My name is Antoinette de Bont, I'm a health scientist from the Erasmus University Rotterdam. In this lecture, I'll discuss the cost of health care technology. In addition, I give instructions to do an ethnography. Companies like Xero, Philips, and Kaiser use this method to understand what users need and want. If you only ask feedback from your users, you will know too late that your technology does not fit in their lives. Healthcare technology is to be love-based. It promised improvement that comes with high costs. Technology is a key driver to health care costs. Health economists calculated that new technology explained 50% of the increase in cost and care. According to organizational scientists, health care technology fail to make health care more efficient. They did not disrupt the way health care's organized. Health care still centered on physicians. They decide how a care is organized. The sectors, technology disrupted the production. In a car industry for example, technology standardized the production. This made cars cheaper and better. The rising cost of healthcare will change innovation. Healthcare's expensive. In the Netherlands, my home country, we spend 15% of our national income to healthcare. I started to understand this figure when I moved with my family to the United States. We paid 25,000 euros for healthcare insurance. It was a quarter of my research grant. We paid insurance, but several friends could not afford it. They had to choose between spending their money on the house, the school for children, or health insurance. Policy makers take measures to manage the development of new technology. They ask to prove the added value of your technology. Policy makers also ask patients to pay for a new technology. Patients will have to pay for an import device like this plate. This is a plate developed for patients who are underweight. They need to eat more. Scientific research show that patients eat more from a red plate. I ordered a red plate from a specialized online shop. Unfortunately, delivery was delayed, but I found this alternative. It's a red plate from an outdoor shop. And I got it within a day, and for a quarter of the price. And if red is the key for the right for me to eat, I presume it will work the same. Last night we set a table with this red plate. I was curious to eat from a red plate. I also set a table to illustrate how organisations like Kaiser Permanente and Philips study what patients need and want. They do ethnographic studies. The first step of ethnography is to observe. The second step is to make notes. When you want to observe me, as an ethnographer, you would make extensive notes. For example, you observe and note how I look in the camera, and how you see me reading the text from a teleprompter. The third step is that you analyze your notes in detail. It helps you to distance from what I say and you can better see what I do. You will start to study my gestures. The fourth step is that you interview me and ask me why I do certain things. You careful listen which words I use. This will help you to understand what is important to me. And with these four steps, you will understand what matter to me as a lecture in this MOOC. And this will help you design a studio that enables me to perform. Ethnography involves more work than organizing a focus group. Observe, interview, and make notes. It's all necessary because what people do, what people say, and what people say they do are entirely different things. And only when you combine observations with interviews, you will understand what patients value. Their decision to bio-technology is full for what they know about innovation and how they value it. They make value based decisions. Value based decisions combine rationality and legitimacy. To underline important facts and failures in decision making, I'll give you an example. It's about drugs for patients with bowel problems. Family physicians have prescribed this drug for many years, until the Ministry of Health decided to stop the reimbursement. Because chemical research showed that the drug was not effective. Family physicians objected, they went to court and they won. The judge concluded that drug worked for physicians and patients. According to scientists it was not a real effect, it was a placebo effect. The judge decided that a placebo effect is a real effect, because for patients there's no difference. Let me end my lecture with a short video to illustrate ethnography. It's about innovation and care. It's a new service that has the potential to disrupt the way we organize healthcare. It's part of a study to understand when and how patients like to move. In this project, researchers and dancers went to the nursing homes to observe and interview elderly patients, how they enjoy life and what they long for. Based upon the ethnographic work, the density found a dance class as an alternative to do exercises, enjoy. >> I always worked with the people of my generation, and as far as we can really see of the things, as simple as it is, ageing just goes away. So, we begin just breathing, very simple. There is a moment in which I understood that it's just a meeting between people. Now we are ready for a massage, so we put our hands in the head, okay. And we do a massage in the head. Really, this is very good. [MUSIC] So for me aging has been more like a second layer. I will begin with the four volunteers that can stay, it’s very easy but who can stay still. [MUSIC] After this experience, my relation with older people is completely different. [MUSIC] >> [FOREIGN] [MUSIC] >> [FOREIGN] [MUSIC] >> [FOREIGN] [MUSIC] >> Remember this, end users will pay more innovations out of pocket. It will become even more important what matters to end users. Therefore, observe and analyze what end users actually do. Thank you for watching my lecture.
