The healthcare sector has witnessed numerous changes over the past few decades—telehealth being one of the most significant. Despite coming from a lagging position, heading the change and innovation, Irish hospitals have advanced to the point with digital clinical solutions where they are now likely the first hospital system in the world to offer real-time motion tolerant respiratory monitoring as the standard of care in respiratory wards.
Professor Martin Curley is one of the torchbearers in Ireland’s healthcare industry. He is a health technology executive, an engineer, an academic, and a widely recognized top innovator. Curley embraced the goal of attempting to revolutionize healthcare using digital technologies and data. He has created “Open Innovation 2.0” using the innovation paradigm, which is turning out to be revolutionary in using an aligned ecosystem and emergent architecture approach to drive a structural change in the health industry using digital technology.
All Round Qualities
Curley has had a varied international career spanning both industry and academia. He has worked as an engineer and business executive in the Netherlands, various US cities, and at MIT for a period. Curley has published eight books and a large number of papers on technology, IT, innovation, and entrepreneurship. He is no stranger to political organizations like the UN, European Parliament, 10 Downing Street, and the White House. He is a Professor of Innovation at Maynooth University and a member of the Royal Irish Academy.
Curley has used digital technologies in a variety of industries, including manufacturing, smart cities, education, and the energy sector. Curley is Professor of Innovation at Maynooth University and chair of the Irish Digital Health Leadership Steering Group. He oversees open innovation and digital transformation at Ireland’s Health Service Executive (HSE). Additionally, he directs research towards frameworks for developing digital health capability with medical professionals and executives from businesses like Medtronic, Roche, Blackrock Health, Centric Health, Huawei, and Cisco.
Taking Nation’s Healthcare Responsibility
The HSE is Ireland’s National Health Service provider, with 130k direct and indirect staff delivering all public health services across the country in hospitals and communities. The goal of the HSE is to create a healthier Ireland with high-quality healthcare. However, despite highly professional and dedicated clinicians the Irish Healthcare system is poorly ranked, coming in at number 80 in the CEO world rankings for healthcare systems and ranked last in the OECD business and technical readiness for electronic healthcare records. However, the Irish Healthcare system now has a very fast Digital improvement trajectory.
The HSE’s mission is to ensure that health and social services in Ireland enable individuals to reach their full potential and get the proper treatment at the appropriate time and location. HSE is by far the largest employer in the nation, with a budget of >20 billion euros yearly. The Irish Government launched a cross-government and party strategy known as ‘Slaintecare,’ a ten-year initiative to reform the health and social care system and create a blueprint for developing a world-class health and social care service for the Irish people. However, despite cross-political party support the strategy has not been successful thus far with waiting lists almost doubled since the policy has been formalized despite record expenditure.
With the Irish Health System under increasing pressure with lengthening waitlists, hospitals at full capacity, and significant issues of clinical staff fatigue, recruitment, and attrition, Curley and other citizen leaders in Ireland created what Harvard Business Review calls a ‘Grand Coalition’ called the Irish Digital Health Leadership Steering Group (IDHLSG) to help. Rosabeth Moss Cantor describes Grand Coalitions are an emerging organizational form that involves large multiple stakeholder collaboration to solve gnarly societal-level problems.
Three Copernican Shifts – A new kind of Health and Wellness System
Curley has a vision of a new kind of health and wellness system which is focused on three Copernican shifts.
- From an Illness System to a Wellness System
- From Doctor knows Best to Patient Knows Best
- From Hospital to Home
Most current healthcare systems have never been explicitly architected and engineered focusing on the rule of rescue. The emergence of a slew of disruptive digital technologies is transforming the functionality and economics of the production and distribution of healthcare services and offers the opportunity to reimagine a completely different health system with a focus on wellness.
Curley and other thought leaders such as Prashant Parida have a vision whereby a digital health system is built around a personal electronic health record on each individual’s mobile phone. Dr. Mohammad Al-Ubaydli, CEO of ‘Patients Know Best’ has made this vision a reality and over one million European citizens now use the PatientsKnowBest solution for personal health.
