In the movies, this would be a “bromance” – think Bill and Ted’s Excellent Adventure, Butch Cassidy and the Sundance Kid or Will Smith and Martin Lawrence in Bad Boys (but without the guns and explosions).
Engineer Geoff Chase and clinician Geoff Shaw contradict and interrupt one another, they joke, and they don’t always finish their sentences. However, they’re profoundly serious about finding answers to difficult questions when it comes to healthcare, and intensive care (ICU) in particular.
Both are clearly used to being interviewed as a “couple”. They’re terribly obliging, but their chemistry delivers rapid-fire patter that would tax any interviewer.
It began in 2001.
Shaw: I wanted help with agitation and sedation management in ICU patients and had a whacky concept that I wanted to talk to someone about. So I emailed Geoff.
Chase: I nearly deleted his email.
Shaw: A few weeks later, Geoff calls and says, “I think I have an answer. I’ve got a PhD student.” I asked him if “we really wanted to destroy a career with a wacky notion on a Friday afternoon?”.
And they’re off.
Chase the engineer understood what Shaw the clinician wanted. While their solution was never used because more advanced drugs took over, they still solved the problem. Well, part of it. “What I learnt through that experience forever changed my approach, but we’re still over-sedating ICU patients. They go under quickly but take a long time to wake up,” says Shaw.
Chase responds with descriptions of bolus sedation versus constant infusion and the difficulty of measuring agitation. And then he segues neatly into the problems of the one-size-fits-all approach to healthcare, and ICU practice in particular.
Intensive care eats money. Shaw mentions the 80/20 rule where 20 per cent of the patients use 80 per cent of the resources. Chase offers up the cost of ICU in a hospital budget – about 10 per cent of the budget for just 1 per cent of the patients. People and buildings, he says, account for most of the healthcare budget.
Both talk about the changes that are needed – the magic bullet.
Shaw says while clinicians set the directions, it’s the nursing staff in ICU who make the real difference at the bedside. “I call that the elephant in the room. Intensive care has largely failed to recognise how care delivered by the bedside nurse impacts on patient outcomes.
“People get better because of nursing care and that can hugely up the patient’s outcome. Everything we clinicians do is about the process – everything the nurse does is about bedside care.”
He moves back to sedation. “The better we deliver sedation, the less pneumonia, delirium and lengths of stay. Technology is one possible solution. We automated systems in cars, and we can use it to improve patients outcomes.”
Chase takes the automation cue. “My first job was designing cars. In those days, there were lots of workers. Today, we have 3-5 times fewer auto workers for the 7-10% more vehicles produced, so productivity is up threefold or more. Healthcare is the opposite – we have three times the junior doctors we need in a system that can ill-afford it.”
Shaw says our clinicians need more freedom to innovate, to begin looking at scalable solutions, where Chase interrupts to note engineers must be equally willing to cross over and learn about the other person’s area of expertise.
Chase notes the crux of our healthcare problem is people have less and less access to care but bear more and more of the cost. He mentions our ageing population multiplied by increasing chronic disease, and all they amplify.
Shaw continues “The district health boards have to go because they don’t share ideas and efficiencies in care, the heterogenous approach to healthcare isn’t working. Over the next five years in ICU for example, we’ll see more and more personalisation of care which will improve outcomes and reduce time and cost in ICU.”
Chase says it’s very difficult to penetrate our complex healthcare systems. “Our systems must be agile, adaptable and open to change, but the cost of change in healthcare is huge.”
Shaw offers up a thought that goes to the heart of how we train clinicians. “I’m the only clinician in this part of New Zealand with medical qualifications doing research in engineering where the focus is on scalable solutions anyone can use. I see the undergrad medical students struggling because they think it’s about them and their skills. It’s not. It’s about the difference they can make in ICU, in outcomes for their patients – how better scalable processes and systems of care can make that difference
Two days before this interview, the government announced its major reforms – replacing all DHBs with one organisation, a new Māori Health Authority, a new public health agency and a strengthened Ministry of Health.
Who are these two interesting men?
We took Professor Geoff Shaw’s bio from the University of Otago at Christchurch website because it sums him up so perfectly.
…intensive care specialist at Christchurch DHB, Professor of Intensive Care at the University of Otago, Christchurch, an Adjunct Professor in the Department of Mechanical Engineering, University of Canterbury. In 2013 he became the only clinician to be made an Honorary Fellow of Engineering New Zealand.
- Modelling and control of agitation-sedation
- Insulin-glucose dynamics
- Cardiovascular dynamics
- Acute respiratory distress syndrome (ARDS) in critically ill patients
Other interests include arguing why evidence based medicine might be bad for you, building sundials and cosmology.
Distinguished Professor Geoff Chase’s bio on the University of Canterbury (UC) website is rather more traditional – dynamic systems modelling and control applied to medicine and structures, with focus on intensive / acute care medicine and earthquake engineering.
In 2017, UC awarded him their prestigious Research Medal, citing his work as world-class. He pioneered “a very strong clinical-applications focus called Model-Based Therapeutics (MBT) for cardiovascular diagnostics”. He was the first to use virtual (computer-based) trials to design a therapeutic protocol now used as a regular standard of care here and overseas.
His research includes clinical practice changes in the Neonatal ICU for glycaemic control and novel very low-cost methods of diagnosing type 2 diabetes before the ability to intervene and reduce long-term costs is passed, and low-cost and non-invasive means of breast cancer diagnosis.
There is no mention of any interest in building sundials or cosmology.