Building a GPS for doctors – the potential of learning elimination in health care
Many regions in low- and middle-income countries (LMICs) struggle with a shortage of trained health workers, making it more difficult to fulfill the high demand for health care. Creating digital short-cuts for frontline health workers to gain the expertise they need could be part of the answer.
The views expressed are those of the author and do not necessarily
reflect the position of Re:solve Global Health.
In the 1980s, London’s taxi companies had their work cut out for them. Every single one of their drivers needed to pass “The Knowledge”, possibly the most difficult test in the world, certifying that they were intimately familiar with the city’s 25,000 streets and any business or landmark on them.
Then someone invented GPS, and everything changed. Suddenly, anyone could navigate a taxi through London’s streets, and do it well. With real-time data they could even outperform experienced local cabbies. Thousands of hours of study and a series of gruelling examinations were obsolete.
Learning innovator Nick Shackleton-Jones uses this example to explain the concept of learning elimination. It is a phenomenon not only in London’s taxi market, but also in a wide variety of business and service sectors – including healthcare. I believe learning elimination has the potential to help us solve some of the greatest healthcare challenges of our time, if we can embrace it.
Imagine a GPS for frontline healthcare workers navigating a care journey with their patients. A digital compass filled with resources and guidance that allows people with little existing capability in a specific therapy area to get up to speed very quickly.
When we imagine this scenario it’s easy to picture smart devices in the workplace, providing expert step-by-step advice. However, guidance and resources can also be much simpler. The process begins by understanding what health care professionals need in order to offer good quality care for patients and then providing simple tools that help get the job done.
Digital tools to support better diabetes care
I’ve spent many years in the field of diabetes – and believe this is an area where learning elimination could be transformative.
Diabetes is a global health crisis that is hitting low- and middle-income countries (LMICs) the hardest. Today, nearly 350 million people in LMICs live with diabetes and 77% of these do not receive adequate care. That number is expected to grow to 450 million by 2030, putting immense pressure on healthcare workers and healthcare systems. Yet, many healthcare professionals in LMICs lack the skills and resources to prevent, diagnose and treat diabetes.
We’re about to test the theory of learning elimination on a global scale. In April 2021, Novo Nordisk A/S and the Novo Nordisk Foundation announced a joint donation of 100 million Danish Krone (DKK) (approx. 13.5 million Euros) to the World Diabetes Foundation (WDF) to kickstart a new global initiative: The Diabetes Compass. It is a commitment to improve quality of care in LMICs by leveraging emerging digital resources to find new ways of enhancing the capability of healthcare professionals to prevent, diagnose and manage diabetes.
Why now? One hundred years ago, the discovery of insulin revolutionised the treatment of diabetes. Today, technology is driving change in health care, and the emergence of new digital health solutions and technological innovations offers great potential for disrupting existing educational models. These digital solutions can provide more doctors, nurses and community health workers with low-cost, personalised assistance – helping them to better serve their patients.
The Diabetes Compass reflects WDF’s long-term support for digital health solutions in LMICs and joins a growing movement to use simple, digital resources to support health care professionals in their work. The Diabetes Online Risk Assessment (DORA) initiative was launched across 12 African nations to provide an accessible web‐based tool for diabetes risk stratification. Digital Clinical Decision Support (CDS) tools are being used to teach community health workers with little or no training to deliver evidence-based care – this is happening with malaria management in Kenya and cardiovascular screening and management in rural India. These projects support task‐shifting from doctors to community health workers without developing formal training curricula. They also allow resource-constrained health systems to better identify patients needing specialist review.
There are most certainly challenges, both technical and financial, to scaling up these types of digital solutions in LMICs. But trends all point to a world in which these challenges can be overcome. The time will come when local health organisations can drag and drop functionalities into software product templates, plug into the latest treatment guidelines, and connect with third‐party services such as remote diagnostics.
Creating user-friendly solutions
Digital innovation is fueling the movement toward human‐centred design, where solutions are created in close consultation with end‐users. In the process, digital health is being transformed. The Diabetes Compass will be developed together with the users and based on an understanding of their lived experiences and everyday challenges. The goal is to put digital resources in the hands of healthcare workers in LMICs, strengthening their ability to deliver the right diabetes care at the right time.
Not every medical challenge can be solved with simple digital resources. Yet digital tools have the potential to enable even the most hard-pressed healthcare systems deliver better performance with their existing workforces, without significant investment in costly capability building programmes.
We recognise that it can be hard for people and systems accustomed to traditional learning approaches to embrace learning elimination and let go of the idea that what is most important is filling peoples’ heads with information. Moving from building individual capability to building health system capability requires thinking, and acting, in new ways.
But if we can let go, we can empower healthcare professionals to improve outcomes for people with diabetes – and many other conditions as well.