Curley often quotes Thomas Edison when he refers to the new kind of Health system he envisions. “Future doctors won’t prescribe medication; instead, they will educate their patients about diet, human body care, and the causes and prevention of disease”. Increasingly the evidence points to the fact that clinical care is only responsible for 10% of health outcomes with factors such as nutrition, exercise, and genomics being far more important.
Thus, a new kind of health and wellness system needs to emerge – but how can this be done?
Curley’s Open Innovation 2.0
As a vice president of Intel, Curley was driven to develop and advance computing technology to connect and improve everyone’s lives worldwide, aligned with the vision that former CEO Paul Otellini had espoused. Curley, therefore, joined the HSE as Chief Information Officer when the opportunity arose to digitally change the Irish healthcare system.
“Open Innovation 2.0” comprises an integrated ecosystem approach based on a Shared Vision, the creation of Shared Value, and the use of Shared Values to drive a structural change in an industry using Digital technology. Design Patterns such as Industrializing the Innovation Process, Ecosystem Orchestration, and Design for Adoption underpin an Open Collaborative Ecosystem. For a summary of OI2 please refer to Curley’s 2016 paper in Nature. https://www.nature.com/articles/533314a
A network of over 50 living labs has been developed and deployed across Ireland where new digital solutions are tested, iterated, and improved in collaboration with clinicians and patients alike.
Curley led the co-creation of a Master in Digital Health Transformation with Annette McElligott of the University of Limerick, whereby all Irish Universities collaborated to create a Master to teach leading Irish clinicians the principles of OI2 and Digital Transformation and involved clinicians designing and delivering a digital change project as part of their class work. Not only was this a great learning experience but a new mechanism for digital change was instituted in the health service as a result.
Curley’s goal is to establish an “Accountable Care Ecosystem in Ireland” where physicians, hospitals, and other healthcare providers collaborate to give the best-coordinated care at the most affordable price.
The Concept of ‘Stay Left, Shift Left-10X’ (SL2-10X)
In his first significant conference as the new CIO of HSE, Curley introduced the concept of “Stay Left, Shift Left” (SL2). He worked in advance with roughly 10 Irish digital health SMEs who were able to align their products/services with this new approach.
The idea behind Stay Left is to use technology to keep healthy individuals in their homes or, if you have a chronic illness or require rehabilitation, to do this as effectively as possible from your own house. Shift Left focuses on utilizing technology to move patients as quickly as possible from an acute setting to a community setting and then to their homes.
Sl2 favors four benefits commonly referred to as the enlarged quadruple aim:
- Better care and outcomes
- Lower cost or better value
- Better patient and clinician experience
- Better patient and clinician quality of life
10X refers to the pattern that Curley pushed and noted that the application of digital technologies in Healthcare could deliver benefits that were 10 times or 10X better than the current system.
Curley’s Law
Curley’s Law, the convergence of exponential technologies, network effects, the information-intensive aspect of healthcare, and the exponential innovation methodology (OI2). This innovation is driving a Cambrian explosion of new digital health solutions that will be the primary force behind health improvement for the ensuing decades.
Delivering 10X benefits (better faster, cheaper, etc..) through the application of exponential technology and an exponential mentality will be a fundamental feature of OI2 collaboration in a healthcare setting. And these technological advances are probably going to generate supra-normal benefits and profits.
Curley recognized both the potential and the trend that digital technologies applied in a healthcare setting could deliver exponential returns. His early analysis showed consistent >10X returns in Ireland living labs and subsequent validation by the University of Bath and Dr. Charles Larkin showed strong empirical validation of Curley’s Law. Like Moore’s Law, Curley’s Law is not a physical law but a competitive challenge for the health industry to continue to deliver exponential improvements and benefits using digital technology as the raw material.
The Two Ronnies
Recently Richard Jones, a serial entrepreneur and President of C2AI described Curley as the equivalent of Maverick in Topgun for Healthcare at the United Nations General Assembly Health Symposium. While Curley was flattered, he readily admits he does not fly missions on his own and is part of a tight group of Digital Health advocates who work together to drive healthcare transformation. Perhaps his closest collaborator is Dr. John Sheehan, Clinical Director of Radiology at Blackrock Health, Hermitage Clinic in Ireland, and Clinical Vice-chair for the IDHLSG. John is also a leader who transcends his daily role to help lead digital health transformation. An avid fan and practitioner of the Japanese IKAGAI principle, John generously opens his home to serve as a base for key strategic meetings of the IDHLSG including leading clinicians, technologists, former Government ministers, venture capitalists, and others. His home is now affectionately known as the ‘Embassy’ and Curley now pins an Irish flag to John’s gate when the IDHLSG is in session.
