Gemic

Building More Resilient Markets, with Care

We are starting to realize all the ways in which everything is connected.

Quarantine in Mumbai is disrupting the global distribution of labor, since many people working in the city’s claim processing centers don’t own laptops and can’t work from home. 

Limited access to clean water in places like Flint, Detroit and Newark is interfering with personal hygiene, expanding the spread of the virus and the scope of the public health emergency.

Slow-downs in the construction and service industries are preventing many migrant workers from sending remittances, transmitting the economic crisis in richer countries to poorer countries throughout South America, Asia, Africa and Europe. 

And so it has been – through a systemic contagion across people, communities, supply chains and beyond – that C19 has found the perfect conditions for crippling markets and economies.

It is within this context that businesses must locate their role within the broader social systems, and act to make these systems more resilient. 

This kind of “systems thinking” draws material connections between the supply, the demand and the structural conditions across employment, education, health, mobility, information and technology within a given market. It reimagines a market as a market ecology, rather than a matrix of segments and competitors. Most importantly, it draws correlations between the health and resilience of that market ecology with the health and resilience of the business sector – acknowledging that when a key structure within the system is compromised, the whole system is at risk. 

Approaching growth through this kind of systemic framework will certainly challenge the orthodoxies within many corporations, upending pre-COVID notions around who businesses really serve and how businesses really generate value. For example, what would it mean for a grocery chain to focus on community access to nutrition, rather than just selling food and bev? What would it mean for a social media company to help build ecosystems – of restaurants, schools, grocers, banks, other households – in addition to building networks? There is nothing like a crisis and the threat of market collapse to raise these kinds of questions and put established value propositions into perspective. 

Inevitably, many companies will steer backward, seeking to regain some sense of pre-COVID “normalcy.” But the allure of that familiar status quo comes with the risk of another contagion in the relative short term – and so far, there is no evidence to prove that markets would fare any better in the second round. Therefore, the question that businesses must now ask themselves is not just whether they can go back to business as usual, but whether they should. 

Within Gemic, we see an opportunity for businesses to shift toward a more systemic logic that connects business growth and sustainability to the health and investment in the broader social systems within which they operate. 

Practically and symbolically, we find a useful starting point for this shift in the strategy of Care, which has been in shockingly short supply over the past few weeks. 

Beyond health-care, the discourse, practice and principle of Care has been infiltrating every domain: world leaders are adopting lofty rhetoric of Care to placate the citizenry while performing Care through expansive economic stimuli; meanwhile, the balance of world powers is shifting, as geopolitical influence begins to reflect how effectively countries can Care for their citizens, communities and infrastructures; on social media, acts of Care have become a form of currency; whereas on the ground, people are sacrificing personal freedoms to show Care for the collective; and to ensure their survival, more businesses are trading in new promises of made / served / packed “with care.”

In a world where systemic Care is proving to be the best defense against systemic contagion, how can companies employ Care to help rebuild and reinforce their key markets?

We see several essential starting points:

  • Beyond defining a company purpose, define a POV on Corporate Citizenship
  • Beyond achieving scale and efficiency, strive for durability across human labor, supply chain, distribution and demand
  • Beyond affordable offerings, provide accessible experiences of Care in uncertain times   
  • Beyond developing the best experiences for users, develop enduring relationships with people and communities
  • Beyond practicing hygiene standards, develop an ethics of hygiene that helps people to rebuild healthy relationships to themselves, others and the environment
  • Beyond supporting economic recovery, collaborate to ensure support for capitalism, as continued crises threaten to divide societies into winners and losers

While each company will need to approach these starting points in ways that make sense for their unique business, every company will need to move forward with care-based strategies that strengthen the systems in which they operate and safeguard their business in times of crisis.

Doing Wellness Well: The Paradox of Agency

From a health agency perspective, we’ve never been more individually powerful – or more vulnerable.

With the balance of power falling more heavily in the laps of the everyday person than traditional healthcare providers, it is assumed that individuals will engage with their health and wellbeing to the fullest and to make the greatest use of the agency afforded them.

