Transforming healthcare with artificial intelligence

Transcript - Transforming healthcare with artificial intelligence

[00:00:00] Ana: Hello and welcome to Tech Beyond the Hype, the podcast that explores the transformative power of emerging technologies in shaping the future of work. This episode is all about artificial intelligence and its potential applications in the field of healthcare -- specifically within cardiology.

With cardiovascular disease standing as the leading cause of global deaths, claiming a huge 17.9 million lives annually, equivalent to approximately 16% of all deaths, it's imperative that we find new innovative solutions that address the issue of global heart health.

Today's guest, Richard Dasselaar, is a digital transformation leader and visionary specializing in cardiology. At the forefront of healthcare ecosystem transformation, Richard works with healthcare providers, international organizations and other stakeholders to drive strategic innovations that harness technological advancements to optimize outcomes and democratize access to care at a global level.

Although the context of this episode revolves around healthcare, Richard's insights extend beyond his industry. In particular, I think his expertise in navigating huge, complex global problems and his insights on designing solutions that can get buy-in from a multi-generational workforce will be valuable for leaders across a whole spectrum of industries.

Before we dive into the conversation, I have a small request. If you're enjoying this series, please take a moment to like and subscribe to the podcast wherever you prefer to listen. Your support really does mean the world to us and we really want to hear from you and find out what you think. Now, without further ado, let's jump into the show!

So, Richard, it is a pleasure to have you on board today for Tech Beyond the Hype. Thank you so much for joining me today.

[00:01:58] Richard: Thank you. I'm humbled to be here.

[00:02:00] Ana: We're going to start by talking a little bit about, medical AI and your work, but before we do that, could you, just briefly introduce yourself to the audience? Tell us a little bit about what you do?

[00:02:11] Richard: Yes. Thank you. My name's Richard. I'm from the Netherlands, from a small town next to Amsterdam. I'm a digital transformation and strategy leader in the field of AI, where I focus on superior clinical outcomes and a lower cost to care.

I do a doctoral degree in digital health strategy and I'm the section chair of the AI and cardiology working group, where we like to raise the bar on health outcomes. Why cardiology? It's the most costly to society, both in clinical loss of life and cost to the system. So that makes a lot of sense to try to elevate that one, and I love that.

I've lived in India before, absolutely amazing country. I was very humbled to live in the United States for a while, close to Miami. I've been the Head of Marketing for the EMEA region, when I was 30 or 31 for Zimmer Biomed. I like to listen to music, and if I have some time left, I like to go for a run, clear the mind and talk about the things that I'm passionate about, as we have our conversation today.

[00:03:15] Ana: Nice. So, this will be a great space for you then, if you are big on talking about the things that interest you.

On this podcast, we've had a lot of people talking about digital transformation and AI, but from a very business-oriented perspective and profit-driven. Tell us a little bit about, when it comes to AI in medicine and digital transformation, what in practice does it look like in the cardiology space?

[00:03:39] Richard: It's an interesting question. Thank you for asking. I'll try to interweave all the variables here. If you look at cardiology, it's the loss of life, mainly due to a lack of access to care on one hand - so the social aspect and on the other end, it's how we need to rethink the ecosystem, within both the healthcare domain and our political domain. How can we innovate -- if you will -- a new world order? And that would go accompanied with a new business model.

Any transformation goes as fast as the slowest link in the chain, so if you lower the access to care, there are several drivers where stakeholders need to feel comfortable. We have policy makers, we have for-profit organizations, we have the hospital system in itself, and the key thing in any form of transformation -- and in cardiology the most, is that it needs to be an evolutionary process rather than a revolution.

The why there is simple. You need to watch for each other when we do the transformation -- it needs to support all the stakeholders within an ecosystem. That means, if you do a revolution, people get naturally anxious because our history has thought that everything that's revolted, didn't necessarily have a transitionary space, and I think that transitionary space is very important. Now, we can, for example, quantify it. In my country, the Netherlands, we see that about 250,000 people are not yet identified with healthcare and the abrupt uptake of these patients within the health system, can mean two things -- loss of life and unexpected cost. It's very pragmatic.

From a global perspective, I also volunteered in Africa when I was 34. There are like 17.7 million people, that we're not able to reach in time. The way I see it -- so my Ph.D. now is at Erasmus Medical Center and it's the largest, hospital in Europe and the twentieth worldwide. And the reason why I've chosen them is they have power, in that sense, just on the absolute academic field. And I think if you want the other part of my studies go with the health policy.

