Waiting games in healthcare: Towards a predictive, preventive, personalized and participatory (P4) healthcare in the future

Abstract

Due to the risings costs and the increasing demand for healthcare, the reactive nature of the current healthcare system is no longer sustainable. The four principles of P4 medicine to make healthcare predictive, preventive, personalized and participatory can be seen as building blocks for a new healthcare system. However, innovations that could contribute to such a healthcare system seem to have difficulties to get off the ground or even stagnate at an early phase. The concept of waiting games, which can be defined as situations in which actors wait for each other to take the initiative, may explain this stagnation in healthcare innovations. Although the need to overcome waiting games in healthcare, the literature in this field is considered to be very limited. Therefore, this study explored uncertain path in literature by investigating which factors could cause waiting games in healthcare and how waiting games could be avoided or overcome within the transition towards a P4-based healthcare. Given all the uncertainty in which this research had to be carried out, the choice was made to have the data build on each other by means of an interactive learning and action (ILA) approach. By conducting desk research, interviews and organizing a dialogue workshop, multiple factors were found to cause waiting games in healthcare and these were categorized into the following eight factors whose influence on waiting games could also influence each other: infrastructure, learning costs, proven effectiveness, regulation, lack of knowledge, distribution of financial gains, wrong mindset, and leadership. From these eight factors, the first four were based on the literature on waiting games in general and have been confirmed within the context of P4-based innovations. The factors, lack of knowledge, distribution of financial gains, wrong mindset, and leadership, could be seen as a completely new factors that could complement the existing literature on waiting games. With regard to exploring how waiting games could be avoided or overcome within the transition towards a P4-based healthcare, four scenarios have been worked out during a dialogue workshop with multiple kinds of healthcare experts. Although multiple case-specific steps were proposed within these scenarios, the main conclusion was that collective actions are needed in an early phase of the innovation process and that these collective actions should be aimed at inhibiting the influence of the eight proposed factors that could cause waiting games in healthcare.