Future of Surgery - The Emerging View 10 03 16

The
Future
of
Surgery
|
The
Emerging
View

Insights
from
Mul0ple
Expert
Discussions

10
March
2016
The
world’s
leading
open
foresight
program

Context

Discussions
on
the
Future
of
Health
in
2015
were
followed
by
a
deeper

explora0on
of
the
Future
of
Surgery
including
an
event
in
March
2016.

It
is
the
emerging
view
to
be
shared,
challenged,
built
upon
and
enhanced.

Ini0al
View

Feb
2016

Global
Feedback

Mar
2016

Synthesis

Apr
2016

The
Future
of
Surgery
|
The
Emerging
View

This
document
provides
an
overview
of
what
we
heard
from
many
expert

voices
around
the
world
–
on
the
future
of
surgery,
how
it
is
changing,

what
is
driving
this
change
and
how
it
may
evolve
over
the
next
decade.

Six
Key
Themes

Across
the
mul0ple
discussions,
issues
related
to
surgery

seem
to
be
touching
upon
and
connec0ng
with
six
underlying,

and
interwoven,
themes
with
diﬀerent
emphasis
in
diﬀerent
countries.

The
Impact

of
Digital

Technology

Enabled

Change

The
Wider

Team

Funding

Constraints

Agreed

Procedures

Global

Solu0ons

THE
IMPACT
OF
DIGITAL

Data’s
Impact
on
Health

BeUer
use
of
data
and
technology
has
the
power
to
improve
health,

transforming
the
quality
and
reducing
the
cost
of
health
and
care
services.
It

can
give
pa0ents
more
control
over
their
health
and
empower
carers.

Everything
Connected

By
2025
over
1
trillion
sensors
are
connected
to
mul0ple
networks:
Everything

that
can
benefit
from
a
connec0on
has
one.
We
deliver
10,000x
more
data

100x
more
effec0vely
but
need
to
make
sense
of
the
informa0on
that
flows.

Universal
Healthcare
Data
Access

Informa0on
silos
are
connected
via
third
par0es
able
to
unify,
mine
and

discover
new
insights.
Integrated
public
and
private
datasets
provide
holis0c

views
of
the
individual
and
value
shiZs
to
decision-‐making
analy0cs.

Data
PrioriFsaFon

An
increasingly
digital
healthcare
system
is
driven
by
access
to
credible
data

that
is
priori0sed
above
the
noise.
The
value
of
such
key
data
increases

as
its
ability
to
unlock
opportuni0es
and
improve
diagnosis
rises.

Digital
Autonomy

Increasing
access
to
more
personal
and
group
data
allows
individuals
to
take

informed
views
on
their
health.
As
informa0on
is
decoupled
from
the

professions,
the
public
become
more
speciﬁc
about
their
needs.

Ubiquitous
Tracking

Health
monitoring
through
the
use
of
wearables
and
implants
improves
and

more
people
share
their
data
with
trusted
independent
plaorms.
Poten0al

issues
are
predicted
and
dealt
with
earlier
–
so
fewer
interven0ons
are
needed.

A
Data
Marketplace

Data
is
a
currency,
it
has
a
value
and
a
price,
and
therefore
requires
a

market
place.
An
ecosystem
for
trading
data
is
emerging
and
anything

that
is
informa0on
is
represented
in
a
new
data
marketplace.

Data/Human
Teaming

Faster
and
more
convenient
access
to
raw
and
sophis0cated
data
analysis,

through
mobile
and
wearable
technologies,
means
that
data-‐enabled
decision

making
will
increasingly
become
the
norm
for
consumers
and
ci0zens.

TECHNOLOGY
ENABLED
CHANGE

Through
Body
VisualisaFon

High
resolu0on
imaging
and
fast
developing
holographics
provide
us

with
the
ability
to
see,
interrogate
and
explore
within
the
body

before
ﬁrst
incision
–
as
well
as
throughout
the
surgical
process.

Real-‐Time
Bio-‐Manufacturing

In-‐theatre
prin0ng
of
bio-‐materials
brings
mul0ple
opportuni0es

for
the
3D
building
of
biological
0ssue
and
bespoke
organs.
We
can

create
replacement
parts
that
are
made
from
our
‘own’
cells.

Nothing
is
Hidden

Everything
in
the
opera0ng
room
is
tagged
and
interconnected.

Physical,
chemical
and
wireless
sensing
link
with
open,
transparent,

interrogable
data
sets
allow
us
to
see
what
was
previously
unknown.

Remote
RoboFcs

Miniaturised,
data-‐rich
and
increasingly
autonomous
robo0cs
enable

the
surgical
team
to
improve
eﬃciency
and
impact.
Gesture-‐based

control
allows
surgeons’
requirements
to
be
automa0cally
recognised.

