Talking HealthTech: 323 – Utilising objective measures in healthcare. Matt Green, The Wesley Hospital Brisbane

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This episode of Talking HealthTech was recorded live at VALD’s Alta Clinic in Brisbane with an audience of some forty to fifty THT+ Members and guests is Matt Green from The Wesley Hospital in Brisbane. 

Meet Matt Green 

Matt is the Rehabilitation Lead for Outpatients at The Wesley Hospital in Brisbane. He is also Head of High Performance with the Brisbane Lions Women’s AFL team for the past seven seasons. 

Matt started his career as an exercise physiologist in a clinic at The Wesley and also did contract work for a sporting organisation. He then worked in the high-performance pathways in Queensland. Seven years ago, Matt started the Brisbane Lions as the high-performance manager there in an AFLW situation. In the last seven seasons, the Brisbane Lions has seen astronomical growth. 

In March 2022, Matt started a new role as the outpatients lead at the Wesley Hospital.

Measurement Tech

Compared to the earlier days, there has been much change in technology. For example, looking back at what catapult GPS units were like (similar to bricks between two players), as opposed to now, where they are very small and lightweight devices. There are many other examples of how measurement tech has developed over time.

The development, the driver and the investment into technology in the sporting industry have been quite significant. This may be linked to the fact that everything in sports is measured. 

What’s Been Adopted into Health from Sports and Performance?

Because of Matt’s two full-time roles in both sectors, he has been able to transfer some of his sports and performance knowledge into healthcare. He has also used his exposure to healthcare to become more empathetic toward his athletes. There is constant monitoring of athletes to measure their progress; however, patients are most times not even educated about their improvements. 

Patients may become frustrated with a ‘lack of progress’ because they do not understand their progress. Therefore being able to objectively show them that improvement is quite difficult. 

The tests that are relied on, particularly in an outpatient setting, have been relatively archaic, as they don’t show good progression over time. Additionally, they tend to have a ceiling effect where a lot of technology used allows adjustment of the tests with the patient and objectively show that over a period.

What Value does Effective Measurement have for Patients?

It all comes down to two questions:

1. Are you using what you are measuring?

2. Does it change your clinical practice?

If it’s not, then you’re wasting your time because the value needs to be there for the clinician and, obviously, for the patient as well. As such, if the clinician is able then to engage the patient, then the patient will go with them on that journey based on the narrative created by the clinician. 

This narrative should include what the journey will look like and how they will progress along the way. Using such an approach makes a massive difference because they’re with you, as a clinician, for probably 1% of their week. So, if they come into your clinic for their weekly thirty minutes of consultation, then they walk out the door and don’t do anything until they come back to you next time, they are not going to progress and will most likely gonna blame you for it.

This is where education would underpin a lot of what Matt is trying to do with patients and clinicians. He is aiming to get clinicians to show patients these objective measures about how they are progressing and make it really concise.

VALD has done an excellent job with the patient interface or the clinical interface. In terms of the application, clinicians are able to give patients real-time feedback about what they’re seeing, and that’s what patients want. 

Patient engagement should focus on getting them engrossed in their stories and creating this narrative around what both patient and clinician are trying to achieve. Also, it should zoom in on what, as an exercise physiologist, you want the patients to achieve based on the things you want them to do at home, and they’ve engaged in that in a way that they can then look at it a bit further. But if they struggle to understand what it actually means if they do a sit-to-stand and walk out there and back a little bit quicker. 

The Cost Benefit of Implementing Measurement Solutions

There is always the question of return on investment, and in this case, one of the instant benefits is data collection. Within the Wesley, they have used handheld dynamometry for a long time, and that means as they do a test, they will have to write down the results along with averages etc. Then they will need to sit down with the patient and go through the results. From a return on investment point of view, the clinician having to go back afterwards to do all their notes gets a bit tricky. 

Consequently, this has significantly sped up test time, specifically for areas like DynaMo, four steps and ForceDecks. Furthermore, it is relatively repeatable, which helps with improved workflows and gives clinicians an engagement piece. As well, they see that engagement around actually making patients improve, and they can see this progress longitudinally over time, engaging with those patients on a broader level.

Handling Change Management in Healthcare

It is quite the challenge, to say the least, because for The Wesley to reach the point now where they’ve got a full suite has probably been about a four-year journey. However, with the help of a good work relationship with VALD, Matt was able to get his dream off the ground even with an ROI as an organisation. 

So, it again created this narrative around how it will help reduce things like the length of stay, improve patient outcomes and all these other significant areas of concern. Did you know that one in five people is dissatisfied with a total knee replacement? It may be because the healthcare industry tends to be quite reactive instead of proactive. 

The approach taken should look at how to create a different way of doing things and be innovative to understand what could actually be changed for these people. Most likely, a patient will be enthused about doing what they can to get back on their feet. So, coming back to where the hospital looks at that is the next best thing for a business- consumer engagement. If the consumer is engaged in what you’re doing and they’re happy with their outcome and service being provided along the way, this is where growth and the future come into play. 

Application across different conditions and types of conditions that can be seen from a stretch goal point of view was the next piece in terms of engaging different people at different levels. From the top down, looking at the general manager and director of clinical services, it’s not just about how it selfishly impacts you but what it looks like from an organisation’s point of view. 

Management should also look at how it can help everybody else and what works along parallel like for other specialists.

Getting that Clinician Buy-in

The Wesley is a large rehabilitation workforce with well in excess of a hundred and seventy people, which means these variants of people that have been around for a long time, and some of them prefer to do things a certain way. Then there are likely new graduates and people who are thirsty for these types of implementations. The latter is the easier set, as they are eager to learn more and adapt. 

On the other hand, dealing with those who are change-resistant is a real challenge, and for them, it is primarily about starting to understand how they work clinically and how they start to create their narrative around what they use to assess progress or change. For example, something like the 32nd push-up test doesn’t say too much about what’s going on. Here, one can start to sort of generate this narrative with patients and clinicians around what that looks like. 

It may take time just to get used to it, but looking at the clinical workflow longitudinally and the buy-in in terms of what the organisation is trying to do as a business in terms of progress report generation. Additionally, like anything else, if the consumers or the health insurance do not see that you are actually generating change with these patients, they are not going to invest in it. So it leverages across all stages of consumer engagement as well.

How Far Can You Take it Within Healthcare?

Matt is very passionate about orthopaedic musculoskeletal and immediacy is starting to develop an understanding of a patient’s pathway in this area. They are starting to generate these pathways around developing normative data sets regardless of who the patient is and which procedure is being done. The patients want to know where they sit along this trajectory.

It is necessary to start developing a really sound data set and creating these pathways along that line and equally starting to generate these pre-operative expectations for patients with surgeons as well as engaging them. 

Taking a proactive approach may shift a patient’s perspective. For example, if people see that they are dipping below the expected timeframes, it might give them that little kick to actually do their home exercises or go to the gym as instructed by their clinician. 

It comes back to that patient engagement piece, and that is Matt’s dream from a musculoskeletal orthopaedic standpoint. For this initiative, the Wesley has support from some surgeons and also from VALD. They also look to address how their solutions can be applied across all departments within the hospital, such as neurology and oncology.  

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