TED@UPS
Niels van Namen: Why the hospital of the future will be your own home
Niels van Namen: Perché l'ospedale del futuro sarà la nostra casa
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A nessuno piace andare in ospedale, se non a causa delle logiche sfide dello spostamento, per i costi astronomici delle procedure e il rischio allarmante delle complicazioni come batteri resistenti agli antibiotici. Come sarebbe se ricevessimo le cure vitali dell'ospedale nelle nostre case?
Il futurista delle cure mediche Niels van Namen mostra come gli avanzamenti in tecnologia stiano rendendo le cure mediche domiciliari più economiche, sicure ed accessibili alternative al soggiorno ospedaliero.
Niels van Namen - Health care futurist
Niels van Namen leads the UPS Europe Healthcare team as the Vice President for Healthcare. Full bio
Niels van Namen leads the UPS Europe Healthcare team as the Vice President for Healthcare. Full bio
Double-click the English transcript below to play the video.
Forse la cosa non vi sorprenderà,
00:13
Probably not a surprise to you,
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00:16
but I don't like to be in a hospital
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ma a me non mi piace stare in ospedale
00:18
or go to a hospital.
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o andare in ospedale.
00:20
Do you?
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E a voi?
00:21
I'm sure many of you
feel the same way, right?
feel the same way, right?
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Sono certo sia così per molti di voi
00:24
But why? Why is it
that we hate hospitals so much?
that we hate hospitals so much?
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Ma perché? Perché in così tanti lo odiano?
00:28
Or is it just a fact of life
we have to live with?
we have to live with?
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O dobbiamo imparare a conviverci?
00:31
Is it the crappy food?
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È forse il pessimo cibo?
00:34
Is it the expensive parking?
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Sarà il prezzo del parcheggio?
00:36
Is it the intense smell?
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O l'odore intenso?
00:38
Or is it the fear of the unknown?
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O ancora la paura dell'incerto?
00:41
Well, it's all of that, and it's more.
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Beh, è tutto questo e anche più.
00:45
Patients often have
to travel long distances
to travel long distances
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I pazienti spesso devono viaggiare
00:47
to get to their nearest hospital,
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per andare all'ospedale più vicino,
00:50
and access to hospital care
is becoming more and more an issue
is becoming more and more an issue
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l'accesso alle cure è sempre più difficile
00:54
in rural areas,
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nelle zone rurali,
00:55
in the US,
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negli Stati Uniti,
00:57
but also in sparsely populated
countries like Sweden.
countries like Sweden.
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in paesi poco popolati come la Svezia
01:01
And even when hospitals are more abundant,
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e perfino dove ci sono più ospedali,
01:05
typically the poor and the elderly
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solitamente poveri e anziani
01:07
have trouble getting care
because they lack transportation
because they lack transportation
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hanno difficoltà per la mancanza
di trasporto conveniente e accessibile,
di trasporto conveniente e accessibile,
01:10
that is convenient and affordable to them.
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01:13
And many people are avoiding
hospital care altogether,
hospital care altogether,
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per questo molti evitano cure ospedaliere,
01:18
and they miss getting proper treatment
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e non ricevono i giusti trattamenti
01:20
due to cost.
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a causa dei costi.
01:22
We see that 64 percent of Americans
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Il 64% degli americani
01:26
are avoiding care due to cost.
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evita cure mediche a causa del costo.
01:30
And even when you do get treatment,
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E anche quando si ricevono cure
01:33
hospitals often make us sicker.
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spesso gli ospedali fanno ammalare di più
01:37
Medical errors are reported to be
the third cause of death in the US,
the third cause of death in the US,
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L'errore medico è la terza causa di morte,
negli Stati Uniti
negli Stati Uniti
01:43
just behind cancer and heart disease,
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dopo cancro e malattie cardiache,
01:46
the third cause of death.
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terza causa di morte.
01:49
I'm in health care for over 20 years now,
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Lavoro nella sanità da più di 20 anni
01:51
and I witness every day how broken
and how obsolete our hospital system is.
and how obsolete our hospital system is.
