Changing organisational culture in healthcare


Bupa Asia Pacific CEO, Hisham El-Ansary’s keynote speech at the Healthcare Leaders Forum, Sydney.

Thank you. Let me start by acknowledging the Gadigal people of the Eora Nation on whose land we gather today and pay my respects to their elders past, present and emerging. 

As Australians, and healthcare leaders, we are justifiably proud of our health care system – it is without doubt one of the best in the world. 

The pandemic has in many ways highlighted its strengths, but it has also exposed its limitations. 

Today, our healthcare system is operating at full capacity. In my home state of Victoria, there have reportedly been seven code reds declared this calendar year alone. That compares with nine between 2017 and 2021. It points to the extreme stress our acute, primary and aged care sectors are under – not to mention the impacts on our healthcare workforce. 

To build a healthcare system that’s fit for the future, I believe there are two significant cultural shifts we need to make: 

- Firstly, as a sector, we must proactively drive reform. Historically, we have taken comfort in the strength of our system. But in doing so, we have ignored some of the changes necessary to ensure it is ready to withstand the challenges of a rapidly ageing population, which is driving increases in chronic disease, as well as the growing pressure on household and government budgets. We cannot expect governments alone to drive the reform agenda. 

- Secondly, we need to re-orient the delivery of healthcare by putting consumers at the centre. This will necessarily require us as a sector to collaborate better by providing healthcare experiences that respond to consumers’ changing expectations. 

Most other sectors have already re-oriented themselves towards the consumer. We’ve seen monumental change, propelled by technology, data analytics and digitisation to remove friction from the customer experience and empower them to demand better service, better products and, importantly, a better experience. Take banking for example – banking apps and the ability to transact online 24/7 are now very much a part of our everyday lives. For most of us, waiting in queues at our local branch is a thing of the past – and thank goodness for that! 

But while we have seen industries adapt to changing consumer needs, in healthcare we are moving much slower: 

o We still have a health sector that is largely structured vertically, designed to optimise for the provider. As we know, the increasing numbers of people living with chronic conditions travel horizontally through the system and that requires a much greater degree of integration and coordination of their care needs. 

o This is not managed care as some would have you believe! It is about responding to the evolving needs of consumers. In this way, we are able to address the dual objectives – which are often postulated as being in conflict – of improving the quality of care, whilst also slowing down the rate of growth in system costs. This will help us achieve what I think are the fundamental objectives of a well-functioning health system: to deliver the right care, in the right setting, at the right time. 

By embracing these ideals, we can break down the historic information asymmetries that have existed between health consumers and providers. We need to provide consumers with better quality information so that they can make their own informed choices. 

Today, I’d like to propose three areas that will help drive the cultural shift necessary to put consumers at the centre of healthcare, and thereby support its strength and sustainability over the long-term. 

Hisham El-Ansary, Bupa APAC CEO

Firstly, some aspects of healthcare in this country are governed by dated regulations that haven’t kept pace with consumer preferences, including the focus on wellness and the rise in chronic disease. 

Arguably, since the launch of Medicare in 1984, there has not been substantial reform in healthcare. Back then, the life expectancy for a male, at birth, was 72.1 years and the system was designed largely around treating acute illness. Today, we are doing a great job keeping people alive longer, albeit with chronic conditions. A male born in 2020 can expect to live to 82.1 years – that’s an amazing 10 year improvement in less than four decades! 

To build upon our success to date, is it now time for us to consider the next wave of reform? 

Let’s take an area close to my heart, private health insurance, as an example: 

- Directly and indirectly, the sector contributes more than $61bn to the Australian economy each year and also adds to the wellbeing of nearly 50% of the population. 

- McKinsey found that a 10% drop in PHI membership would mean 1.5 million more people would become fully dependent on the public health system. Hospital waiting lists would increase by more than 90%; this is the equivalent of an additional 3,600 hospital beds or the capacity of our four largest hospitals. 

And yet, so often we hear about a lack of relevance and perceived value when it comes to private health insurance. 

As an organisation, our job is to deliver on our customers’ needs. The original Health Insurance Act was established in 1973, and today, health insurers continue to be constrained to largely funding health care for acute conditions in hospital settings. 

As I mentioned previously, this no longer meets the healthcare needs of today’s consumers. 

We must offer consumers a frictionless experience as they travel through the system; one that is integrated and therefore easy to navigate; and one that can address funding of preventative health programs as well as end-to-end care pathways. It will require a re-think of the rules and regulations that govern our sector, as well as a shift in our mindset. This is something we at Bupa have been advocating for some time now amongst policy-makers. 

