Our healthcare system will have to face many challenges in the coming years. To ensure its sustainability for the future, we need to drive social and technological innovation. Dr. Ingrid Wünning Tschol is head of the Robert Bosch Center for Healthcare Innovation at the Bosch Health Campus and talks about the foundation's work in the field of healthcare.
A conversation with Dr. Ingrid Wünning Tschol
Henry Alt-Haaker: The health funding area is older than the foundation itself and can be traced back directly to the philanthropic engagement of its founder, Robert Bosch. Today, it accounts for the foundation’s largest financial commitment. Health is an issue that affects everyone directly: we all grow older and at some point become ill. German chancellor Olaf Scholz visited Kenya recently and spoke about the challenges the German healthcare system is facing, especially the shortage of skilled workers. What are the biggest challenges for the German healthcare system?
Ingrid Wünning Tschol: The demographic changes and their consequences: The baby boomers are reaching an age when they fall ill ever more frequently. In addition, lifestyle-related diseases have increased in all age groups worldwide, including in Germany. Thus, ever more sick people are confronted with ever fewer people willing to enter health care professions. Young people still want to become doctors, but not under existing conditions with the overwork and the responsibility that comes with running a family doctor's practice. This is especially true in rural areas, but even in the suburbs of larger cities such as Stuttgart, it is difficult to fill a family practice. And there are also shortages in health care professions such as nursing.
We want to meet this challenge with social innovation in an ever more digitalized environment. This includes, among other things, proposals to promote the prevention of disease and to redesignate roles in the field of healthcare.
This spring, the ministry of health unveiled its digital strategy. How do you see the increasing digitization in healthcare?
I don't see digitization as a challenge at all. On the contrary, in the context of the healthcare system, it’s a huge chance. Digitization and artificial intelligence can and must support – not replace – physicians and other healthcare. This is the case when it comes to collecting health data or recognizing patterns in the multitude of data collected worldwide.
A specially programmed AI algorithm, for example, has been shown to be more accurate in diagnosing skin tumors than dermatologists. In a 2019 study, 157 dermatologists from twelve university hospitals in Germany competed against computers: both the doctors and the algorithm evaluated 100 images to determine whether they were a mole or black skin cancer. In the end, artificial intelligence was more precise than the clinical diagnostics. By analyzing databases, genetic and rare diseases can also be diagnosed more easily. Of course, this data must be in trusted hands and protected. Thus, a solid legal framework must be created – and this is happening.
One of our model project is the Digital Patient Journey. This treatment process begins when someone seeks medical advice, either digitally or on location, and continues through the entire treatment, all the way to follow-up care or even palliative care. All processes are recorded digitally and are accessible to practitioners in the healthcare system. This promises not only greater efficiency, but an improvement in care for everyone.
Before talking about the programs in the health sector and our approach, I’d like to know more about the structure of your work. Our ecosystem of the health funding area is very complex, at least looking at it from the outside. Can you explain how it all fits together?
The Bosch Health Campus in Stuttgart is a relatively new and unique facility that consists of four elements: the largest element is Care, namely the Robert Bosch Hospital. Then there is the Education component in the form of the Irmgard Bosch Learning Center for training and continuing education in the healthcare professions. The third element, Research, is our research institutes: the Robert Bosch Center for Tumor Diseases, the Institute for the History of Medicine, and the Institute of Clinical Pharmacology. World-class research is conducted here. And finally, there is the Funding component, which is represented by the Robert Bosch Center for Innovative Health, or RBIG in German.
This distinguishes us from university hospitals, which only combine at most three components – research, care, education – under one roof. RBIG wants to test our model projects in cooperation with the other components at Bosch Health Campus and, wherever necessary, also cooperate with national and international partners. A particularly important partner is the Baden Württemberg Telemedicine Coordination Office (KTBW).
A program active nationwide is Patient-Oriented Centers for Primary and Long-Term Care, or PORT. What makes it so distinctive?
Currently, there are more than ten PORT centers nationwide: points of contact for outpatient health care and treatment. The centers are designed to meet regional needs. They often offer social counseling and interpreters, and patients not only receive care, but also services to prevent illness. In the centers, teams from health, social, and other professions work closely together on an equal footing. Academically trained nurses, called “community health nurses”, can take on the tasks of doctors, among others.
You have this strong home in Stuttgart with the hospital and the other institutions, but you work throughout Germany. You also work internationally, for example in networks with other projects.
One of our projects is the SCIANA Health Leaders Network, which brings together leading people from research and practice to discuss current challenges and exchange experiences. From this, we pick up many ideas for our work. International cooperation is also reflected in the joint networks we have, mainly across Europe, for example with the Karolinska Institute in Sweden, the Vall D'Hebron Hospital in Barcelona, and ETH in Zurich. Some examples of ongoing considerations or advanced joint plans with European partners are a research college on the topic of applied artificial intelligence in healthcare and a joint platform on the topic of evidence-based prevention.
We are always asking ourselves, as a foundation, to what extent we can achieve social impact in everything we do, in all funding areas and in all topics. In the health sector, this is particularly challenging because of the large number of players, the number of funds, medical research, the various lobbyists, interest groups, etc. What role do we play as a small foundation in all of this?
Our approach is to provide good healthcare for everyone and make our healthcare system fit for the future. Although we are small, we have already achieved a great deal in the healthcare sector in Germany. Primary care centers, of which PORTs are the model, are now in the coalition agreement of the federal government and imitated by other providers. The Health Centers Initiative in Hamburg has invited us to help them with advice. The new distribution of roles among the health care professions introduced by PORTs is making wide inroads into the German health care system. At RBIG, we use the space to experiment and bring forward new innovations.
So, we try something that no one else dares to do, and when it works well it convinces others to such a degree that we become superfluous. That doesn't sound like a bad approach. Dear Ingrid, thank you very much for the interview.
Henry Alt-Haaker is Senior Vice President of the Robert Bosch Stiftung and heads the Strategic Partnerships and Robert Bosch Academy department.
Dr. Ingrid Wünning Tschol heads the Robert Bosch Center for Innovative Health (RBIG in German) at the Bosch Health Campus in Stuttgart. RBIG is dedicated to promoting promising new ideas for better health care.
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