Healthcare Reform. Ara Darzi FRS

Transcription

1 Healthcare Reform Ara Darzi FRS

2 challenges across health systems Science and technology Unrelen:ng technological change Lifestyle Explosion of lifestyle diseases Aging People are older and sicker Informa:on Wealth and funding Explosion in breadth and depth Con:nually expanding sector of economy

3 responses Improve access through beher coverage and investment in primary care ShiI delivery model to accountable/integrated care models for chronic disease Invest in informa6on technology to improve transparency, involve pa:ents, and reduce opera:onal costs Try and get ahead of the problem by increasing efforts for preven6on (not terribly successfully)

4 Pace of change in the healthcare has been slow to date Physician s office then vs. now Modern medicine is s:ll using fairly primi:ve technology

5 ACHIEVING IMPACT REQUIRES ATTENTION TO A SET OF CORE PRINCIPLES Take a holis:c view of the health system All relevant aspects of government Integra:on of care Social and Health sector Focus change on the target end state Public health outcomes Pa:ent Outcomes Interna:onal goals (e.g., MDGs*) Successful Health System Transforma6on And Reform Follow the pa:ent s journey Pa:ent journeys through the health system Key clinical pathways Engage the system from within Develop leadership at every level Top level Ministry leadership Mid level system leadership Clinical leadership Use a mul:- stakeholder partnership to drive change Governments Donors and bi/mul:- laterals Public and Private sector Social sector and NGOs

6 Focus on the end state The Quality Con:nuum Approach to deliver high- quality care throughout the NHS Define Measure Publish Rewards Improve Regulate Innovate Standards NICE expands to: Change the way standards are created and set Select the best standards available Fill the gaps Run a new NHS Evidence service Quality Metrics Pa:ent experience and pa:ent- related outcomes Clinical dashboards for teams Ini:al metrics being developed for the 2009/10 NHS Opera:ng Framework Work with other OECD countries to agree interna:onally comparable measures Quality accounts Providers of NHS services will publish Quality Accounts from April 2010 Compara:ve informa:on on NHS choice New Commissioning for Quality and Innova:on (CQUIN) Fee for Outcomes New tariff for mental health Stronger clinical engagement in service design Medical Director & Clinical Advisory Board at every Region Quality Observatory in every region Na:onal Quality Board Regula:on extended Strong role for regula:on by the Care Quality Commission. Annual report to Parliament Regula:on to be extended to primary care for first :me, in :me extended to dental prac:ces Programmes Best Prac:ce Tariffs from 2010/11 Health Authori:es to promote innova:on, a new fund and prizes Health Innova:on & Educa:on Clusters Academic Health Science Centres High Quality for All Darzi et all White Paper 2008 Quality Con6nuum SOURCE: High Quality Care for All, Darzi A., 2008

7 Focus on the pa:ent journey.. The Experience Pa6ent Pathway A Maze WITH FALSE STARTS AND DEAD ENDS

8 Quality - Pathway and evidence based Quality Improvement at a popula:on level Disease area or popula:on segment High level across a care pathway Stroke care pathway : Best prac1ces Preven6on Managed primary care Ac6ve treatment of TIA Ini6al diagnosis Immediate treatment Rehabilita6on

9 The 2010 Na:onal Sen:nel Stroke Audit has shown huge improvements in stroke care in London % trusts by SHA all acute criteria for hyper acute stroke care 80% 70% 60% 50% 40% 30% 20% 10% 0% London South Central South West East of England North West East Midlands North East South East Coast West Midlands Yorkshire & The Humber 5 of the 6 top stroke services were in London All HASUs in London were in the top quar:le of na:onal performance Source: Na1onal Sen1nel Stroke Audit 2010

10 Industrializa:on of healthcare Typical Hospital Addressable waste: $10-25 MM/yr Target 70% Industry 45% You 18% 45% Target 85% Industry 65% You 50% 65% Asset U6liza6on Capacity U6liza6on 3. Pa:ent Safety 1. Asset Op:miza:on Hospital Opera:ons is the Pursuit of A Fric:onless Pa:ent Experience 2. Pa:ent Flow 4. Whole Hospital Op:miza:on 70% Bed Occupancy 18% Infusion Pump U:liza:on 45% Hand Hygine Compliance Hospital Opera:ons Management

11 Building capabili:es in our organisa:ons Innova:on Next- genera6on capabili6es Evidence- based decision- making Performance assessment Educa:on and training Technology enablement Commissioning Planning and resource alloca:on Clinical research Financial sustainability Founda6onal capabili6es

12 Qatar Cancer Reform - Work Packages and support structure Qatar Cancer Strategy and Cancer Research Strategy SCH- QF Dialogue, Transforma:on and implementa:on HMC, PHC, SCH Performance monitoring SCH Sponsored through HMC with 6 FTE local and equivalent of 4 FTE in London

13 1 MDTS FOR MAJOR CANCERS The Cancer Strategy requires all patients with cancer to be discussed in an MDT meeting in accordance with international best practice. MDTs are now established for breast, gastrointestinal, urooncology, hepatobiliary, leukaemia, head and neck, neurosurgery and pediatrics. The Palliative care MDT, which is broader than just cancer, discussed 413 cases in Number of pa6ents discussed at a cancer specific MDT

14 2 PATIENT PATHWAY COORDINATORS TO SUPPORT AND GUIDE PATIENTS WITH CANCER The cancer strategy introduced the role of Patient Pathway Coordinators. These staff (who have a clinical background) support patients in their journey through treatment, helping to co-ordinate their care. The first patient pathway coordinators began work in November A team of 12 will eventually support all tumor sites Number of Pa6ent Pathway Co- ordinators at HMC Future 7 12

15 Frugal is not Cheap Frugal Standard Performance Cheap Yasser Bha_ 2011

16 Core Competencies in Engineering for the Developing World (Basu, 2010) Ruggediza6on Lightweight GE s Mac l 400 $800 electrocardiogram in a backpack Cisco and NetHope s Emergency Net- Relief Kit Affordability Araving preventa:ve eye care Simple User Centric Design Jerry Can for Naandi s Safe Water Program Simplifica6on Green Technologies Tata Chemicals Rice Husk water Filter Vodafone s Solar powered Mobile Handset Adap6on Nokia s Mobile Phone Bicycle Charger Kit Use of Local Materials/ Manufacturing Vortex Engineering s solar powered ATMs for rural banking

17 World Economic Forum iden:fied and analysed case examples from across the globe Integrated care solu:on Remote chronic disease care Integrated primary care units Low cost eye care solu:on Mid- wife led, low cost maternal care High- volume, low- cost heart surgery hospital 21 Veteran s Health Administra:on 16 Mini clinics in retail stores 6 Mauritania complete low- cost obstetric care 8 Valencia: Integrated HC 13 Innova:ve emergency response model 12 1 Remote triage/ referral 9 Weighing children to predict and prevent diseases Remote advice and mobile care solu:on 5 22 Co- opera:ve medical system 10 Training for reproduc:ve health clinics PDA: Social marke:ng (humorous) for reproduc:ve health global loca:ons: social marke:