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e vedo quanto sia pessimo e obsoleto
il sistema ospedaliero.
il sistema ospedaliero.
01:58
Let me give you two examples.
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Vi faccio due esempi.
02:00
Four in 10 Japanese medical doctors
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Quattro medici giapponesi su 10
02:03
and five in 10 American medical doctors
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e cinque medici americani su 10
02:06
are burnt out.
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soffrono di esaurimento.
02:08
In my home country, the Netherlands,
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Nel mio paese, i Paesi Bassi,
02:11
only 17 million people live there.
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dove vivono solo 17 milioni di abitanti,
02:13
We are short 125,000 nurses
over the coming years.
over the coming years.
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vi è una carenza di 125.000 infermieri.
02:19
But how did we even end up here,
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Ma come siamo finiti qui,
02:21
in this idea of placing
all kinds of sick people
all kinds of sick people
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all'idea di mettere
tutta la gente ammalata
tutta la gente ammalata
02:24
together in one big building?
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insieme nello stesso edificio?
02:27
Well, we have to go back
to the Ancient Greeks.
to the Ancient Greeks.
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Bisognerebbe risalire agli antichi greci,
02:31
In 400 BC, temples for cure were erected
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al 400 a.C., quando furono eretti templi
02:34
where people could go
to get their diagnosis,
to get their diagnosis,
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dove la gente poteva ricevere diagnosi,
02:36
their treatment and their healing.
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trattamenti e cure.
02:39
And then really for about 2,000 years,
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Per circa 2000 anni,
02:42
we've seen religious care centers
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abbiamo visto centri di sanità religiosi
02:45
all the way up
to the Industrial Revolution,
to the Industrial Revolution,
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fino alla Rivoluzione Industriale,
02:48
where we've seen hospitals
being set up as assembly lines
being set up as assembly lines
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con la costruzione di ospedali
02:56
based on the principles
of the Industrial Revolution,
of the Industrial Revolution,
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in linea con l'industrializzazione
02:58
to produce efficiently
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e la produzione efficiente
03:00
and get the products,
the patients in this case,
the patients in this case,
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per avere il prodotto, qui pazienti ,
03:02
out of the hospital as soon as possible.
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fuori dall'ospedale prima possibile.
03:06
Over the last century, we've seen
lots of interesting innovations.
lots of interesting innovations.
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Abbiamo visto interessanti innovazioni.
03:10
We figured out how to make insulin.
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Abbiamo scoperto come fare l'insulina.
03:13
We invented pacemakers and X-ray,
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Abbiamo inventato il pacemaker e i raggi X
03:16
and we even came into this wonderful
new era of cell and gene therapies.
new era of cell and gene therapies.
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È l'era delle cellule e terapie genetiche.
03:21
But the biggest change
to fix our hospital system altogether
to fix our hospital system altogether
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Ma il cambiamento più grande
03:26
is still ahead of us.
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è ancora da fare.
03:28
And I believe it's time now,
we have the opportunity,
we have the opportunity,
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Credo che sia arrivato il momento
03:31
to revolutionize the system altogether
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di rivoluzionare il sistema
03:34
and forget about
our current hospital system.
our current hospital system.
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e di dimenticare
l'attuale sistema ospedaliero.
l'attuale sistema ospedaliero.
03:37
I believe it's time to create a new system
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Credo sia tempo di creare un nuovo sistema
03:39
that revolves around health care at home.
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che ruoti attorno alla sanità domiciliare.
03:43
Recent research has shown
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Ricerche recenti mostrano
03:46
that 46 percent of hospital care
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che il 46 per cento delle cure ospedaliere
03:49
can move to the patient's home.
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può essere effettuato in casa
03:52
That's a lot.
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È un'alta percentuale.
03:54
And that's mainly for those patients
who suffer from chronic diseases.
who suffer from chronic diseases.
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Questo principalmente
per le malattie croniche.
per le malattie croniche.
