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KIWI hospitals/智通医院 - NEW CONCEPT 

In order to ensure the best response to the aspirations and raising challenges of Digital Healthcare Systems, new organizations are needed that different in how they interpret data, information, knowledge, intelligence and wisdom.

KIWI hospitals of the future are those that combine four elements in an equilibrium. They need to be Knowledgeable, Intelligent, Wise and Interoperable. These four elements must be present in all processes of the hospital:

Knowledgeable – Hospitals will need to increasingly operate and require the highest degrees of science and technology (from the simplest ones to complex genomics, and other “omics”, research outcomes) combined with practical expertise which is still required. The usage of Clinical Decision Support tools as well as extensive clinical pathways structuring of services will be paramount. These elements make up their knowledgeability.


Intelligent – Usage of Artificial Intelligence (AI) in basic medicine procedures (DaVinci Robot; Imaging or Genetics, for example), but also in so called Intelligent Hospital Management.

Wise – Only people can be wise. Wisdom is still a human prerogative yet trust and ethics are needed at the “deeper and transversal levels” of the organization. Trust and Digital Ethics reinforcing structures and processes will need to become their core competencies, as technical and scientific potential to do harm or “bad” is immensely increasing.


Interoperable – A term often associated with information technology (IT). While IT interoperability, standards use, and Big Data spaces for exploiting the value of secondary and tertiary data use remain necessary and difficult. Interprofessional teams and inter-organizational Virtual Competence Centers are key features of KIWI hospitals in their struggle to inter-operate healthcare inside and inside-out.


KIWI in Mandarin:

知识 (Knowledgeable):医院运作将越来越需要顶尖水平的科技(从最简单的技术到複杂的基因组学,以及其他「组学」及研究成果),以及仍然需要的实务知识。使用临床决策支持(Clinical Decision Support) 工具,以及广泛地以临床路径建构服务,将变得至关重要。这些元素构成了医院的「知识」。

智能 (Intelligent):在基础医疗程序中(例如达文西外科手术机械人 (DaVinci Robot),医学成像或遗传学)以及在所谓的「智能医院管理」中使用人工智能。

智慧 (Wise):只有人才能拥有智慧,它仍然是人类的特权。但在机构的「更深层次和横向层次」,我们更需要信任和道德。因为有潜力带来伤害和其它不良影响的技术和科学正在大大增加,注入信任和数码道德 (Digital Ethics) 将要成为结构和流程的关键能力。

互通 (Interoperable):这词彙通常与资讯科技相关。儘管资讯科技的互通性、标准,以及为开發次级和三级数据的价值而设的大数据空间仍然是必要且困难的,可是专业团队和组织间的虚拟能力中心 (Virtual Competence Centers) ,才是智通医院在内部和外部进行互通的过程中的关键特徵。

Read more about KIWIs in my facebook page and recent publications.

New digital services start with concepts not technology

Because Digital Healthcare Systems require complete metanoia (μετανοεῖν) of health and care, so that new concepts, generate new understandings, which in turn create new ways of seeing how information technology and digital world can help us in achieving the ultimate goal - life, health and happiness. Words are therefore very important. In this section I add my new concepts, and speed those words. 

“…for the words must remain pure. Because

A sword can be broken and a man

Can be broken, but the words

Fall into the gears of the world irrecoverably

Making things clear or unclear.

Lethal to humans is the unclear….”


   The Horatians and the Curiatians, Brecht, 1931

Digital Patient

Digital patient is a double sided concept.


On one hand digital patients are those who will progressively be connected, sometimes for life (see examples of brain electrodes implants) to digital technologies, or wear them so close to heart and skin that they feel ultimately connected. Digital patients are us, as we increasingly measure our health, wellness, and now with track apps, the health of others around our physical proximity spaces. Bluetooth zone around our phone is likely to become our new digital skin.