But agency in today’s health context is a double-edged sword. Definitions of health are expanding to become ever more holistic and so too has the market. The onus to optimize the self and body as a marker and sort of “insurance policy” for success and security has also never been stronger. Now, people navigate maddeningly myriad ways to continually surveil themselves and, in turn, try to “solve for” the many potential problems such a gaze elicits. The wellness economy, above all else, acts as both a solution and driver of this current cultural arrangement.

The emergence of the Wellness Age

The world of wellness has transformed from an industry into a culture. The practices and beliefs of modern humans are rooted in the ways we imagine “living well,” which currently exalt the notion of wellbeing and balance across the emotional, social, psychological, economic, political, and spiritual realms of life. We deeply value how well this is ‘achieved’ by the individual, whether in personal or professional domains.

But this doesn’t mean that wellness yet transcends being defined foremost by industry; wellness is a commodity, a resource to be bought, consumed, and sold. How it came to be so, tells the story of why it cannot be decoupled from this relationship, given the important human role it plays in the overall economy.

The wellness movement has grown in a context where trust in traditional authority and metanarratives of power have broken down and global structures have revealed themselves uncertain and fragile. Many factors coalesce to drive this: environmental and ecological movements since the 1970s have delivered a painful awareness of the connectedness between our actions and the world; Western bio-medicine’s monopoly over health and the patient relationship continues to dissolve in the face of increased corporatization and technologization; the globalization of markets, disintegration of the nation-state, undoing of gender binaries, mass migrations, environmental disasters, and the nuclear threat have resulted in the erosion of 20th-century identity roles.

With the dissolution of structures that give us meaning and security, a massive and complex wellness industry has rushed to fill a void, encompassing the worlds of food, fashion, mobility, life sciences, consumer technology, leisure and hospitality, urban design, retail, digital everything, and beyond.

Individual wellness: Today’s primary currency

The rise of the wellness economy is not just a symptom of the undoing of once-stable social structures. Simultaneously, it often serves to perpetuate this very situation.

In a time where many lack yesterday’s signifiers of success – homes, cars, economic capital and the like – we are left with ourselves, our bodies and minds, to leverage. This limits the ways in which we’re free to secure ourselves within the world, and in doing so, how one takes care of oneself transforms into the primary signifier for what kind of person they are and can be. Participation in the wellness economy becomes less a choice than a must; as the individual becomes the subject of investment, the question is not if one participates, but how well.

The problem with this is that wellness is the new luxury in many ways, but less honestly so. Like the luxury market, it’s not actually designed for everyone, but often fancies itself to be so. Luxury markets were traditionally about aspiration but framed intentionally for the upper few, and offered a fairly prescribed set of offerings. In contrast, the expansiveness of choices in the wellness market and focus on holistic life outcomes drives an expectation that to the masses it shall get – that even with sometimes highbrow offerings and exorbitant price points, access is a presumed given, and it is simply up to the individual to take hold of and leverage these offerings to the fullest.

And, with a vast array of goods and services promising improved health, yet being delivered only in the consumer realm (rather than being covered by socialized medical systems), a longstanding neoliberalist paradigm in which responsibility lies with the individual is further perpetuated – the role of social care systems are swept away as individual consumption and action become a prerequisite for modern survival.

Casting the eye inward

In this arrangement, the role of informal interpersonal relationships takes precedence. As wellness is framed to be holistic and all-life encompassing, so too is the performance of it. Humans have always “performed achievement” in one way or another, which has a demonstrative but also reproductive effect; when we believe who and what we see, we celebrate and therefore reinforce their belief systems and associated practices.

Today, wellness is not just sold between market players in the formal economy but is continually being “sold” through interpersonal engagements in the social economy – not just as a signal of social and cultural capital, but acting, I would argue, as the defining marker for achievement in today’s global landscape. In order to perform to the fullest, we must be watchful and mindful of our every personal move, engaging in a form of hyper self-surveillance that can be emotionally draining and psychologically overwhelming.