Smarter
Sensor
Systems

Ubiquitous,
miniaturised,
intelligent
systems,
built
around
common
standards,

enable
an
aﬀordable,
pervasive
and
connected
world.
This
leads
to
improved

security,
greater
personalisa0on
and
the
‘massiﬁca0on’
of
data.

Full
ManipulaFon

Mul0-‐axis,
conformable
manipula0on
devices
allow
surgeons
beUer

and
less
invasive
access
within
the
body.
Coupled
with
more
accurate

posi0oning
and
precision
ac0ons,
collateral
0ssue
damage
is
minimised.

Specialised
Training
SimulaFon

As
surgeons
focus
on
being
more
expert
at
fewer
procedures,
the
use
of

simula0on
in
training
increases.
Virtual
and
augmented
reality
become

commonplace
and
accelerate
familiarity
with
technologies
that
enter
the
OR.

The
Rise
of
Machines

The
growth
in
the
intelligence
and
capabili0es
of
machines
presents
both
a

threat
and
an
opportunity.
Greater
automa0on
frees
up
0me,
but
also
has

the
poten0al
to
threaten
more
jobs
in
managerial
or
administra0ve
roles.

Complex
CollaboraFon

Increasingly
integrated
services,
end-‐to-‐end
provision
as
well
as
deeper

and
wider
collabora0on
provide
the
ability
to
work
more
eﬀec0vely

within
a
system
designed
for
con0nuous
improvement.

CollaboraFve
Business
Models

Partnerships
shiZs
to
become
more
dynamic,
agile,
long-‐term,
democra0sed

and
mul0-‐party
collabora0ons.
Big
challenges
are
addressed
by
global
groups

of
diverse
stakeholders
built
around
new,
non-‐ﬁnancial
incen0ves.

High
Quality
Support

Surgeons
are
are
like
technicians
-‐
the
more
surgeries
they
perform,
the
beUer

they
get
at
it.
But
behind
every
skilled
doctor
you
need
to
have
at
least
two

highly
skilled
nurses,
at
least
four
or
ﬁve
technicians,
and
good
administrators.

Shared
Authority

Decision
making
authority
is
shared
by
surgeons,
pa0ents,
and
other

clinical
and
opera0onal
staﬀ.
There
is
increasing
emphasis
on
the
complex

range
of
agendas,
understanding
and
responsibili0es
in
play.

Stressed
Surgical
Load

The
supply
/
demand
limits
of
the
overall
surgical
load
is
increasingly
tested
in

some
areas
due
to
an
imbalanced
surgeon
pool,
increasing
pa0ent

expecta0ons
and
regulators
focused
on
performance-‐led
eﬃciencies.

MoFvated
Surgeons

Industry
eﬀorts
are
taken
to
re-‐mo0vate
the
surgeon
pool.
These
include

more
public
discourse
about
surgery,
greater
alignment
of
process
and

pa0ents
and
system
wide
ini0a0ves
toward
improving
its
image
and
credibility.

The
Healthcare
Debt
Time-‐Bomb

The
rising
cost
of
healthcare
results
in
ra0oning
and
the
end
of
universal

healthcare.
Individual
health
budgets,
preven0on
technology,
migra0on
and

working
longer
all
increase
as
new
approaches
seek
to
improve
eﬃciency.

IncenFves
in
Flux

Budgetary
pressures
con0nue
and
reimbursement
models
will
need
to
change.

There
is
greater
emphasis
on
paying
healthcare
providers
based
on
measurable

outcomes,
rather
than
simply
for
the
number
of
procedures
they
perform.

Living
While
Dying

We
will
see
policy,
product
and
service
innova0ons
in
the
ﬁeld
of
end-‐of-‐life

planning.
Businesses
and
professions
will
come
to
recognise
the
need
to

provide
more
(end-‐of)
life-‐style
choices
to
individuals
and
consumers.

EnFtlement
is
not
Universal

The
implica0ons
for
some
are
clear:
we
need
a
diﬀerent
healthcare
model,

we
need
technology
to
really
deliver
improvements
at
scale
and
at
low
cost

and
to
reduce
the
level
of
cover
to
a
good
propor0on
of
some
popula0ons.

CollecFve
AcFon
to
Control
Chronic
Disease

To
stem
the
runaway
costs
of
trea0ng
chronic
diseases,
mul0ple
stakeholders

collec0vely
seek
to
halt
key
condi0ons:
Remote
monitoring,
educa0onal

programmes
and
focused
budgets
are
all
integrated
around
common
aims.

Sustainable
Healthcare

With
limited
resources,
rising
demand
and
escala0ng
costs,
decoupling

healthcare
spend
from
economic
growth
is
a
global
challenge.
A
more

sustainable,
integrated
model
may
emerge
from
beyond
the
US/EU.

Prescribed
Surgery

Payers
increasingly
dictate
how
surgery
is
performed
based
on
quality
and

cost.
League
tables
of
hospitals
and
surgeons
and
wider
sharing
of
informa0on

provide
greater
transparency
that
helps
to
deﬁne
the
op0mal
approaches.

