Probe, sense and respond
To account for the aforementioned uncertainty and conflicts, one can reference the Cynefin framework. First published in the Harvard Business Review, the framework is a widely used sense-making approach to guiding interventions under different levels of uncertainty and agreement in a system. Under this framework, a system could be labeled as obvious, complicated, complex or chaotic. Based on the above analysis, biomedical I&T falls under the complex domain, where closed-form solutions such as best practices are not possible. There are many unpredictable interactions in so many unknown ways that the observer cannot determine a “right” answer in advance. Consequently, the approach is to utilize the “probe-sense-respond” approach, where interacting on the system with multiple experiments would lead to emergent practice.
For example, to attract more international clinical trials to Hong Kong, some have recommended that the government establish a central support unit similar to the Singapore Clinical Research Institute. This would be a multi-year investment with much uncertainty, however. The government can first probe the system with smaller initiatives, such as producing epidemiology reports or adopting more remote monitoring technologies in trials. These experiments change how stakeholders interact, as the authority changes from being as an approver to a facilitator. After multiple types of experimentations, an overall positive response would indicate that active support from the government is beneficial to the industry. Hong Kong can then consider making more long-term commitments to clinical trials.
Another proposition would be admitting breakthrough therapies as self-financed items to the Hospital Authority’s drug formulary as soon as they are registered and deemed safe by the Department of Health for a trial period of several years. This is a “safe experiment” in that it imposes no direct cost on the Hospital Authority's procurement budget, as patients will bear the cost. Rather than simply asking for more public funding, this changes how stakeholders interact. The Hospital Authority can then closely monitor whether an experiment poses any risk to patients, increases staff workload, provides insights on the real-world holistic values of therapies, improves patient satisfaction, or enhances the Hospital Authority’s reputation in biomedical I&T. This may attract more talent to work in the overstretched Hospital Authority as more innovative therapies would be available faster.
"The worst thing you can do is nothing"
By applying the concepts of systems thinking, we have identified several stakeholders that are often overlooked in biomedical I&T discussions in Hong Kong. With substantial uncertainty and disagreement within this system, policy makers should probe and experiment with caution and adjust policies according to feedback from society. As Theodore Roosevelt famously said, “The worst thing you can do is nothing." If we are to create change in the Hong Kong biomedical I&T sector, the SAR government should start implementing low-risk experimental policies.