The experience of surveillance and the onus to self-surveil are not impelled by only the wellness economy of course. We live in an era where the topic of surveillance and privacy festers in the public consciousness, driven largely by the ways in which human personal data is shared, stored, and manipulated. This extends not only to the online world, where our second selves exist as either carefully curated representations or discrete sets of data we have little to no control over but the offline world where we are virtually always being watched; our every move in public places captured and tracked on video.

No time to waste

A number of other cultural shifts align and coincide with the emergence of wellness culture. For one, much has been made of the notion that millennials somehow inherently value experiences over things. But it can just as easily be suggested that millennials may lack the ability to accumulate things and in response, experiences become a source for achievement and meaning – that experiences have value in culture precisely as a result of economic limitations.

Interestingly, the experience economy transforms and revalues how we see time. It states that time is of the essence – as one among few “possessions,” it cannot be wasted and so must be optimized for memory-making, for doing, for action. That time is a space that is fillable as we choose, and where non-action is something to scoff at. Similarly, our culture today glorifies the entrepreneur and the entrepreneurial mindset, which is founded on risk-taking and seizing the moment. These dominant values lead to pressure to imbue each moment and move with meaning, and to jump on any signal of potential. The failure to take hold translates into the failure to live well and to attain the expanding definition of health, in turn.

Breaking down bodies

As each minute is scrutinized and broken down, so is each facet of our bodies and selves. Our contemporary culture likes to claim that we have reached a point of maturity and self-awareness that appearance doesn’t matter, that it is what’s inside that counts, but in a culture of wellness, appearance and performance are inherently social cues that may ‘say’ more about the individual now than ever.

Objectification theory proposes that in a society in which people are valued highly for their appearance, continual exposure to objectification from others leads people to take on a third-person perspective of their own bodies; they view, monitor, and judge themselves against an ideal standard. When these are out of alignment, feelings of dissatisfaction, shame, and anxiety can result.

But what happens when these ideal standards themselves start to break down?

Global movements tackling the breakdown of the cis-gendered self and body are a ripe example of how fluid and fragmented the very notion of identity has become. The wellness economy has served as both a champion for and beneficiary of these shifts, operating at the intersection of new engagements with and articulations of the body, and in doing so, giving permission and space for the ‘other-bodied’ and the non-cis-gendered to flourish.

Cultural phenomena abound that tell this story-in-the-making, such as the body-positivity movement, or the institution of hegemonic masculinity under fire in the face of #metoo and the global rise of hyper-masculine authoritarian governments, populism, and nationalism. These movements and shifts expose long-held ideals that, to be sure, are deeply problematic for society on the whole. But they also force a new kind of engagement with the body and self-making, prompting us to see the spaces between dominant boundaries and binaries – making the invisible visible, but also necessitating that people look at the world around them, and the assumptions they hold dear, for what it is.

This truth often isn’t pretty. And it takes real, emotional labor to unravel the complex and deep-seated factors in our personal and shared histories that shape why we feel certain ways when we look in the mirror – a painful kind of self-surveillance, in and of itself. Not surprisingly, anti-movements to the above, such as in the context of the questioning and re-formation of what it means to be a man, emerge in a doubled-down attempt to retain the hegemonic expressions and definitions characterizing a preferred past era.

Nonetheless, the emergent identities given rise by these global movements, in flux and myriad, means permission for one to explore. The broad array of offerings in the wellness economy make this possible, and indeed the wellness market has helped expose these dominant discourses themselves. For example, the sanction against male self-care – and notions of ‘vanity’ or ‘self-indulgence’ connected to it – has been dismantled as market offerings become intentionally less gendered and part of the standard wellness project.

The ever-looming potential of illness

In a culture of self-surveillance, being better – doing better – is a standing invitation. So, too, is illness; its prevention is ever a task to be carried out, and it’s potential to seize us never more so on our minds. As with the broader wellness market, there is an expectation that with patient agency comes the ability and access required to surveil the body in ways that incite positive action. Above the many facets of everyday wellness – social, financial, spiritual, emotional, and so on – illness, or the identified or imagined potential for it, becomes yet another layer with which people must grapple.