03:58
With that, hospitals can and should
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Con ciò, gli ospedali possono e dovrebbero
04:01
reduce to smaller,
agile and mobile care centers
agile and mobile care centers
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ridursi a ospedali più mobili e attivi
04:05
focused on acute care.
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focalizzati su emergenze.
04:07
So things like neonatology,
intensive care, surgery and imaging
intensive care, surgery and imaging
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Neonatologia, interventi e imaging
04:13
will still remain at the hospitals,
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resterebbero in ospedale,
04:16
at least I believe
for the foreseeable future.
for the foreseeable future.
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almeno per l'immediato futuro.
04:20
A few weeks ago, I met a colleague
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Poche settimane fa, ho visto una collega
04:22
whose mom was diagnosed
with incurable cancer,
with incurable cancer,
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la cui madre ha un cancro incurabile,
04:25
and she said, "Niels, it's hard.
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mi ha detto, "Niels, è difficile.
04:27
It's so hard when we know
that she's got only months to live.
that she's got only months to live.
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È difficile sapere che vivrà pochi mesi.
04:32
Instead of playing with the grandchildren,
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E invece di giocare con i nipoti,
04:34
she now has to travel three times a week
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deve viaggiare tre volte a settimana
04:38
two hours up and down to Amsterdam
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due ore su e giù per Amsterdam
04:40
just to get her treatment and tests."
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solo per trattamenti e analisi."
04:43
And that really breaks my heart,
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Mi spezza il cuore,
04:45
because we all know
that a professional nurse
that a professional nurse
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perché tutti sappiamo che un infermiere
04:49
could draw her blood
at home as well, right?
at home as well, right?
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può fare analisi anche a domicilio, no?
04:51
And if she could get her tests
and treatment at home as well,
and treatment at home as well,
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potrebbe ricevere le cure anche da casa,
04:55
she could do the things
that are really important to her
that are really important to her
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così da poter fare cose per lei importanti
04:58
in her last months.
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nel suo ultimo mese di vita.
05:01
My own mom, 82 years old now --
God bless her --
God bless her --
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Mia madre stessa, di 82 anni adesso
05:06
she's avoiding to go to the hospital
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evita di andare in ospedale
05:08
because she finds it difficult
to plan and manage the journey.
to plan and manage the journey.
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perché per lei è difficile andare
05:12
So my sisters and I, we help her out.
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quindi io e mia sorella la aiutiamo.
05:15
But there's many elderly people
who are avoiding care
who are avoiding care
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Ma ci sono molti anziani
che evitano le cure
che evitano le cure
05:18
and are waiting that long
that it becomes life-threatening,
that it becomes life-threatening,
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e attendono così tanto,
05:22
and it's straight
to the costly, intensive care.
to the costly, intensive care.
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da andare diretti
nella costosa rianimazione.
nella costosa rianimazione.
05:26
Dr. Covinsky, a clinical researcher
at the University of California,
at the University of California,
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Il Dr Covinsky, ricercatore universitario
05:30
he concludes that a third
of patients over 70
of patients over 70
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ha detto che un terzo
dei pazienti sopra i 70
dei pazienti sopra i 70
05:33
and more than half of patients over 85,
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e più dell metà sopra gli 85,
05:36
leave the hospital more disabled
than when they came in.
than when they came in.
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lascia gli ospedali più disabile di prima.
05:41
And a very practical problem
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Un problema prettamente pratico
05:44
that many patients face
when they have to go to a hospital is:
when they have to go to a hospital is:
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che molti affrontano
andando in ospedale è:
andando in ospedale è:
05:48
Where do I go with my main
companion in life,
companion in life,
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dove lasciare il proprio compagno di vita,
05:52
where do I go with my dog?
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dove lasciare il mio cane?
05:57
That's our dog, by the way.
Isn't she cute?
Isn't she cute?
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Questo è il nostro cane. Non è dolce?
05:59
(Laughter)
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(Risate)
06:02
But it's not only about convenience.
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Non soltanto come comodità.
06:04
It's also about unnecessary
health care stays and costs.
health care stays and costs.
