My year as a Harkness Fellow with Kaiser Permanente

October 18, 2022

My year as a Harkness Fellow with Kaiser Permanente

By Angel Arnaout, MD, MSc, FRCSC, FACS, MBA 

Angel Arnaout is an independent researcher who participated in the Commonwealth Fund’s Harkness Fellowship in Health Care Policy and Practice Innovations. Although HEC supports the recruitment of fellows from Canada for this program, the views expressed herein do not necessarily represent the HEC’s views, or our funder, Health Canada.  

The new digital age of medicine has the potential to democratize access to care, improve efficiency and support patients as they actively engage with their healthcare. As organizations struggle with adopting digital technologies, innovative design approaches are an excellent way to envision a future configuration of health services that effectively uses digital resources. 

I explored this topic of digital transformation in healthcare for an entire year in the United States during my fellowship with the Commonwealth Fund’s Harkness Fellowship in Health Care Policy and Practice Innovations (“fellowship”) in 2021.Under the mentorship of the Cancer Quality and Digital Strategy Team at the Kaiser Permanente Headquarters in California, I contributed to the integration of digital technology into the cancer system strategy and helped identify methods to transform the way cancer care is delivered and received.  

Five key things I learned from my Harkness Fellowship

My time during the fellowship was spent participating in strategy meetings, conducting in-depth interviews with key opinion leaders in the field, examining Kaiser Permanente’s existing standard operating procedures for virtual care services, and envisioning possible future digital patient and provider touch points along the entire cancer care continuum. From this research, five key themes emerged. 

  1. Successful digital health initiatives require an integrated enterprise-wide strategy with buy-in at all levels in the short and long-term.  Digital transformation is not about the technology or tool itself but also about operations, workflow integration, and the patient and provider experience. A strategy that values this commitment with robust, long-term funding and alignment of provider incentives will contribute to successful integration. 
  2. Digital technology needs to be used in a way that is appropriate, personalized and compassionate for the patient.  The pandemic has demonstrated the need for humanity in care delivery. At this time, digital technologies have reduced the ability to incorporate touch and recognition of non-verbal cues in the patient-provider interaction. Proper training in the use of digital technology for both the provider and patient, as well as a heightened sensitivity for non-verbal cues on the part of the provider, can help deliver a compassionate, patient-centric digital cancer experience. 
  3. The quality of care delivery needs to be inherent to digital health technologies.  Just like in-person care, virtual care must satisfy the requirements of quality and safety (effectiveness, timeliness, equity, patient centricity, efficiency). Traditional metrics to assess these quality domains can be modified and tailored for digital technology use.  
  4. Digital technology can contribute meaningfully to evidence-informed care delivery and healthcare system sustainability.  The benefits of digital technology not only include the ability for passive capture of data regarding patterns of care but also the ability to have provider/patient support systems that encourage practices in accordance with evidence-informed care. Data can be used to assess gaps between evidence-informed guidelines and real-world practices, and recommender systems (algorithms that synthesize information and provide a recommendation) can support evidence-based behaviours. 
  5. Digital tools and analytics can be used to improve cancer care at a population level.  Artificial intelligence can be used to anticipate the future demand for healthcare services and identify the proper complement of services required to deliver the best outcomes for a specific population. These services should include community services that address the social determinants of health.  

In addition to these considerations for implementation, there are implications for policy-makers as well. Although my area of focus was on cancer care, these principles can be applied in multiple care and policy settings.   

  1. There is a need for a cohesive national digital cancer strategy to adopt new technologies through a unified, systematic, and evidence-informed approach. The strategy should embed the ability to conduct rapid experimentation on technologies on a large scale to inform the evidence for its use.  
  2. Metrics need to be developed to assess the quality and safety of care. Along with ongoing evaluation, monitoring and improvement.
  3. The healthcare workforce needs to be equipped for a digital future. Digital technologies can augment skillsets. Digital services can help automate certain simpler tasks so that providers can focus on safe, timely and compassionate care. Culture change, education and training can also be more purposefully implemented on a large scale. 

The fellowship helped me solidify my career goals and build on the skills needed to get there. Although I am still a full-time practicing surgeon, my view of cancer care delivery at a healthcare systems level has changed, and my focus is on using my skills to both help the individual patient and the population. The single-payer healthcare system in Canada has the unique ability to address cancer system challenges and deliver large-scale improvements at a population level. Digital technology use is integral and can be leveraged for this purpose.  

With the learnings I’ve gained from this fellowship, I look forward to opportunities to work with regional, provincial and national Canadian healthcare system partners and the Commonwealth Fund to impact global healthcare change and policy positively. 

Are you someone who likes to tackle sticky health policy and practice issues? Learn more about the fellowship and how to apply.

Looking for resources to improve virtual care delivery?

HEC, in partnership with Canada Health Infoway, has developed a Virtual Care Clinician Change Toolkit to help others deliver safe virtual care.