The urgent need for innovative changes in the health-care system: A challenge for nursing and nursing research

Demographic changes concurrent with rapid developments in medical technology, raise new challenges for nursing as well as nursing research. The most notable of the demographic changes in many parts of the word is that a greater number of the population will reach a high age. The older the population, the greater number of illnesses that used to be rare and believed to be incurable in a younger population are anticipated in older persons. However, age is not a ‘problem’ by itself, but indicates that we will also have an increased number of patients requiring regular and reliable health care.

Medical technology offers nurses, as well as other health professionals, a number of new tools. These tools include improved methods to reach people with information and to communicate advice concerning health care. On one hand it is even possible to treat patients at a distance, which saves time and resources. On the other hand, it is a challenge to ensure that communicated data are safe and secure. The systems used should also be capable of development.

There are many challenges and dilemmas due to increased health-care costs associated with a continuously ageing population. The possibilities and potential of the use of new solutions within health-care organizations should be considered as well. There is an urgent need for change. The prevalence of personal technology, especially ‘smart’ mobile telephones, creates opportunities for new ways of delivering health-care services and for service integration. Nowadays many consumers have access to information and communication infrastructure. This can increase their possibilities of self-care and decrease the burden for the health-care services. This may relieve pressure on common resources which would be beneficial to those who require professional care.

Ageing demographics and declining health in older adults are predicted to put unaffordable pressure on care systems worldwide.^1,2 The World Health Organization concludes that change and innovation are required to better cope with these challenges in order to ensure that health and social systems are ready to make the most of this demographic shift. ³ Information and communication technology (ICT) can provide better, continuous, more efficient and more cost-effective care. Moreover it can make the care profession more attractive to the young generation. There is potential to improve general wellbeing, quality of life, self-efficacy, and social inclusion of the individual. Additional gains are securing the environment and strengthening the ICT industry. Hence technologies for healthy ageing need to be implemented in home care and nursing homes.

Old-age support ratios are estimated to decrease by 50% between 2012 and 2050 across OECD countries. ⁴ During the same time period, the proportion of the world’s population over 60 years of age will increase from 12% to 22%, according to World Health Organization. ³ Disorders in people aged 60 years and older cause approximately 23% of the total global burden of disease today.

eHealth solutions have the potential to address the urgent need for change, to reduce costs and increase quality as well as to meet consumer expectations of quality and availability. ⁵ An ageing population, an increasing prevalence of lifestyle diseases, new treatments, drugs and medical technology together drive demand and health-care spending. Contributing to this are other factors such as increased urbanization and migration, which further accentuate this trend towards expected increased health-care costs. These factors taken together will increasingly result in older people living alone and contribute to rendering unsustainable current approaches to professional care, informal care and service delivery. ⁵

Much of the discussion concerning future health challenges worldwide is based on the multi-ill elderly and people with high care needs who demand more complex health care. The argument that older people are a burden allows little room for how much older people actually contribute. Population ageing is interacting with a society that at the same time is being transformed by broad social changes which affect social and intergenerational dynamics. ⁶ However, a certain age does not entail a certain level of health or care needs. We cannot generalize people’s needs. The proportion of health-care costs in connection with the ageing population creates a great potential for development and use of new solutions. Demand is not only growing, it is changing, as consumers are becoming a stronger force and their expectations are changing. Better-educated, increasingly well-informed and mobile consumers place new demands on health-care providers. Health-care consumers now have an increasing awareness that proactive behaviour, such as exercise and diet, leads to a healthier life. ⁷ They have access to an information and communication infrastructure that can vastly increase the reach of health-care services. The prevalence of personal technology, especially ‘smart’ mobile telephones, creates opportunities for new ways of delivering health-care services and for service integration.