We don’t need new regulators, but what we do need is a regulatory overhaul that addresses product relevance, particularly given our system of community rating which relies on the participation of young, healthy people to support generally older claimers. 

It is pleasing that over the past two years we’ve seen growth in health insurance participation in Australia, on the back of successive years of decline. My belief, however, is that the structural factors that were diminishing the value proposition for our young people pre-COVID have not changed, and over the medium-term, we will continue to see declines. 

To be attractive and relevant, we must have the ability to offer products that appeal to younger Australians. 

Our research found that 85% of millennials are actively managing their health and wellbeing. Allowing insurers to fund wellness and lifestyle products – like gym memberships, skin care products and services, as well as a range of alternative therapies including naturopathy and aromatherapy – that are relevant to younger peoples’ desire to invest in their health and wellbeing would undoubtedly increase their participation. It will also promote healthier lifestyles, removing pressure on our health system in the longer-term. 

While the evidence-base is not always well established for some of these therapies, it is evident that the science generally lags consumer preferences. And if consumers believe that something is valuable, then as a provider, why shouldn’t we be able to fund it? 

The second area in which we can drive a cultural shift is to embrace digital delivery because it’s what consumers want and it provides the opportunity to take pressure off our healthcare system which, as we all know, is under unprecedented pressure. 

The AMA, amongst others, have recently commented on the crisis that is unfolding in our public hospitals1 with increased wait times for surgery, and hospital overcrowding impacting access to emergency care and elective surgeries. The challenge before us is how we leverage digitisation to help address this imbalance. 

We saw demand for telehealth skyrocket during the pandemic and since then it has continued – in the first quarter of this year it accounted for 27% of total MBS services, compared with 25% since the pandemic began. This is because it is meeting a latent need like hybrid working, online shopping and ridesharing; quite simply, it’s how we live our lives in today’s world!

In addition to health insurance and health services, Bupa also provides aged care services globally. One of our challenges in the local market – particularly in rural and regional areas – is finding clinicians to attend to our residents; the home visit is fast becoming a thing of the past. 

The opportunities for digital service delivery to address these issues is enormous. Yet there are still hurdles in place – such as the need to have undertaken a physical consultation with a doctor within 12 months of a telehealth appointment. This limits the consumer experience and ultimately creates inefficiencies in the system. 

Eventually, the convergence of advanced data analytics and digital capability will empower consumers by giving them real-time access to their health information, enabling them to play a greater role in managing their healthcare to both get well and stay well. 

Our ambition at Bupa is to become a ‘digitally-integrated healthcare partner’, which plays directly into this trend and we have recently launched a number of start-ups in this area – Blua and Benefit Pocket. 

Hisham El-Ansary, Bupa APAC CEO

The third and final opportunity to drive a cultural shift is for us to accelerate alternative models of care to deliver a better patient experience, and better allocate our precious healthcare resources at a time when government and household budgets are stretched. 

In Australia, we are way behind in embracing alternative models of care. 

Same day and short stay care has been increasing in Australia but still lags the rest of the world. The Australian Institute of Health and Welfare estimates 63% of hospitalisations in this country are same day, compared with 77% in the UK, 83% in the US and 88% in Norway. 

For example, in most cases you don’t need to stay overnight in hospital for a hernia repair. And yet in Australia, 80% of people undergoing this procedure stay in hospital for at least one night. Similarly, Australia performs 16% of tonsillectomies on a same-day basis, compared to the OECD average of 38%. 

Bupa’s approach is to expand our partnerships with hospital groups that share our vision for the future. We have, for example, concluded new agreements with Cabrini Health, the Mater and Epworth which focuses on at-home care, virtual and preventative health to drive strong clinical outcomes and better customer experiences. 

An overhaul of the rules and regulations governing what insurers can fund, together with supporting increased digital uptake, are critical enablers to the acceleration of these new care models. 

In conclusion, we are at a critical point – the events of the past two years have exposed a healthcare system that is not as robust as perhaps we may have believed. 

And it’s a system that is not moving fast enough to respond to consumers’ changing needs. 

I’d like to suggest to you that we as healthcare leaders need to change the way we think and help enable reform that puts the consumer in the centre of our focus and empowers them to make decisions about their health and healthcare. 

This is our opportunity to evolve our system for the better, ensuring it can continue to be the world-class system that we both expect and deserve.