There are significant challenges facing UK and US healthcare systems that have been exasperated by the COVID-19 pandemic. In this deep dive and following a series of interviews with key stakeholders in both regions, we take a look at the C-Suite perspectives on the current challenges they face on the frontline of care.
Proximie was originally designed by surgeons for surgeons and is therefore committed to being a customer-led solution for optimising efficiency and outcomes in the operating room, meeting the needs of healthcare managers and surgeons alike. The voice of our customer matters.
“The voice of our customer matters.”
To that end, we conducted a series of one-hour long interviews with a targeted list of senior healthcare stakeholders not familiar with Proximie, we spoke to individuals from a variety of locations, system types and senior job roles in the US and UK, to help identify the challenges and opportunities within their given healthcare systems.
Across the US and UK, respondents during these interviews identified a variety of healthcare system challenges.
1. Workforce retention
The workforce challenges faced by clinicians in the US and the NHS in England present a significant risk to patient safety and staff wellbeing.
The US faces a deficit of 450,000 nurses by 2025, with the shortage contributing to a patient-to-nurse ratio being stretched to suboptimal levels. In England, the workforce plan produced by the NHS says the health service is already operating with 154,000 fewer full-time staff than it needs, and that number could balloon to 571,000 staff by 2036 on current trends.
Fundamentally, health systems can only function with health workers; improving health service coverage and realising patients’ rights to access the highest attainable standard of health is dependent on the availability, accessibility and quality of staff.
Respondents during the interviews raised comments about:
One of the respondents, a COO from the UK, explains: “It is a bit of a perfect storm because we haven’t got enough staff, we haven’t got enough theatres and at the same time you have got more and more demand coming through the door.”
There is also an unseen cause that is affecting workforce retention and recruitment – and that’s employee peace of mind about personal safety. Patient safety is not possible without a workforce that is physically and psychologically safe. Workforce safety and patient safety go hand in hand, and in turn have a direct impact on workforce recruitment and retention.
"Workforce safety and patient safety go hand in hand, and in turn have a direct impact on workforce recruitment and retention."
During our discussions it became apparent that there are significant workforce safety challenges to overcome, many of which could be solved by bringing cameras into the operating room to be able to record and objectively understand the human factors that can contribute to a safe and efficient OR.
2. Patient safety
Proximie’s patient safety in surgery report brought to life new analysis related to surgical procedures and new research with 1,500 patients that revealed an equally worrying picture of declining patient safety standards in surgery (1). The report highlighted an increased number of patient safety incidents and a lack of real progress to reduce the number of Never Events.
Limited staffing is adding further pressures to the elective backlog across both the US and the UK, with surgeries being cancelled or postponed due to insufficient numbers of staff who are able to conduct the surgery safely.
In the US alone, over 200 deaths happen each year from hospital errors, injuries, accidents, and infections (2).Medicare patients in the US have a 1 in 4 chance of experiencing injury, harm or death when admitted to a hospital (3).
“In short, the current status quo won’t do.”
3. Increasing demand, either from waiting lists or population growth.
According to statistics, the average person will need anywhere between five and eight surgical procedures over the course of their lifetime (4); surgery is something that affects all of us.
By 2032, the United States will have a shortfall of as many as 23,000 surgeons, an issue that will be exacerbated by a growing, ageing population with increasingly complex health needs (5). The number of people aged 65 and older is expected to reach 83.7 million in 2050, almost twice the 2012 level of 43.1 million, according to the U.S. Census (6).
NHS England figures show the waiting list for NHS consultant-led hospital treatment grew to a record high and now stands at 7.75 million people at the end of August 2023, which is up from 7.68 million in July. It is the highest number since records began in August 2007.
In the US, millions of elective surgeries and other non-urgent procedures have been delayed as a result of the pandemic. Many hospitals are struggling amid staffing shortages, inpatient bed availability and operating room (OR) capacity to expand patients’ access to surgical care and clear the backlog in cases. These delayed surgeries have also had a significant financial impact.
During the interviews, participants cited this increasing demand as having a significant impact on patient care.
A CFO in the US interviewed, explains: "Our biggest concern right now is population growth. We have experienced so much growth and we cannot keep up."
"Our biggest concern right now is population growth. We have experienced so much growth and we cannot keep up."
4. Tighter budgets since the pandemic
Meanwhile in the US, the combination of higher healthcare costs and the increased inability of employers, consumers and the government to meet rising prices is placing a similar strain on budgets. By 2027, US healthcare costs are predicted to be up to $590bn higher than pre-Covid-19 estimates made in 2019. Again, this is partly due to soaring inflation, but also the rising cost and shortage of clinical staff; the US is expecting a shortfall of more than 200,000 registered nurses and 50,000 physicians over the next three years. On top of that, the increased testing, vaccination and treatment of Covid-19 is projected to add up to another $220bn in annual costs over the next five years.
The NHS is facing a £7bn cash crisis amid inflation and increased strike action, partly brought about by the budgetary demands of dealing with the Covid pandemic. Now, as a result of soaring inflation and high energy costs devaluing healthcare budgets even further, and the current NHS funding settlement being front-loaded to provide more money earlier to help deal with the burdens imposed by the pandemic (e.g. providing free lateral flow tests to staff, which are no longer centrally funded by government), the Institute for Fiscal Studies has said the NHS is facing real-term budget cuts in 2023-2024 and 2024-2025 (7).
Proximie: tailoring the solutions to the challenges
These challenges are faced by healthcare systems everywhere, not just somewhere. Every healthcare system now effectively needs to do more, with less. But how do we achieve greater productivity in an area of healthcare as analogue as the operating room? By inherently understanding the system and its pain points, we can collectively drive change in any given system. Proximie is not a point solution, it is a software that drives system level change. Integral to achieving this aim has undoubtedly been Proximie's software-first design, which means we can plug-in our software to any existing hardware within any operating room.
“By inherently understanding the system and its pain points, we can collectively drive change in any given system. Proximie is not a point solution, it is a software that drives system level change.”
Building and refining a technology like Proximie means you have to adapt for different environments, and we’ve been working tirelessly on how we can utilise the cloud for better connectivity, because when it comes to surgery, it can be a matter of life and death. The quality and the milliseconds do really matter, so this experience needs to always be seamless, whether you are in Boston, London, Delhi, Nairobi or Antarctica.
(1) Proximie Patient Safety in Surgery Report: January 2023.
(2) McKinsey & Company: Assessing the lingering impact of COVID-19 on the nursing workforce May 11, 2022.
(3) The New England Journal of Medicine: The Safety of Inpatient Health Care, David W. Bates et. al. Jan 2023.
(4) Journal of the American College of Surgeons 207(3):S75 DOI:10.1016/j.jamcollsurg.2008.06.186
(5) The Association of American Medical Colleges: Desperately seeking surgeons report: April 26, 2019.
(6) An Aging Nation: The Older Population in the United States, Population Estimates and Projections Current Population Reports Issued May 2014.
(7) NHS funding, resources and treatment volumes, Institute for Fiscal Studies, M Warner 2023.