In this way, we are all born patients; patienthood extends across the lifespan, as each moment and action of our lives becomes rich with the potential for improvement and greater health. We have seen and will continue to see, incredible advances in our lifetime predicated on this promise. From early identification of genetic risk to the means to decide when and where one’s death can take place, we have a greater ability than ever to predict and act in ways that will determine our health and wellness.

These advances have and will improve our overall health as a society. At the same time, the self-surveillance ask of these endeavors can lead to the opposite intended reaction. When significant mental attention is required from us, a common behavior is to seek means to disengage in any way possible. Trying to escape the encompassing constancy of conditions such as chronic pain – the sensory ‘noise’, the need to pretend it’s ‘not there’ in social situations given the impossibility of its communicability, and the isolation that results – is but one example of what can happen when people fail to get respite and reprieve from an inward focus on the body.

Beyond wellness

The domain of health used to occupy a discrete time, space and set of relationships: sickness was a temporary scenario, dealt with mainly in private, between oneself and their physician. In contrast, the emergence of wellness culture, as a critical aspect of the health delivery picture, reflects and shapes an engagement with personal health that has no beginnings or ends: the project of attaining wellness has the potential to occur at all times of day, in every physical space, and from birth until death; it must be performed in public and in private, as appearance relies on outcomes of consumption occurring everywhere; it involves players and goods across the market spectrum alongside traditional care delivery.

On top of this, in the process of engaging, people navigate new products and tools touted as the answer to something, or the antidote to first answer. Many wellness tools have tapped into this overwhelm, claiming to cast aside the noisy multitude with one simple solution; in doing so, eventually, products become the antidote to the antidote to the antidote, and we find ourselves in a Borgesian nightmare. Not only is self-surveillance and self-construction paramount today, but we are asked to do this in a dizzying market of options, with a fluid and boundless set of paths to take, and with unprecedented personal risk. And in seeing every facet of our lives as a space for wellness to be attained by the individual, we run the risk of pathologizing all of normal life while glossing over the role of local and systemic approaches to help forge the balance and security people need.


If the world of wellness promulgates a problem-fix arrangement, do we see ourselves as inherently flawed and in need of its offerings? What is the alternative? And, if narratives and structures of meaning are being undone, what then becomes the opportunity to support a healthy engagement with those that are emergent?

I don’t claim to have the answers, nor that there are necessarily clear answers at all; to suggest so would likely miss (or contradict) the point. For players in this space, one way to potentially think differently is, in fact, to let go of the idea of answers at all. With the current problem-orientation, the wellness market today has been increasingly serviced by the school of design-thinking. In this vein, the outcome of innovation is often touchpoint solutions designed for today, rather than the addressing of deeper systemic reasons why issues exist – or might exist in the future. The accounting for compensatory behaviors that point to an unformed market, or the mapping and forging of emergent structures that situate the individual as part of a larger system of meaning and support, for example, tend to be overlooked in such an approach to value delivery.

Companies in the wellness space are changing the face of health care, even when they don’t explicitly see themselves as health companies – and arguably for the better. The interesting challenge for these organizations is to understand the ways in which wellness culture, as intertwined with other broad shifts and market and behavioral practices, leads to new experiences that all grapple with in one way or another. This is critical to play within these shifts in order to deliver value yet imagined.

When the offerings of the wellness economy incite a new kind of engagement with the self, they redefine what it means to be alive and human. Just starting with that recognition alone will set organizations apart, helping them to look inward in the way that the culture they’ve helped generate asks of everyone else.

The Future of Patienthood

We’ve been thinking a lot about the future of patienthood lately. It used to be that being a patient came with a clear set of social expectations and responsibilities. What was also clear was the time of patienthood, a time that was always temporary and clearly demarcated. We became patients when sick and in need of medical care and then, when we were better, we returned to our daily lives and roles and left patienthood behind. This is nothing new, the great sociologist Talcott Parsons wrote about “the sick role” in the 1950’s. The edges between patienthood and personhood have eroded over the years and decades, though, to become less and less distinct. In particular, chronic disease, with its “forever” timelines, make the phases of sickness and health fuzzy at best. To be fair, the healthcare industry from pharma and life sciences to payers and providers have invested heavily in patient-centric strategies which could be seen as ultimately helping people to regain personhood from within a designation of patienthood.