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Ma anche per cure superflue e costi.
06:09
A friend of mine, Art,
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Un mio amico, Art,
06:11
he recently needed to be hospitalized
for just a minor surgery,
for just a minor surgery,
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è stato ricoverato per un intervento
06:15
and he had to stay in the hospital
for over two weeks,
for over two weeks,
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ed è rimasto lì per più di due settimane
06:17
just because he needed
a specific kind of IV antibiotics.
a specific kind of IV antibiotics.
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solo per un antibiotico in flebo.
06:21
So he occupied a bed for two weeks
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Ha occupato un letto per due settimane
06:25
that cost over a thousand euros a day.
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che costa più di 1000 euro al giorno.
06:27
It's just ridiculous.
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È ridicolo.
06:29
And these costs are really
at the heart of the issue.
at the heart of the issue.
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I costi sono il problema principale.
06:32
So we've seen over many
of our global economies,
of our global economies,
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Abbiamo visto le nostre economie globali
06:35
health care expense grow
as a percentage of GDP
as a percentage of GDP
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e i costi della sanità far crescere
06:38
over the last years.
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il PIL negli ultimi anni.
06:40
So here we see
that over the last 50 years,
that over the last 50 years,
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Abbiamo visto che negli ultimi 50 anni,
06:43
health care expense has grown
from about five percent in Germany
from about five percent in Germany
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i costi della sanità
sono cresciuti dal 5 per cento
sono cresciuti dal 5 per cento
06:47
to about 11 percent now.
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in Germania
all'attuale 11 per cento.
all'attuale 11 per cento.
06:50
In the US, we've seen growth
from six percent to over 17 percent now.
from six percent to over 17 percent now.
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Negli USA, sono cresciuti
dal 6 al 17 per cento.
dal 6 al 17 per cento.
06:56
And a large portion of these costs
are driven by investments
are driven by investments
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Gran parte sono dovuti agli investimenti
07:00
in large, shiny hospital buildings.
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in grandi ospedali nuovi di pacca.
07:03
And these buildings are not flexible,
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Questi edifici non sono flessibili,
07:05
and they maintain a system
where hospital beds need to be filled
where hospital beds need to be filled
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mantengono un sistema dove i letti
devono essere occupati per efficienza.
07:08
for a hospital to run efficiently.
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07:11
There's no incentive
for a hospital to run with less beds.
for a hospital to run with less beds.
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Non c'è incentivo per minor occupazione.
07:15
Just the thought of that
makes you sick, right?
makes you sick, right?
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il solo pensiero è nauseante, no?
07:18
And here's the thing: the cost
for treating my buddy Art at home
for treating my buddy Art at home
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Il costo del trattamento di Art in casa
07:22
can be up to 10 times cheaper
than hospital care.
than hospital care.
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sarebbe 10 volte meno caro che in ospedale
07:27
And that is where we're headed.
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Questa è la direzione.
07:29
The hospital bed of the future
will be in our own homes.
will be in our own homes.
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Gli ospedali saranno le nostre case.
07:34
And it's already starting.
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Sta già iniziando.
07:35
Global home care is growing
10 percent year over year.
10 percent year over year.
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Le cure domiciliari crescono
del 10 per cento annuo
del 10 per cento annuo
07:39
And from my own experience,
I see that logistics and technology
I see that logistics and technology
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Vedo che logistica e tecnologia
07:44
are making these home
health care solutions work.
health care solutions work.
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aiutano le cure domiciliari funzionino.
07:48
Technology is already
allowing us to do things
allowing us to do things
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La tecnologia ci permette già di fare cose
07:50
that were once exclusive to hospitals.
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che erano esclusivamente per ospedali.
07:53
Diagnosis tests like blood,
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Diagnosi da analisi del sangue,
07:56
glucose tests, urine tests, can now
be taken in the comfort of our homes.
be taken in the comfort of our homes.
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analisi di glicemia e urine
oggi possono essere fatte in casa.
oggi possono essere fatte in casa.
