A Future-savvy Health & Care: Transition in Progress

The future of the Health & Care sector is uncertain, but one thing is certain: the sector is at the beginning of a transition. How does such a major transition work? Derk Loorbach, director of DRIFT and professor of Socio-economic Transitions at Erasmus University, explains the process around transitions.

"Technology, economics, behaviour, culture, ecology and worldviews/paradigms. Transitions are systemic changes that result from interacting changes in all these dimensions. Transitions takes place from a dynamic equilibrium to another equilibrium through a jerky, abrupt and chaotic process. But according to the theory they do follow specific patterns of build-up and break-down. Three factors bring about this transition:

• The dynamic equilibrium leads to a decrease in resilience and diversity,
• The environment changes, which leads to tensions with the increasingly rigid regime and
• Deviations from the norm occur. There are many indications that we are now in the middle of such a process."

An expected surprise

"We do not view COVID-19 as something that triggered this transition, but as an expected surprise. Many people had warned of a pandemic, but obviously it was never clear when and how it would occur. Such ‘expected surprises’ however are everywhere. If there are indications that a system is increasingly reaching its limits, then you can wait for disruptions and crises. These accelerate the transition dynamics that push us out of equilibrium. For example, we have been in the run-up to the next healthcare transition for 20 years, but the dominant system itself is very stable and resilient. 

But in society, a huge shift has already taken place, with a greater focus on sustainability, digitalisation and international knowledge sharing. At the same time we have developed alternative concepts, technologies and practices, for example around social obstetrics, public health, positive health. COVID-19 is increasing the societal pressures on the health care system from society and accelerating investment in and support for alternatives. Ideally, we will now see a more profound shift to a society based on health with a largely reduced health care-system."

"People now see that things must and can be done differently. Where these transitions are visible on a small scale, they can already be used as a starting point or as a building block for the new system." - Derk Loorbach, director of DRIFT and professor of Socio-economic Transitions at Erasmus University

Transition management

"Transition management is an approach developed to help guide and accelerate desired transitions, that requires determining a direction and formulating missions. Transition management consists of four dimensions. First, an analysis of where the current system is failing and identification of the design principles for a health system in the future. The second focuses on building new ways of thinking, working and organising, such as developing an integrated health policy, training the future workforce in the health sector differently and developing new technologies that serve those guiding principles. 

The third is about adapting the existing system, changing the existing rules, regulations and conditions so that the new practices break through. How are people assessed and rewarded? What is being made possible? How are things regulated legally? The final dimension is about phasing out. This is simple for food and energy: coal-fired power stations are being closed and intensive livestock farming is being phased out. But you can also phase out in healthcare. If you are going to invest in prevention, you need to cut back in cure and care."

Towards a resilient society

"The greatest possible diversity of relevant perspectives is essential for such a transformative, mission-driven, innovation policy, in which the building, converting or dismantling of the current system is examined. Transition processes furthermore need to start from a future vision of health beyond the present system and look for promising alternatives that are not present in the current, but could be part of the health system in the future. Examples are a healthy environment, healthy mobility, debt breathing space and new food initiatives.

People now see that things must and can be done differently. Where these transitions are visible on a small scale, they can already be used as a starting point or as a building block for the new system. It is a long and tough process. But I see progress. Together we are working on healthy communities and a vibrant economy in a resilient society."

This interview is also published in Year in Preview 2021, which is filled with the most important developments in the Dutch Life Sciences & Health sector and provides a glimpse of what’s on the map for 2021. Read the Year in Preview here!