But while chronic disease brought new, sometimes permanent timelines to patienthood, new health technologies and new developments in biology introduce a new and entirely different view on patienthood that must be considered as we consider how to make patients part of the health process and how to provide them with increasing literacy, engagement and agency. As diagnostic and treatment techniques and technologies continue to develop we are able to make interventions earlier and earlier in people’s lives. With the ability to test genetic markers, with the development of criteria for ‘at risk’, we move into an area where the lines between sick and healthy are no longer clear. Instead, many people now are situated along a spectrum that sits somewhere between healthy and diseased. What does it mean for a person when they are diagnosed for a disease long before they ever have symptoms? On the one hand, it may mean earlier intervention with the promise of better long-term outcomes. But for the person, it casts them into a grey zone that is neither patienthood nor personhood, a place in which uncertainty is the order of the day.

What does it mean to seek out treatment for a disease that you are told you have but is still latent and would not manifest for many years? How does one weigh the pros and cons of risk, of potential, of an unknown future experience against a potentially unpleasant or invasive treatment today? These are questions that are faced head-on by a very small segment of the population today, most notably women with the BRCA1 gene for breast cancer, some of whom opt for preventive mastectomies in the face of possible or likely future manifestation. But these decisions and these experiences will become more and more widespread as more genetic markers are identified and as treatments are developed that intervene very early in disease progression.

These issues raise a number of questions about the evolving landscape of relationships doctors and patients will have to navigate. Questions of trust and the exchange of meaningful information come to mind. But more importantly, the fundamental question is: is the health system ready for an influx of patients who bear no discernible resemblance to sick people – or at least sick people as we have come to think of them? Many things will have to be rethought for this group of “patients” – from the mundane to the philosophical – such as what support services are relevant and useful; how does adherence work; what does proactivity mean and, even, what does sick leave look like?

Of course, this set of circumstances is not just relevant to sickness. States of so-called health and wellness are no longer absolutes but aspirational guides. We live in an era where every decision, every act, has health considerations and consequences. Of course, the backdrop to all this is a profound episode of convergence wherein questions of health and wellness have simply become part of the everyday fabric of life. In some ways the word patient is just a name that we give to a state of being sick and under the care of professionals. But names connote things of meaning. Patienthood demarcated a socially acceptable time and space to be ill, to need and deserve care, and while it denotes a sort of reliance and deference to others, it also signified a trajectory that implied an end or an exit from that status. But when the very architecture of what it means to be a patient is eroding before our eyes we must consider the consequences.

For care companies – be they life sciences and pharmaceutical or clinical providers of care – the consequences may be profound. The future of patienthood will demand that they rethink how they identify, talk to, engage and care for their clients. Without clear times and spaces of patienthood, or of sickness and health for that matter, spaces and services exclusively devoted to those concepts may need to be rethought or have an opportunity to redefine themselves in more plastic and dynamic ways. As an exercise, considering the possible futures of patienthood, and other socially foundational terms and roles that will be radically reshaped by emergent technologies, needs to be a part of everyone’s toolkit.

A future where people will increasingly be “diagnosed” with diseases – like Parkinson’s or Alzheimer’s – that they don’t in any meaningful sense yet have, and by that, I mean “experience”, provides us with a kind of limit case for interrogating the futures of terms that we currently take for granted. But in an era where terms, meanings, states of being are colliding, reforming and converging anew, the new possibilities of patienthood demonstrate the fluidity by which health futures are currently forming. By considering how technologies may reshape meanings we can get ahead of the changes we will need to build into the system before it’s too late.