Digital patients are also humans suffering from, what I call as a physician Internist, a new category of systemic diseases - Digital Sickness. Under which, one can find, for example, digital obesity, digital dependency syndromes like restlessness, anxiety and irritation from lack of immediate access to wifi/internet resources. Our sadness and depressive symptomatology for lack of likes and comments in social media.    

Backstage Leadership 

Backstage leadership, or sometimes confused with "informal leadership", is not only the capacity to lead and exert influence, achieve and make others achieve a certain target or goal without holding a formal (and thus visible role of organizational/national leadership), but also, it is to do this, without the "leaded leader" realising this influence is being exerted in him/her.


Some "sexist" literature would call this "feminine" leadership as for centuries women, forced to be excluded from formal (and visible) leadership roles matured and perfected this way of leading matters, families and even societies, from the "back".


I normally use the story of the "academic with white socks” in my leadership classes to illustrate this:


Once upon a time, there was this academic who use to wear white socks with dark/black suit. His wife was concerned that he was out of fashion and that such socks could divert the attention of his audience, rendering his keynotes ineffective. Unable to tell this to him, as she feared he would find this ridiculously unimportant compared with his high scientific concerns and endeavours, she decided to progressively substitute his white socks for darker/black ones, making the white ones disappear in the washing/cleaning circle (an uncharted terrain for him at the house) as he/she would pack quickly for the many travels to conferences. In that rush he would not take note… she thought. One day, he came back, wearing dark suit and black socks. She, asked: “So, how did it go?”, he answered “Brilliant, I think they really were paying attention and questions were great”, to which she replied: “Great, and this dark outfit from for head to toe looks so good on you!” and smiled.


Education is a way for backstage leadership. Organizational educational strategy is a key component of Digital reform in healthcare.


The establishment of solid processes of change, rooted in deep digital shifts in healthcare paradigms is equally a way to lead this change.   

Five Backstage leadership instruments:

1. Influencing the network basis of the target leadership

2. Publish ideas "without fear or favor", so vision can be sustained even without formal leader's contribution

3. Sustain hope in follower-ship by teaching and developing people

4. Identify problems (inefficiencies) and the make-up (what things he/she uses to cover them) of the leader

5. Neutralize the bad influence of the target leader by immunizing its circle of contacts


#DigitalHealthcareSystems #Leadership #digitalhealth #health #management #leader

Digital Healthy Leaders


“Leaders that think digital

in a “good” way,

 are good for your health,

and that of everybody else”

Four Dimensions of "Healthy Leadership"



•“Think Digital”

•“Think “well” and ethically


   -Data  - Open and FAIR principles, (the NEW GOLD)

   -Information – Sharing is key

   -Knowledge – is rare (like JEWELLERY)

   -Meta-knowledge – network and strategy

•Are good for you!

  -Human Resources – Motivation and Change-oriented Organizational Cultures

  -Focus on developing workers and clients

  -Know that work can kill… and can be a killer (of creativity, innovation, motivation and life)


•Worry with the health of everybody else:


  •Digital Healthcare Systems and Digital Patients

         Work on the needed healthcare system paradigm change


         Digital Healthy Leaders need to think of their organizations as

                    “Health” UNITS  (it is where people work/live often many hours)

               Organizations and Companies can be new healthcare providers, this means rethinking Occupational Health, Workplace Medicine, and how you CARE for your staff

H4i Agency

A H4i Agency is more than a Digital Health Agency for a country or region. This is needed for the current coordination and advancements in DigitalHealthSystems. 

H4i stands for: Health 








All 4 dimensions and not just ehealth (information) or even digital health (information and integration of care via digital means) are needed. Such agencies have the capacity to build and promote systemic innovation, in form data analytics, digital use, but, perhaps even more importantly, healthcare processes. Lastly, these should be the reference organizations for the biggest change yet to come in the health sector, in progressive and massive use of AI (Artificial Intelligence). H4i Agencies should ensure its use in health follows the 3Ts (transparent, transferable, and trustworthy), as well as, works on hybrid AI/HI models and systems.   

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