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Dr. Ziggy Arfeen

Updated: Feb 5


Dr. Syed (Ziggy) Arfeen serves as the Vice President of Strategy and Operations at the Hospital for Special Surgery, which has been ranked as the #1 hospital for orthopedics in the US for the past 13 years. Ziggy started his career as a surgeon and emergency physician in the UK NHS working across the cardiothoracic, vascular, orthopedics, colorectal and urology specialties. During this period, he was also an interim medical director for International SOS covering China, Azerbaijan and Myanmar. Following business school, he joined McKinsey as a management consultant, supporting healthcare strategy, operations and organizational design projects, primarily in the Middle East. He subsequently worked in innovation investment strategy for Children's Hospital of Philadelphia and Medicspot, a remote diagnostics start up.


What inspired your career in healthcare?


Reflecting on my journey, my initial interest in medicine was instinctive, inspired by TV programs and personal experiences with doctors. The idea of problem-solving to benefit people's health issues appealed to me. Entering medical school, I remained open-minded, prepared to switch paths if necessary. I found a deep affinity for the field, and my sense of purpose solidified over time as I interacted with patients and understood their needs.


However, my focus evolved from specific diseases to more holistic healthcare. A central theme emerged: "Where can I be most useful?" At first, it was being a specialist, then it expanded to a more general role, capable of assisting anyone, anywhere. The scope further broadened to international service, then further upstream, seeking ways to create a larger impact.


This led me to the business side of healthcare. Today, my guiding principle remains the same: "Where can I maximize my usefulness for those with health problems?" This question continues to shape my journey in the healthcare industry.


How do you stay on top of the key trends in healthcare?


In healthcare, and more specifically in my role in musculoskeletal care, my learning is generally tangential and omnidirectional. I maintain an open mind, keenly observing insights from friends, media, and unexpected and non-medical areas, as these often hint at larger trends or driving forces.


In the field, my sources of learning are twofold. Firstly, I turn to industry experts for vetted opinions. This information comes from a variety of mediums, such as reports, meetings, and conferences. Secondly, my personal reading contributes significantly to my learning, though it's not random but targeted. I rely on particular newsletters, journals, and specialized news outlets for this purpose.


What do you think are the most pressing issues in healthcare today?


My perspective on healthcare is anchored on two constants: prevention and patient responsibility, and these beliefs only strengthen over time. The concept of prevention underscores the importance of early interventions to circumvent downstream complications and costs. This preventive mindset is applicable universally, irrespective of the condition or geography.


On the other hand, patient responsibility, though less obvious and potentially controversial, is equally crucial. While prevention might seem the domain of governments, large organizations, and healthcare systems, the role of the patient cannot be underestimated. Given the current wealth of information available, patients have more resources to make informed decisions than doctors did three decades ago. The modern patient has unprecedented access to information, varied perspectives, and increased options.


Hence, patients must harness this power to challenge their medical care, create their own preventive routines, and promote adherence to prescribed treatments. There's a pressing need for patients to embrace their autonomy, to pursue better solutions, and to share their findings. This heightened patient responsibility complements prevention to improve health outcomes. I've expounded on this subject in a TED talk, highlighting the crucial yet often overlooked role patients can play in their own healthcare.


What are the biggest opportunities and obstacles to innovation in the healthcare environment?


Innovation, particularly in healthcare, faces two significant barriers: self-interest and the inertia of large organizations.


Self-interest, although natural, can hamper innovation. This is true at both organizational and individual levels. Organizations may resist change, fearing it could disrupt their existing business models. Similarly, individual caregivers might resist technological advancements, apprehensive about their roles becoming obsolete or less significant. One concrete example is the rising cost of travel nurses despite their presence locally, a scenario indicative of self-interest potentially overshadowing an aggregate collective maximization of good.


Secondly, the inertia in large organizations and the imperative to maintain day-to-day operations can impede innovative efforts. With the increasing influx of digital technologies and new healthcare strategies, it often feels overwhelming to accommodate these changes while maintaining routine work. This challenge restricts quick trials of potential solutions and their subsequent scaling.


Ultimately, the issue isn't a lack of new ideas, patents, or technologies, but the capacity to distribute and integrate them effectively, even in advanced societies. This distribution challenge becomes even more pronounced when considering less developed regions like Sub-Saharan Africa and rural communities in Asia. Navigating these barriers is crucial for progressing healthcare innovation.


You've worked in a variety of international healthcare settings. If you had to retire in one place due to the optimal nature of the healthcare system, where would it be and why?


Regrettably, the United States does not feature on my list for best healthcare location to retire. It's challenging to pinpoint a single country, but in my view, it's likely a smaller one where entire health systems can be managed more effectively, without interference from self-interests or larger organizations. New Zealand and the United Arab Emirates come to mind. The former, I imagine, ranks high due to its manageable size, and the latter, while perhaps lacking in overall quality, does have the leadership capacity for efficient public health management.


As for acute care, the UK leads the way. If I were retiring and concerned about severe health issues like cancer or a hip fracture, I'd prefer to be in the UK. However, for nonlife-threatening chronic conditions like hip arthritis, the UK would not be my first choice, given the long wait times and scarce interim physical therapy, consequences of the strain on the NHS.


Who are a few healthcare heroes in your eyes?


There are two individuals who particularly inspire me in the field of healthcare. Firstly, Dr. Rowland Illing, who is currently with Amazon, acting as the Chief Medical Officer for their non-US Public Sector Health division. His role revolves around getting different countries to adopt AWS for managing their healthcare data. I first met Dr. Illing when I was about 17 and starting medical school. At the time, he was a training surgeon, and his vitality, humor, and humanity stood in stark contrast to the typical stoic doctors I had encountered before. His multifaceted career, ranging from radiology to artificial intelligence and now leading an international division in Amazon, represents the blend of innovation, internationalism, and medicine that I find highly appealing.


The other is Shantanu Gaur, CEO of Allurion Technologies. Shantanu, along with Samuel Leadley, both Harvard medical students, conceived the idea of a new, non-surgical gastric balloon for weight loss. Unlike traditional bariatric surgery that requires an incision, their balloon is swallowed and then inflated remotely. When no longer needed, it can be deflated and excreted. They have managed to grow a business around this innovative concept, with the product now available in numerous countries. Their journey, from novel idea to successful implementation, despite not being in a traditional entrepreneurial role, is very inspiring to me. The common problem they're tackling and their elegant solution demonstrate the kind of significant impact that I'd like to achieve.


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