The End of Patient Centricity

We live in the age of patient centricity. Look to the mission statements of every big healthcare player – from life sciences to insurance providers – and all of them inevitably cite their commitment to delivering patient-focused or patient-centric care. Let’s be clear: this in and of itself is not a bad thing. The embrace of patient centricity has been responsible for very real improvements in the ways that the industry thinks about the people it serves, how it orients and delivers care to them, and in the experiences of patients themselves who, for so long, were the buried lead of healthcare. And yet it must also be acknowledged that the patient centricity movement has neither lived up to its potential nor is even adequate, even in theory, for the needs of the ecosystems of people who make up the primary actors in any healthcare setting. This includes patients, their families and loved ones, doctors, nurses and all manner of other healthcare practitioners. But if not patient centricity, which has for some time now provided a valuable ethical underpinning that the industry relies on, then what?

So, what comes after patient centricity and why do we need to move on from it as the central organizing principle of delivering care in the 21st century?

What is patient centricity?

The origins of patient centricity can be traced back to social movements of the 1960’s when established hierarchies and power structures were being challenged. The notion that sick people were just passive receptacles for doctor’s superior knowledge and that medicine was just a functional exercise in treatment became the target of patients’ rights movements. At the same time, systemic and social changes allowed this thinking to burgeon. But it was really with the advent of the Internet and easily available access to all kinds of information – medical information, doctor ratings, drug prices and alternative therapies – that the true disruptive nature of patient centricity began to be fully realized.

With the Internet in play, the consumerization of medicine and healthcare really came to the fore. Customers – patients in this case – had choices and healthcare companies found that while they understood the science and the medicine behind their products and offerings, they did not have a sophisticated understanding of their patients’ lives, experiences, key needs and challenges.

What then is patient centricity now? Obviously, it’s no one thing but a collection of intentions (or a collective intention?) to account for the needs and experiences of patients in the provision of care. What does this mean in practice? The narrative of patient centricity has informed everything from the plethora of patient support services offered by pharma and life science companies to new ways of orienting services and care in clinical settings. Most of all, many might argue, patient centricity has come to reside in health companies’ mission statements and marketing materials. That’s not to say that it is empty of effect, but it has re-oriented the ways in which healthcare is spoken about and the ways in which the needs of patients are said, at the very least, to be prioritized. 

Why patient centricity is not enough

As a movement, a genuine exercise in empathy and as a marketing strategy, patient centricity has been inadequate to the task. We need to move on now. As an organization that has and continues to bring genuine patient experiences to bear in the allocation of healthcare resources and the design of healthcare services to make healthcare more patient-centric, it may strike some as strange for us to advocate moving on from it. But we stand by this position not as a rejection of patient centricity, but in the spirit of evolution, of striving for more and doing better. The move to patient centricity was a beginning – not an ending – of how the system needs to adjust. However, there are plenty of examples how and why the system needs to evolve:

  • We keep spending more and more on healthcare but do not have dramatically better outcomes to show for it. Beyond this, patient satisfaction lags behind where it should and could be. According to some measures, Americans are amongst the most globally pessimistic about the future of their healthcare.
  • The promise of digital technologies – for so long mooted as the means to pull healthcare into a more patient-centric world – has largely failed to live up to its promise. Digital in healthcare has been transformative in some ways for sure – think EHRs – but have the potential benefits of digital truly trickled down in ways that have scaled out benefits for the patient population at large?
  • Patient centricity as it is currently defined seems stuck and needs a reboot. Apps, nudges, patient support programs, reimbursement support, adherence reminders, diet and exercise advice and a whole host of patient experience offices, personnel and surveys encompass the material evidence of the patient centricity movement. With all this in place, though, patients continue to feel disconnected and alienated from the system. One example is adherence. For all the effort to make adherence patient-centric and to try and equip patients with tools and advice that genuinely will help them to adjust their behavior and take their meds, little evidence is out there that these have had significant effect and resonance in people’s lives. Numbers abound on this, here are just a few cited from the American College of Preventive Medicine: non-adherence costs the US economy as much as $300 billion dollars a year; it accounts for 30-50% of treatment failures; and depending on the condition 20-50% of patients are non-adherent at any one time. These numbers are only expected to rise in the coming years as the burden of chronic disease management increases.
  • Perhaps most importantly, patient centricity is inadequate as a paradigm for contemporary care because it itself emerges from and is stuck in a cultural model of care that, while it may remain dominant, is no longer ascendant. Patient centricity’s cultural DNA reflects old models of medical authority, social arrangement and cohesion, and economic realities. Largely built on a model of individual acute care reflecting older socioeconomic realities, patient centricity has done little – and may very well have exacerbated – forms of atomization and alienation from the care system that continue to plague healthcare delivery and affect outcomes negatively. The democratization and distribution of medical knowledge, the increasing challenges of managing chronic care alone, the costs of care and the increasing inequality of income distribution, the hollowing out of the middle class and even the reformation of extended families all point to a model of care that needs to evolve.