08:01
And more and more connected devices
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E sempre più dispositivi connessi
08:05
we see like pacemakers and insulin pumps
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come pacemaker o microinfusori di insulina
08:08
that will proactively signal
if help is needed soon.
if help is needed soon.
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indicheranno i casi di emergenza.
08:12
And all that technology is coming together
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Tutta questa tecnologia arriva insieme
08:14
in much more insights
into the patients' health,
into the patients' health,
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alla conoscenza della salute dei pazienti,
08:18
and that insight and all of
the information leads to better control
the information leads to better control
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e porta a informazioni che conducono
08:22
and to less medical errors --
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a un miglior controllo e a meno errori --
08:24
remember, the third cause of death
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ricordiamo, sono la terza causa di morte
08:27
in the US.
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negli Stati Uniti.
08:29
And I see it every day at work.
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Lo vedo tutti i giorni a lavoro.
08:31
I work in logistics
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Lavoro in logistica
08:33
and for me, home health care works.
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e per me, la sanità domiciliare funziona.
08:38
So we see a delivery driver
deliver the medicine
deliver the medicine
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Abbiamo così il corriere che consegna
08:42
to the patient's home.
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le medicine a casa.
08:44
A nurse joins him
and actually administers the drug
and actually administers the drug
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Un infermiere che somministra le dosi
08:47
at the patient's home.
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a domicilio dal paziente.
08:50
It's that simple.
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È semplice.
08:52
Remember my buddy, Art?
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Vi ricordate il mio amico, Art?
08:54
He can now get the IV antibiotics
in the comfort of his home:
in the comfort of his home:
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Può fare le flebo di antibiotici da casa:
08:57
no hospital pajamas, no crappy food
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nessun pigiama da ospedale né pessimo cibo
09:01
and no risk of these
antibiotic-resistant superbugs
antibiotic-resistant superbugs
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né rischio di batteri
resistenti agli antibiotici
resistenti agli antibiotici
09:06
that only bite you in these hospitals.
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presenti solo negli ospedali.
09:08
And it goes further.
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E molto più.
09:10
So now the elderly people
can get the treatment that they need
can get the treatment that they need
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Gli anziani possono ricevere
le cure necessarie
le cure necessarie
09:14
in the comfort of their own home
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direttamente nelle loro case
09:16
while with their best companion in life.
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rimanendo con i loro compagni di vita.
09:19
And there's no need anymore
to drive hours and hours
to drive hours and hours
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Non c'è più bisogno di guidare per ore
09:22
just to get your treatment and tests.
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per ricevere cure e fare analisi.
09:25
In the Netherlands and in Denmark,
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Nei Paesi Bassi e in Danimarca,
09:27
we've seen very good successes
in cancer clinics
in cancer clinics
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abbiamo visto grandi successi in oncologia
09:29
organizing chemotherapies
at the patient's homes,
at the patient's homes,
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facendo la chemioterapia a domicilio,
09:34
sometimes even together
with fellow patients.
with fellow patients.
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a volte anche insieme ad altri pazienti.
09:38
The best improvements for these patients
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Il miglioramento per questi pazienti
09:40
have been improvements
in reduction in stress,
in reduction in stress,
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è stato la riduzione di stress,
09:44
anxiety disorders and depression.
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ansia e depressione.
09:47
Home health care also helped them
to get back a sense of normality
to get back a sense of normality
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La sanità domiciliare aiuta
a riprendere un senso
a riprendere un senso
09:51
and freedom in their lives,
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di normalità e libertà,
09:53
and they've actually helped them
to forget about their disease.
to forget about their disease.
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e aiuta a non pensare alla malattia.
09:59
But home health care, Niels --
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Va bene la sanità a domicilio, Niels --
10:02
what if I don't even have a home,
when I'm homeless,
when I'm homeless,
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ma se si è senzatetto,
10:06
or when I do have a home
but there's no one to take care of me
but there's no one to take care of me
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o si ha una casa ma non vi è nessuno
10:09
or even open up the door?
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che possa prendersi cura di noi?
