Game theory is a fascinating concept and one who has not been used much in healthcare. We live in uncertain times. Almost everything in our lives has been affected by the COVID-19 pandemic. The scale and pace have been incredible. Not sure where general practice will end up after COVID-19 pandemic, but I’m pretty sure that it won’t go back to where it was. Perhaps it’s time to have another look. A clear understanding of this would enable our digital future. Led by well thought through goals, rather than just technology.
What is Game Theory?
Game theory is a mathematical theoretical framework which helps to predict behaviour. One ‘player’ anticipates another ‘player’s’ likely moves and helps to result in better outcomes. It stems from economics and has applications in business, auctions and politics. It’s rarely been used in healthcare. I think game theory can could be applied to healthcare and help to improve care.
Consider patients and doctors as players and you may assume that they’re cooperating – but in fact, they often have competing agendas.
Conflict builds itself into the system. Perhaps game theory can help better understand the challenges in healthcare and come up with ideas of where to innovate. Patients want quick, holistic, personalised care. However, workload is overwhelming clinicians, resulting in delays, silo working (even within teams) and delivering care in disease ‘buckets’ (eg diabetes). In short, patients often play a long-term or infinite game and clinicians resort to playing a short-term, finite game. We can perhaps understand the importance of prevention – the infinite game, but it’s hard when clinicians struggle to cope with current demand. It is also difficult to measure a thing that has not happened yet.
Healthcare uses technology more and more to support both clinical care and administration. It can help bridge the gap between patients competing agendas and support prevention at scale. However, adoption has been slower than hoped, both from patients and clinicians, and there has been a paucity of evidence of its impact.
Role of technology
So what’s happening now, after all the effects of the pandemic? Well, the adoption issue has gone. General practice has totally changed the way it delivers services, within a few weeks, with rapid mobilisation for remote working. Initially, our practice patient demand has fell, so we felt it was the perfect time work proactively. We’ve done lots of face to face events, so we decided to move this online as we can deliver such events quickly and at scale. Our practice tested groups of clinicians supporting groups of patients, online using, Microsoft Teams, online messages and social media. Our survey of ~2,000 patients shared how they’d like for us to communicate with them. There was a huge patient huge demand. for using social media. Perhaps there is a way that we could meet this demand by changing our systems and workflow. Everyone wins the game.
Currently, a huge number of IT providers are willing to offer their software for free. However, there’s a risk that those practices facing uncertainty will quickly deploy a bunch of different softwares, and the result will inevitably be fragmentation of current services and stressed staff during deployment.
Applying a framework
We can apply many frameworks to the challenges raised by the COVID19 pandemic. One of my favourites is outlined by Professor Markides, a strategy professor at London Business School, in his book ‘Game-Changing Strategies’. He shares that innovation is not improving what we currently do but re-thinking the entire system. The WHO, WHAT, HOW model, set out below, might help. It’s probably worth thinking about what it is we really do. Are airlines selling flights or memories? In the same way, is general practice all about ‘GP appointment’ or should we support the relationship before and after their appointment? Ultimately, is healthcare’s focus solely illness, and should it move to wellness? Perhaps healthcare could be more effective by applying game theory principles.
Game theory in healthcare – Who is for?
Traditionally we group patients according to a disease model such as diabetes. Perhaps we also ought to consider grouping them as per their behaviour. We have used Patient Activation Measure (PAM), which measures patients’ knowledge skills and confidence in managing their health and further aims to provide them with support.
We developed fictional characters, personas, and considered which interests or hobbies they might have – thus helping us understand their behaviour. Rather than putting patients into groups of diseases, we put people into behavioural groups and thought through how we could support change in behaviour. We like the CQC population groups as it includes groups who are not unwell but still need to have input from healthcare. This includes groups such as families and children as well as those of working age.
Game theory in healthcare – what is it?
Explore the patient ‘pain points, (excuse the pun!). What frustrates patients? What adds value? Access is always a challenge. If patients want evenings and weekend appointments and staff want flexible working. Perhaps this could be matched. If patients want more remote consultations, perhaps we could combine that with staff who prefer to work from home. Understanding the patient’s & clinician’s needs and behaviours can help result in better outcomes for all.
It can be difficult to use absolute numbers as one would in the case of economics. However, we can estimate numbers by using patient and clinician feedback.
Game theory in healthcare – how could it be used?
How do we deliver innovative care? We can then choose the technology that best fits our priorities. The best place to start is to build on the needs identified and competencies within our practices.
Understanding game theory models in healthcare helps to mathematically calculate which areas of technology might bridge the gap between competing drivers for patients and clinicians. This could result in better outcomes for all. Technology is one aspect, however, we need culture, structures and processes to make a meaningful change.
General practice must be made future-proof, we need to own problems and solutions and innovate, now is the time. Game on!
Tal Mahmud. GP West London. Student at London Business School, with an interest in Game Theory in healthcare.