Where do we go from here?

Moving on from patient centricity should not be thought of as evidence of its failure. More to the point, the current iterations of patient centricity have just exposed gaps in how it could come to life in a more robust, systemic and authentic way. In some ways this means patient centricity is a victim of its own success – that said, there are probably a few people out there that would argue that there isn’t significant room for improvement. So where exactly do we go from here?

People, not patients

While some might argue that the word ‘patient’ implies a duty of care, the word comes with a heck of a lot of baggage. Becoming a ‘patient’ is a process of linguistic and social transformation from a whole person into an object of intervention. The word patient, then, and the services designed to support it, struggle to recognize the patient as a whole person. This means that patient centricity efforts still tend to box in the person as the site for and the object of one-sided interventions of care. Seeing the person as a patient leaves distorted power imbalances in place.

Fragmented and inflexible care

In terms of care delivery, we have a significant distance to go in terms of bringing care to people on their own terms. For too long we have relied on the fictions of personal responsibility and the notion of the proactive patient to remove ourselves from the responsibility of the provision of care to all. But if patient centricity and whatever follows it means anything, it means bringing good care to as many people as possible. In recently published research by Accenture, more than 60% of patients said they would happily switch providers if it meant getting an appointment sooner. Similarly, the same research found that just over half of respondents would change providers if they were offered care in a more convenient location. What we have learned, in effect, is making access and delivery of care as flexible and integrated as possible makes a huge difference in the outcomes that are generated. But what seems easy and straightforward is actually difficult to implement. That said, the organizations that are pioneering this (such as the Commonwealth Care Alliance in Massachusetts) and making it a core value of their healthcare delivery are seeing genuine results.

Ecosystems, not individuals

One of the biggest limitations of current conceptions and orientations toward patient centricity is its bias towards individualism. Now we know, of course, that diseases are experienced by individuals. But ample work by medical anthropologists, sociologists and many others orient the experience of illness much more broadly than simply the sick individual. From these perspectives, illnesses can most productively be understood as social entities, with the experience of being sick reverberating across many different people. This can most clearly be seen in the experience of caregivers. Patient-centric services have, in some cases, sought to include them in their outreach. Yet, for the most part, patient centricity is focused on the individual with the disease and has little to offer those (beyond that individual) who remain profoundly affected by the illness. This has the unintended effect of placing enormous burdens on the sick person as the one responsible for coordinating and marshalling the help of others and places them, ironically, too often in the opposite role intended: giving care and support to others.

Care, not products and services

Most healthcare organizations have followed a model based on a blend of market research and design thinking that assesses and determines “unmet needs” and then determines which of those needs are most acute, most impactful and most easily solved. Then, they try to “solve” for them. These solutions run the spectrum from simplistic and quite spartan in nature to relatively robust. What they have in common is that they think of needs in isolation from one another.  Consequently, such organizations see the patient as a patchwork of disconnected “needs” that can be serviced. While there are notable exceptions, the industry has never been able to step away and see what the connective tissue between these needs and how they can start to connect them to people within the context of building authentic relationships of care.

A commitment to care

It is on this last point that we should reflect for a moment. We need to rally around a set of cultural values that allow us to orient health within our economies, companies and everyday lives. For too long, sickness has been seen exclusively as the purview of biomedicine and bodies as sites for medico-scientific intervention. But the rise of chronic illness alongside and in conjunction with patient centricity has successfully challenged this notion. Now sickness is largely about management, health is aspirational, and we are always at risk. As such, sickness and health are knitted intricately and intimately into people’s everyday lives, inseparable from the activities, emotions, hopes and values that animate it. As part of the everyday, illness is no longer something that can be isolated or time-boxed. It has become complexly itself, tied into all the events, emotions, networks and actions that compose life.

