system while also helping patients avoid the ‘taboo’ of hospitalisation. Major hospitals focus on being centres of excellence for complex treatment while standard procedures are undertaken in the community without an overnight stay.
In the search for lowered costs, increased efficiencies and improved outcomes, payers will increasingly become more hands on and directive about procedures and securing the best return on health possible. The power of surgeons will decrease. Payers and insurers dictate how and where a surgery will have to be performed based on quality, cost and long-term benefit. Payers are directly involved in decision-making, selecting hospitals, and at times even surgeons, as well as defining the procedure. Many countries will correspondingly have national transparency ratings on cost and quality performance.
The Digital Operating Room
Lastly, many see a gradual evolution and adoption of new digital technologies leading to a fundamental integrated transformation of surgery, processes and health outcomes. Surgery will embrace a portfolio of digital tools that are all interoperable.
- Centralised data sharing will integrate healthcare systems and a digital ecosystem
will emerge that is recognised by all players using common standards and protocols;
- Multiple physical and chemical sensors are increasingly embedded in all equipment to enable full real-time analysis and navigation; and
- With significant data visualisation and imaging improvements, high-resolution imaging and fast-developing holographics will provide us with the ability to see, interrogate and explore within the body before first incision – as well as throughout the surgical process.
The implications of these and other shifts on the future of surgery are clear:
- Many hospital procedures will have to be significantly redesigned to accommodate not just a different funding approach focused on outcomes but also greater weight from payers and the resulting reduced influence for the surgeon.
- Surgical equipment providers will need to become part of the increasingly digital infrastructure and many will have to reinvent their underlying business models. The funding pressures and the entry of data analysis experts into the sector will disrupt the status quo. Many will seek to expand their activities deeper into training: keeping surgical teams up to date on the latest techniques will become more of a continuous learnign experience than today and will be assisted by the advent of more virtual reality based simulation.
- Lastly, the relationship that we, the patient, have with the system will change. We will be given greater opportunity to make informed decisions earlier, see consequences and options and so, if we choose, adapt our behaviours. Behavioural change may be financially driven or on the basis of seeking better health. Either way, greater control will pass to the consumer of healthcare.
If you have any comments on the above, do let us know and we will be happy to include in an updated view later in the year.