Sheehan and Curley have become affectionally known as the ‘Two Ronnies’, a nod to Ronnie Barker and Ronnie Costello, two British comedians who spearheaded leading Comedy several decades ago. One of their more famous skits focused on the future of telehealth which was prescient and far ahead of its time.
Transforming with the Team and the Ecosystem
Following two challenging years of Covid, the HSE Digital Transformation team has been able to build momentum and the first of a range of initiatives with like-minded professionals in the healthcare system and ecosystem that are fundamentally changing healthcare in Ireland.
Curley established the Irish Digital Health Leadership Steering Group (IDHLSG) with a group of professionals, patients, and citizens to advocate for the Stay Left, Shift Left 10X implementation in Ireland along with leaders from other sectors of the healthcare industry.
Leaders such as Dr. John Sheehan, Dr. Donal Bailey, Prof Richard Costello, Prof Anthony Staines, Donal Morris, Dr. Charlie Larkin, Mr. Michael Sugrue, and many others have taken on a system that appears not want to change and has a culture that is reptilian to Innovation, despite many excellent clinicians embracing digital solutions.
Famed cardiologist Erik Topol said, “There’s no group more resistant to change than medicine” However, in Ireland, the experience has been different with doctors and nurses embracing change but a small cohort of senior administrators strongly opposing change.
The use of Data-Driven innovation is set to deliver a 10X improvement in understanding of disease but particularly how closed loop Digital Medicine can significantly improve outcomes. Prof Richard Costello’s company Phyxium use of digital therapeutics has shown that 90% of patients with severe asthma can be brought from uncontrolled states to controlled states in a living lab thereby providing much better health to patients while avoiding prescribing a 20k euro biologic.
Curley and the IDHLSG recognize that they are in a culture war to digitally transform a system where there is often resistance. Curley quotes Mohammad Ali who says to be a champion you need skill and will, but the will has to exceed the skill. The IDHLSG leaders are deeply committed to driving a transformation of a challenged health system.
Danger
Machiavelli famously wrote that “It ought to be remembered that there is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success than to take the lead in the introduction of a new order of things”. Because the innovator has enemies in all those who have done well under the old conditions, and lukewarm defenders in those who may do well under the new. This coolness arises partly from fear of the opponents, who have the laws on their side, and partly from the incredulity of men, who do not readily believe in new things until they have had a long experience of them”
A leading Irish broadcaster Jonathan Healy recently referred to Curley as ‘the disruptor in chief’. As an Innovation Professor and as a proven innovator Curley understands resistance to Innovation is normal however what Curley and his IDHLSG colleagues experienced from a small subset of Irish Health executives was ‘extreme’.
Curley is the co-founder of the Innovation Value Institute of Maynooth University. The team is developing a digital health and wellness capability maturity framework (DHW[1]CMF) in collaboration with the open collaborative ecosystem that will serve as a roadmap for the transition and a mechanism to track progress and include strategies and tactics to improve digital health capability and tackle organizational inertia and resistance.
Occasionally Curley gets discouraged but reflects on a famous quote from Gandhi to re-energize “When I despair, I remember that all through history the way of truth and love have always won. There have been tyrants and murderers, and for a time, they can seem invincible, but in the end, they always fall”.
Manhattan Manifesto
Key Health leaders such as Dr. Charles Larkin, Carolyn Gullery, Mary Carabjal, Brian O’Connor, Ryl Jensen, Donal Morris, Dave DeAngelis, Dr. Caroline Whelan, Dr. Ghada Trotabas, Mei Jiang, and fifty others have co-authored the Manhattan Manifesto with Curley. Having a globally aligned manifesto for the digital transition can only accelerate the health and wellness and system benefits for all.
Quote:
Dream, Dare, Do!
Also Read: “The 10 Most Admirable Healthcare Leaders, 2022.”