Conversely, since the flow of available information, via the Internet, is completely unselected and uncontrolled as to content relevance, it is of uttermost importance that health-care providers take part in the rapid development of technology and services. Sweden offers a good environment for eHealth innovations, and there are a great number of Swedish eHealth providers. However, the organization of the public health-care system leads to fragmented purchasing systems. A remaining and important challenge is the missing integration between health and social care for the elderly due to legislative differences and the lack of shared information systems. One example is that different health-care providers use different, often non-compatible, documentation systems for their patient records and referral systems, resulting in a worst-case scenario with discontinuity of care for the individual and, in the long run, deteriorated patient security. This inefficient way of working leads to poor resource utilization, time-consuming consumption and increased costs for society, which in turn become barriers to growth and make the development of standardized offerings difficult. Therefore, very few eHealth providers have successfully internationalized – and often such expansion tends to be limited to neighbouring countries. The European Commission wants to enable patients to access their electronic health records at any time anywhere by recommending a cross-border interoperability of electronic health record systems. The eHealth declaration from 2008 states (p.1):

There is a need to emphasise the improvement to patient safety that ICT can facilitate, especially as a result of the enhanced interoperability of systems. Combining standardisation and safety in eHealth must now be seen as a priority issue by all stakeholders. It is fundamental to define a common understanding through semantics in healthcare. ⁸

The Commission continues (pp.1–2):

Participation of industry in the planned large-scale pilot on cross-border use of patient summaries and medication data is particularly welcome. The paradigm shift towards clear support for eHealth can be achieved only by involving the key industrial and user stakeholders in developing eHealth solutions from the earliest stage. ⁸

The health care of today does not always meet demands from society or caretakers, and problems that have been known for decades are still not always adequately addressed. ⁹ At the same time, society’s technological development outruns the technological developments used in health care, and antiquated, retrograde practices and attitudes continue to exist within organizations. It is also a known fact that much time and money is spent on profound knowledge education in health-care organizations, but health-care personnel are still reluctant to change their working behaviour and/or routines. However, human changes will not be the key to solving routines and clinical practice. Health-care personnel do what they can to help patients with their needs, using the tools offered. Hence, the key to change lies within the organization. The organization can change guidelines, processes, systems and products, thus the staff can change their ways of managing care. Advances in ICT, assistive devices, medical diagnostics, and interventions are promising, but to benefit from these technological advances, designers must also better understand the changing needs of and opportunities for older individuals. ⁶

These developments pose challenges to the health-care system as well as plenty of opportunities. Traditional health-care providers need to adapt to changing expectations and increased competition when consumer-oriented companies such as mobile telephone operators and consumer electronics manufacturers enter the market. Care supported by new information and communication systems represents a huge market potential, linking information, communication, financial and insurance systems to supporting care and self-care. ⁹ It has the potential to enable people to look after themselves and their next of kin and to motivate self-care through social interaction with peers, assuring quality information and care. Information and communication technology can enable more effective and efficient care provision not only by reducing the costs of care but also by leading to a higher attractiveness of the professional care sector. A paradigm shift through digital health innovations, new working processes have the potential to make the care profession more attractive to younger people, with less repetitive tasks as well as technology-assisted communication.

There is a potential for better access to care and better choice of care as the private sector expands and new companies, products, technologies and service providers enter the market. In the Nordic countries, with advanced information and communication infrastructure, technology-friendly users (e.g. early adopters) and well-developed health-care systems, registered nurses could and should be recognized as potential promoters in interventions aiming to stimulate the needed changes. This could entail that elderly persons continue to live in their own homes longer and to gain an increased accessibility to care providers. This could reduce the burden on health care organizations and ultimately improve continuity of care for the individual.

In the health-care environment, nurses play an important and major role as care providers when integrating different aspects of nursing practice and research, thereby contributing to effective health-care outcomes. Studies have shown that nurse-led interventions, among other positive effects, can reduce illness and re-admissions to hospital and also increase quality of life. These are things to consider when planning for the future health care.

Conclusions

Today’s health-care systems face many challenges and dilemmas due to a large proportion of health-care costs associated with a continuously ageing population. It is essential that we find new ways of dealing with these challenges. Therefore, it is important to highlight the possibilities that are created in relation to the problems of demographic changes, as there is great potential in the use of new solutions within health-care organizations. Nurses play an important role in finding and implementing new solutions, with their key position within health care. However, the health-care system (e.g. organization management) must be prepared for and open minded to shifting from old solutions in order to test and implement new solutions.