Now, what's the benefit of having that combination? It's like coming up with a model for ecosystem innovation -- and the bottom line here is AI, of course -- to have a system that everybody in the world can unite behind. And for that, to bridge the gap with how we started the conversation, most people tend to take a uniform view on AI on the commercial side, and I think they can go together if we harness the transitional space. Now keeping that simple, we call that, 'unifying behind a shared purpose with a coalition of the willing.' So, you find people who are eager to get the job done, who are resilient in nature and can be provocative when they need to.

On the other end, you need to bind people from various walks of life, and I think, the easiest thing is if you can mitigate and share the purpose while you're doing it for something that I call 'convergence economics.' That's a very old understanding -- basically it's how can you unite the global south with the global north. And the takeaway there is I'm having conversations with people from the UN and WHO on the same, to get that thing moving. Yeah.

[00:07:19] Ana: It sounds like you have, a lot on your plate, and some very, very inspirational purpose and objective behind your work. I want to ask more about your work at the WHO and about your research, but before we do, I think it might be helpful if you could explain how you're using the AI. What's the value proposition of using AI in this context?

[00:07:42] Richard: I think it's an interesting question. So, first of all, start with the definition of AI and two, the value proposition.

Now I've been a marketer for Phillips too, and it gave me the look in what a value proposition would mean. And it's usually the type of thing or the pain point that you try to prevent, and what a good marketer or strategist knows is that different drivers appeal different to people. So, the value proposition of AI is different to a CEO of a hospital, it's different to a legislator and it's different to a clinician. And talking about patient or customer centricity, I think they're the same. What does it mean for them?

The second, what is an AI --an artificial intelligence? So, there are various degrees. We've clopped them together to make it convenient -- and there are three tiers when it comes to cardiology. One would be the in-hospital analysis of, for example, imaging or ECG readings. So that's the known domain, in-hospital setting, where you can apply AI and that is on a functional level. The AI is a tool for efficiency in the broadest sense -- it should make our lives a little bit easier. But without the system around it, it doesn't work. See it as the car radio. So, a car radio is very nice, but you would still need four wheels, a chassis and an engine to get it moving.

AI is a tool for efficiency within the cardiology space to improve accuracy on readings. Let's say you're doing an examination and you are an average person. It's tricky stuff, so you would like to see a good diagnosis with as high enough accuracy as soon as possible, because you're in an anxious situation.

The value proposition there is reduced stress, improved outcome. So, if AI is very scalable in its sense, a second tier would be out-of-hospital, very logical. And then you would have the definition of already being a patient. And the third tier is a digital self-care intervention, to name a term.

So to, summarize the value proposition, I think it would be different for each individual. If you're the CEO, you look at how to scale, how to do it cost efficiently, what problems does it solve. If you're an administrator, does it ease the burden of employee working hour planning, and is it more cost effective than what we do -- because it needs to work, right?

From a societal point of view -- and I've done this in detail -- the cost of care for cardiology, to make that measurable, is 1.4 billion U.S. dollars per day. So, the market potential is huge. The adverse effect there is that you may attract the wrong crowd of people who are willing to solve the problem.

Per my view, the right incentive to make it through the end is if you take the holistic view, look at the value propositions for all the stakeholders, most of all the clinician, because the clinician– -- let's make it a practical Dutch example. We have a top-tier health system, but what we see is that the average person is driven to the hospital late Friday night. It never happens at 9:00 AM on a Tuesday, so it always comes unexpected and that shock absorbs or overflows the health system.

And we've seen that with the Coronavirus too. So I think the system is geared to providing the best service at an average moment, and the cracks always show at an un-average moment. So I think AI can help mitigate both the cost and the clinical outcome, on the three levels: in-hospital, outpatient and digital self-care.

[00:11:27] Ana: Okay. So, if I'm understanding correctly, say I'm a patient -- the AI allows me to track, firstly my wellbeing or my health. Then identify early prognostics or how inclined I might be to have a cardiac arrest, or some form of heart-related problem. And then provides the hospital with the information about that so that the shock is less if and when that flare up happens. Is that correct?

[00:11:56] Richard: Yes, that is correct. So it's about an ecosystem innovation and what we've just described are the individual actors that need to harmonize, both on the regional but also in the context of global healthcare.

[00:12:10] Ana: Right. And in the context of global healthcare, obviously you're coming from, as you said, from the Netherlands, where the, the system's very advanced and very efficient. Well, more advanced than a lot of places, let's put it that way.

How do you go about encouraging the widespread use of such a technology in -- and I guess this kind of relates back to what you were saying about ecosystem innovation -- how do you encourage the providers of the technology or the people who make that technology to find value in expanding their position into markets where perhaps there's not the economic incentive?