To meet this experience, we need to place a cultural value around health, patients and the things that we do to help people recover from sickness and stay healthy. I think we can find those values in the notion of care. Care is more than the delivery of services or functional transactions between two parties; care implies a relationship. We might even say that care implies a kind of responsibility or a social contract between two parties that goes beyond economic exchange. Care, as a guiding concept, might also allow us to see how to integrate the system in ways that help to speed more transformative health solutions. Care can be a mandate for traditional health actors as much as it can or should be for food, financial services and insurance companies (just to name three).

What would patient centricity reimagined as a commitment to care mean for you and your company? Moreover, where can companies find new sources and forms of value in this shift? In the life sciences, the first one is obvious: embracing care as a commitment to the people you serve offers up the promise of better engagement with them. Better, more authentic engagement can help to communicate and embed educational materials and adherence advice as well as offer a pathway to creating relationships that can truly support behavior change. This engagement can also offer physicians more meaningful tools to forge actual human relationships with their patients. Creating an ecosystem where true and significant engagement can take place – by which I simply mean interactions that are grounded in more than a transactional or mechanical basis, interactions that take into account identities that go beyond the singular formulations of “patient” and “doctor” and interactions that take into account our emotional selves as important aspects of social need – offers the ability to create more longitudinal, lasting relationships between all persons in the care system.

A commitment to care also means enabling your company to prepare for known and unknown disruptions to come. The democratization of knowledge, the distrust of authority (scientific or otherwise), new technologies from AI to IoT ecosystems to 3D printers, to increasingly imbalanced distributions of income are just few commonly realized signals that point to significant upheaval of current business models. There are more. Because of this, resilience and sustainability will be an important feature for companies to acquire both as attributes of their working culture and as elements of their business strategy. How does looking beyond patient centricity help build these qualities of resiliency and innovation? To begin with, having the foresight to contemplate modestly and radically different futures is a means of forcing oneself to reckon with alternative business models and new paradigms. It becomes a form of discipline that helps companies to anticipate changes in the marketplace.

Perhaps more importantly, looking beyond the orthodoxies and models that have defined patient centricity up to this point will allow companies to forge more direct relationships with what truly motivates them, allowing people to live healthier, more meaningful lives. While there is appetite for innovation in this space, it is too often incremental and bogged down in what exists today rather than what could exist tomorrow.

Embracing these changes will not be easy, as even the most basic tenets of patient centricity have been unevenly taken up across the various sectors of the health industry. Moreover, these changes do not just entail adjusting how you speak to and engage with your customer. It also means taking a sober look at how you are organized internally to meet and address these challenges. Building programs and services is one thing, but building a corporate culture of care, one whose values mirror those your company wants to project to the people it employs as much as to the people it serves is hard work. But it is worth it. In an era where the values and ethics of companies are among the first things evaluated by consumers, healthcare companies are not exempt from this, despite the necessity of their services. Finding, articulating and acting on those values of care is the future of patient centricity and it must be rooted in a cultural transformation.

What does this boil down to? At the end of the day, healthcare is still more of a machine than it is a set of relationships. We are still missing the responsibilities, intimacies and care that comes from human relationships. Anthropologists and sociologists have spent a long time trying to figure out the qualities that are essential to universal and essential for human societies to form and thrive. One of those elements – communitas – refers to the ties that bind us together, the spirit of community that dispense with social hierarchies, social rules that connect us as humans living alongside one another. It’s a simple concept, but a profound one. Communitas can be the guiding north star of healthcare reform and, indeed, another way of saying communitas is: care. No matter how complex, how efficient, how mechanized or digitized or logical we need to make the system going forward, we also need to make it more human. Bringing all of these qualities together, the systemic and the human, is difficult but by no means impossible. Care lies at the center and it can lead the way.