Personalised
Healthcare

For
the
privileged
few
with
access,
personalised
healthcare
tailored

around
individual
medical
and
pyscho-‐social
needs
provides
therapies

that
are
beUer
aligned
with
speciﬁc
rather
than
generic
proﬁles.

InfecFous
Diseases
Post-‐Ebola

The
world
prepares
for
infec0ous
disease
outbreaks
with
renewed
vigor.

There
is
increased
prepara0on
and
coordina0on
among
both
public
and

provider
stakeholders
and
greater
investments
in
early
warning
systems.

ElecFve
PrevenFon

Equipped
with
greater
understanding
of
the
individual’s
gene0c
predisposi0ons

and
new
interven0on
technologies,
we
proac0vely
undertake
minimally

invasive
surgery
and
reduce
the
need
for
major
surgery
in
later
years.

Greater
Evidence

Wider
genera0on
and
sharing
of
data
shiZs
the
scale,
type
and
accuracy
of

evidence
used
to
make
decisions.
The
best
procedures
become
more
visible

and
are
beUer
supported
by
payers,
surgeons
and
the
wider
health
industry.

PrevenFon
Wake
Up
Call

The
combina0on
of
spiraling
healthcare
costs
and
a
subsequent
demand
for

eﬃciencies,
leads
to
the
‘wake
up
call’
for
all
payers
with
less
focus
on
costly

correc0ve
procedures
and
greater
emphasis
on
the
ability
to
keep
people
well.

MulF-‐Step
Care
Journey

The
idea
of
surgery
as
a
discrete,
scheduled
interven0on
is
replaced
by

an
understanding
of
surgery
as
part
of
mul0-‐step
process
involving

tailored
planning,
prepara0on,
aZercare.

Sources
of
Global
SoluFons

Global
healthcare
aﬀordability
will
not
come
from
the
Unites
States
…

but
rather
from
those
na0ons
of
the
world
that
have
liUle
today
and
have
no

choice
but
to
perform
at
the
highest
levels
possible
in
the
future.

Need
for
Process
InnovaFon

Today,
most
healthcare
interven0ons
are
not
accessible
to
nearly
90%
of
the

world’s
popula0on.
The
way
forward
is
not
a
new
medicine
or
a
new
scanner

or
a
new
opera0on
-‐
it
is
a
process
innova0on
to
bring
healthcare
to
everyone.

Small
and
Distributed
Surgery

With
the
democra0sa0on
and
digi0sa0on
of
personal
health
data,
surgical

support
shiZs
to
more
local
systems
for
earlier,
minimal
interven0on.
Providers

correspondingly
become
smaller,
de-‐centralised
and
more
outcome
focused.

Greater
RegulaFon

Rising
regula0on
drives
up
costs,
reduces
innova0on
and
limits
small

companies’
ability
to
develop
new
products.
As
global
and
regional
standards

become
more
stringent
proac0ve
lobbying
by
larger
organisa0ons
increases.

Mass
Medical
Tourism

Medical
tourism
goes
main-‐stream
as
low-‐cost
cardiac
surgery
and
broader

healthcare
provision
join
den0stry
and
cosme0c
surgery
to
have
global
impact.

Western
systems
pay
for
pa0ents
to
travel
to
leading
loca0ons
abroad.

Human
Approach

We
see
a
diverse,
plural,
human-‐centric
approach,
or
simply
wider
access.

Pa0ents
are
treated
as
individuals,
and
technologies
emphasise
usability

and
ergonomics
as
much
as
their
innate
technical
func0onality.

Some
QuesFons

From
these
discussions
on
and
around
the
future
of
surgery,
there
seems
to

be
a
number
of
key
ques0ons
to
be
addressed
by
payers,
providers
and

pa0ents
–
some
global
and
some
more
local
or
regional
in
focus.

1.  In
an
increasingly
cost-‐conscious
world,
how
will
payers
take
greater
control
away
from

surgeons
and
pa0ents
and
who
will
set
the
global
prices?

2.  How
quickly
can
we
knit
together
the
mul0ple
data
streams
to
make
more
informed

decisions
and
reduce
systemic
waste?

3.  With
more
technology
in
the
opera0ng
room
and
increased
automa0on
will
the
surgeon

remain
the
team
leader?

4.  As
ever
more
global
standards
emerge,
how
will
individual
states
and
health
systems
best

op0mise
healthcare
delivery?

5.  How
will
the
pa0ents
voice
be
heard
in
the
changing
system,
both
in
terms
of
choice
as

well
as
(co)funding
of
surgery?

Future
Agenda

84
Brook
Street

London

W1K
5EH

+44
203
0088
141

futureagenda.org

The
world’s
leading
open
foresight
program

What
do
you
think?

Join
In
|
Add
your
views
into
the
mix

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Future of Surgery - The Emerging View 10 03 16

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