[00:12:50] Richard: You need the crazy people that care in that sense, and there are plenty, but what I see is that we have an unequal distribution, so it's an obstacle to the adoption of medical AI. And I think what I hinted to in the beginning, how to overcome that is to unite behind the purpose. Crazy enough, I think, Mr. Jobs said the same. You need someone who's incredibly dedicated to making these things happen and who are willing to persevere, be resilient in it, understand both the business and the human dynamics in it, and have the heart to switch between the two. Compassionate when it comes to the context of global healthcare.

I was invited, for which I was very humbled two years ago, at the strategy briefings at the World Health Organization, which was unique because I'm not a nation member. What I learned there is again, we move as fast as the slowest. And slowest, I mean with the highest form of respect because part of the solution is that we have a not equally distributed system and having such a system would take away the incentives for some parties to innovate properly. So it's a bit of a Catch 22, if that makes sense.

[00:14:01] Ana: I'm not sure I fully understand what you mean. Could you elaborate a little bit more?

[00:14:04] Richard: So, with the development part, what I'm trying to suggest is that the world in itself is pretty well-balanced. I think all the solutions are here to automatically fix all the things that we have, but it requires the one thing we're lacking -- and that's a certain kind of empathy to our fellow men.

So, let's take it at the food thing. I think it was early as 1900s. So, you have the SDGs, the Sustainable Development Goals, and I think we're already up to our second version of the SDGs. They're not different than the ones that we did like 40 or 50 years ago.

It's tough because if you've volunteered in these markets, you see that the world isn't equal. And to look at it from a business point of view, we're not able to help everybody at the same time. But I do think that we have the capacity to make a change.

One of the great equalizers in that sense, from my view, I think there is enough food in the world, but we lack the distributional logistics. So, it's a logistics problem in that sense. And logistics can be twofold. Either you move the people closer to the food or you move the food closer to the people. And it's that simple.

From a technology point of view on AI, I think we're finally at a point where the style of solution that we have is more scalable on regional levels, and I take my inspiration from the fintech solutions. Now, if you've been to Africa, there is not a bank in sight, but everybody has a cellphone. It's amazing how without what we would call in the rich west a 'solid infrastructure,' they all have a cellphone and there is pretty good coverage. It's amazing. And everybody has a bank account. That's I think where the digital self-care intervention is a very scalable solution.

And that may be different with food because you cannot text a sandwich, but you can democratize healthcare and with that confidence, you are potentially able to give an ease of mind to people that they are healthy. If there is work, you can participate in that, for example. And then slowly but surely, I think it's an American saying, 'gradually and then suddenly.' So, I think we should look out for these early signals that we're on the break of something very positive.

[00:16:27] Ana: Every time I have a conversation with you, you fill me with positivity and I'm very grateful for you for that. And, definitely when it comes to the growth and expansion of AI, I mean, you've mentioned food and healthcare, but there's so many different applications where this new technology could be majorly transformative. It's definitely a really exciting space to watch.

What would you say to someone who says it's great being able to have that diagnostic, but what about the scenario where I get told by the AI that I have early signs of something?

[00:17:04] Richard: That's an interesting point. I've been in healthcare my entire working life, which is now 14 years, and I've made a very steep growth.

My second job was to implement advanced chemotherapy for patients with a limited span of life left -- usually two to four months. I was 27 at the time, and my counterpart was a professor, Dr. Dick Shell, and I remember every Friday afternoon, we would eat these mushy cheese sandwiches because of course we were always late, because we were working and all the other physicians took away the good sandwiches. But I think those were the tastiest cheese sandwiches I've ever had. What he taught me is that we have the right not to be cured.

[00:17:48] Ana: Meaning?

[00:17:50] Richard: If you don't want to, that's fine, but it should be a choice. So, the AI gives you that choice and the knowledge, is that what you use?

They choose not to choose life. And it's a very legitimate choice.

This goes, I think, to the edge of where most people feel comfortable to discuss this, but for physicians, it's a meaningful conversation to have, because you would like to hypothesize, on what's the alternate answer to that question.

So, what does a tech guy like myself do with the existential questions? I don't have an answer to that, but what I know is it's the same as GDPR. You have the right to be forgotten when it comes to GDPR data, but you also have the right not to choose life. You have the right to learn the options, but you also have the right to, but it should be a right and it's not a nice thing to have.

[00:18:41] Ana: What's coming across is that your career or the work that you do comes into contact with a lot of very deep human questions and challenges. So, what brought you into this space? What drives you and what do you see as your purpose within this field?