10:12
Well, in comes our sharing economy,
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Qui entra l'economia condivisa,
10:15
or, as I like to call it,
the Airbnb for home care.
the Airbnb for home care.
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i cosiddetti,
Airbnb per la cura domiciliare.
Airbnb per la cura domiciliare.
10:19
In the Netherlands,
we see churches and care organizations
we see churches and care organizations
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Nei Paesi Bassi, chiese e organizzazioni
10:22
match people in need of care and company
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abbinano gente bisognosa di cure
10:25
with people who actually
have a home for them
have a home for them
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a gente che ha casa per loro
10:27
and can provide care and company to them.
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e che può dare loro cura e compagnia.
10:30
Home health care is cheaper,
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La sanità domiciliare è meno costosa,
10:32
it's easier to facilitate,
and it's quick to set up --
and it's quick to set up --
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È semplificata e veloce da organizzare --
10:36
in these rural areas we talked about,
but also in humanitarian crisis situations
but also in humanitarian crisis situations
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Nelle aeree rurali, anche per emergenze
10:40
where it's often safer, quicker
and cheaper to set things up at home.
and cheaper to set things up at home.
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spesso è più sicura, veloce ed economica.
10:48
Home health care is very applicable
in prosperous areas
in prosperous areas
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Questa sanità è ben applicabile ovunque
10:52
but also very much
in underserved communities.
in underserved communities.
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anche nelle comunità meno servite.
10:55
Home health care
works in developed countries
works in developed countries
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Funziona sia per i paesi sviluppati
10:58
as well as in developing countries.
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che per paesi in via di sviluppo.
11:00
So I'm passionate to help facilitate
improvements in patients' lives
improvements in patients' lives
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La mia passione è facilitare
miglioramenti nella vita di pazienti
miglioramenti nella vita di pazienti
11:06
due to home health care.
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tramite la sanità domiciliare.
11:08
I'm passionate to help facilitate
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La mia passione è facilitare
11:11
that the elderly people
get the treatment that they need
get the treatment that they need
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gli anziani a ricevere le cure necessarie
11:13
in the comfort of their own homes,
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nel comfort delle proprie case,
11:15
together with their
best companion in life.
best companion in life.
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insieme ai loro compagni di vita.
11:18
I'm passionate to make the change
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Promuovo il cambiamento per far in modo
11:21
and help ensure that patients,
and not their disease,
and not their disease,
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che siano i pazienti
a controllare le proprie vite,
a controllare le proprie vite,
11:24
are in control of their lives.
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non le loro malattie.
11:27
To me, that is health care
delivered at home.
delivered at home.
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Per me, quests è sanità domiciliare.
11:30
Thank you.
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Grazie.
11:31
(Applause)
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(Applausi)
ABOUT THE SPEAKER
Niels van Namen - Health care futuristNiels van Namen leads the UPS Europe Healthcare team as the Vice President for Healthcare.
Why you should listen
Niels van Namen has more than 20 years of experience in the health care and life science industry, working closely with customers across R&D, supply chain and manufacturing. He is passionately involved in key developments and supply chain challenges in the health care value chain; in clinical and commercial biopharmaceutical supply chains; in the complexities of medical device distribution, returns, consignments; in hospital logistics; and in final mile, home healthcare distribution and care systems. He is responsible for all health care customers and the team across all UPS business units, providing strategic direction to leverage UPS's expertise in supply chain transportation, inventory management, distribution and regulatory compliance to support healthcare companies.
van Namen started his career as an engineer and an entrepreneur in clinical trials management. He initiated Diagnostic Units, a company performing clinical trials and providing regular diagnostics and care to patients in Europe. And he worked in the IBM Healthcare consulting practice and then joined DSV to lead the global Healthcare solutions industry.
van Namen is a PDA member, holds an MSc from Delft University of Technology, obtained his MBA on the Rotterdam School of Management and holds a certificate from l'École Nationale des Ponts et Chaussées in Paris. He lives in the Netherlands, is married and has three children.
Niels van Namen | Speaker | TED.com