[00:19:00] Richard: So, uh, that's a very complete question, so thank you for that. If there's such a thing as a purpose-driven person. And it depends on philosophy. I think I'm perfectly attuned to do what I'm doing now, so I can have the business sense and look at it from an economic perspective and be very business-like on that.

But on the other hand, I'm empathetic enough and understanding enough to bridge that gap between various stakeholders in the field. And I think with hard work, balancing the leadership challenges there with the opportunities that are in the market and in that sense help to facilitate an evolution in healthcare or with the transformation.

And, and why? It's purpose. I think so. You, you would know. Yeah. You choose a direction where it feels logical to do that, although it doesn't make sense to X, Y or Z, for you it makes sense, and I think that's instrumental in fully developing yourself.

[00:20:05] Ana: So, it works well for you and you're happy with, you know, the direction that you've chosen?

[00:20:11] Richard: Well, on a good day. Yes. You never know, because it's hard. It's super hard. The thing is, a friend of mine works at a healthcare insurer. I haven't mentioned them so far, but she said, well, 'you're crafting, if you look at the individual who is Richard, I'm crafting my own path in that sense.'

And that's, per definition, I need to be kind on the days where it seems slow going. So we zoom in and we zoom out in that sense. But I think for me, it's, and, and I'm being explicit here because I would think that a lot of people are very much different in that they go to work, get a dog and I think getting a dog or a cat is a great idea, and do that. But I'm very curious and I'd like to understand things and be of value in the long-term and sharing what I've learned and hopefully to be of a positive impact.

And I love it. So, it resonates very deeply within, and I think that's, well in the books, you have various names for it. You can call it an Ikigai. There are various terms and various things, but I think you'll feel it. And in that sense, I think Nietsche or Jung said the same -- if you take a long-term choice, choose with the heart, or if you do something pragmatic, then make it a short-term decision, and find a balance between the two.

[00:21:32] Ana: You mentioned a little bit earlier that there's difficult days and days that are challenging. And I think you kind of hinted to some of the challenges beforehand, but would you, for the audience, could you kind of elaborate on what the key challenges are that you face in your role? What are the big things that keep you up at night?

[00:21:49] Richard: I tend to sleep pretty short, and I think it's because timing is very difficult to get. And I think the cadence of things is a challenge. So, of course you need to have the variables and then it's always down to, um, because it's an expensive thing, it takes a lot of time. You need to keep people engaged. Sometimes you're not clear on where the end will be and when will that be reached.

Per my view, you have two types of people -- and one of the professors I like to listen to, and she's very pragmatic, Rita McGrath -- said it's discovery-driven growth in that sense. So, it's very difficult to exactly predict everything in advance, how things will go. The challenge there is if you limit it too much, and the same goes with AI -- if you cap the potential scope, it'll never grow better than that scope. I think striking the balance between the two is for me, most challenging.

And I think then comes the question of how are we able to sustain it? Because I put a lot of my own resources into it, and it's a terribly expensive hobby to have. I do it because I'm passionate about it, but ultimately, there are different things, and if you'd like to commercialize it, you're bound with investors in the early stage, which you wouldn't like to do because the 1970s taught us that you need a combination of both. But what I said before -- you need a coalition of the willing and the same goes with investors too. Because it's a very oversightful system.

[00:23:26] Ana: You mentioned that you're talking to lots of different stakeholders. I imagine that leading from the front in that situation is complicated. How do you, as a leader, lead in that scenario?

[00:23:42] Richard: I think Peter Drucker is one of the best management thinkers and he says that 'Leadership is not always a march. We tend to look at this military style, but it's more like a dance.' It's not always when to step forward, but also when to step sideways or backwards.

My leadership style in that sense is that I think a lot. I get a good idea of where we should be going and what makes sense. So, I start from where I need to be, and go backward -- and then I facilitate the conversations and help steer it in a desired direction with one thought: It needs to be in accordance with the grain of things. It's almost like the Chinese old proverb of wuwei. It means not forcing. We need to be very careful not to force things to happen because it gets clogged up and people tend to feel it.

Giving an answer to this question is like a painting -- it's never finished. The people I tend to work with are capable and I think there's nothing more challenging or more fun than to work with people that are capable. Usually, we find each other on purpose. I'm a millennial. I also have the privilege of working for boomers and it can be, uh, different.

On the other end, as well as being a leader, I'm a coach, I'm a tutor -- so you need to be all these things and you need to be a facilitator with the boomers because uh, well, they're not always ... that's a challenge.

So there, are no complete answers to your question, but I do think that I'm an innovative kind of person, and that means you need to be thick-skinned. Which is a challenge because on the other end, while you need thick skin for the boomers, you need to be more kind for the younger generations, because, I'll make a joke -- avocado toast doesn't go well with a very rigid structure.

[00:25:36] Ana: I like it.

[00:25:37] Richard: Yeah. Yeah.

[00:25:40] Ana: I like it. And it makes a lot of sense talking about your context as a leader trying to implement a large technological change that goes to the core of the practice, right? I guess what I'm trying to get at is, something that comes up a lot in this podcast and with people that I speak to about technology and leading technological innovation and change is that resistance to the change, and trying to come up with ways of creating a transformation, as you said, not making it a revolution, allowing it to be a transformation where people feel included and that their perspective is valued and validated.

From what you're saying in terms of the boomers and having both generations on either end -- it's something that I've thought about a lot lately, about how millennials and millennial leaders especially, well, you've got it on both ends. You're straddling two very different ways of thinking about how we work and what we value.

What would you say are the lessons from leadership from the boomers that you're going to take on board and that are valuable in the long run?

[00:26:54] Richard: I value their experience foremost. I do not necessarily always agree with their methods of living, but I also am compassionate enough to understand that they had a generation before them and that helps. That makes it tangible. So, they're not necessarily always comfortable with what I say or do, but you need to find each other on mutual respect. I'm big on the respect part because that's something you can always give to someone in whatever situation.

They're tough people in that sense. I have the luck of being part of various groups in the Netherlands. The Titan Netherlands and I'm also part of a fraternity and so they're a lustre group of gentlemen, and what I learned from them, they're like super tough -- these are all former ex-Navy Seal kind of guys, and they're tough. For me as a guy, we need that tough love in that sense too. So, I think bridging that gap between the generations that's come behind me or after me, you need to mitigate both the knowledge from them and I think the best leaders in that sense, and what I aim to do -- though I realize I'm not perfect -- is to mitigate those interests. Balance as far as possible.

[00:28:09] Ana: Yeah, I think that's, I think that's the best way to go.

And for audience members listening, thinking about leadership strategies and trying to manage a lot of different perspectives and in any industry, I think that we are all kind of going through the same thing, with a set of people in management or in leadership who have different values to the people who are delivering.

And then again, different values to people on the ground, and it's definitely important what you said about listening and mitigating the different perspectives and trying to find middle ground between them, so that everyone feels like they're included in the transformation.

So, thank you. I think that's really a great point to make and a great thought. I have one last question for you before we go, which is one that I'm asking everyone in the podcast, which is, what is the ideal scenario with your work at the moment? In 50 years' time, if you have the impact that you want to have and your work has done what it needs to do, what are we looking at?

[00:29:10] Richard: Well, I'd like to end global heart disease, full stop. When that's done. I'll probably be on the boat somewhere in front of a coast just with a fishing boat. I've never done that. I've set myself that target to help end global heart disease. Within the next 10 years to reach 500 to 700 million people with the solution that we envision and trying to make ready today.

[00:29:33] Ana: Nice.

That's a great place to end. Thank you so much for coming onto the podcast. Good luck with ending global heart disease -- it's a lofty ambition, but I'm one that I have no doubts in my mind that you are able to conquer. Thank you again for joining us. And, finally, is there anywhere that the audience can go if they want to connect with you or if they want to find out more about your work?

[00:30:02] Richard: Well, I can recommend connecting via LinkedIn and I think it's the platform I use most. I answer almost all messages within 48 hours. But websites and stuff we don't do but, you know, stay tuned.

[00:30:17] Ana: Fantastic. Well, thank you again and have a wonderful rest of your day.

[00:30:22] Richard: Thank you, Anna. Thank you so much.

[00:30:24] Ana: Thank you so much for listening to this episode of Tech Beyond the Hype, and a huge thank you to Richard Dasselaar for being such a great guest.

There is so much hype around Artificial Intelligence at the moment and a lot of focus on the potential harms that this tech could have on society. I hope this episode has offered you a fresh perspective and that you come away with a more objective understanding of the potential positive impact that AI can have.

Personally, I found Richard's insights on the challenges in democratizing access to this technology really enlightening. As we move towards a sustainable digital future, entire business ecosystems will need to be redesigned to ensure that everyone can benefit. Richard wisely reminds us that bringing about this sort of change requires a coalition of the willing.

This means that we need more leaders and teams to start thinking beyond short-term profits and prioritizing the creation of inclusive and compassionate solutions that add value to everyone's life.

If you've enjoyed this episode of Tech Beyond the Hype, please do make sure to like comment and subscribe wherever you get your podcasts. We really want to hear from you, let us know what you think of the show and if there are any big hypes that you want us to delve into next.

Tech Beyond the Hype is a TechTarget original production.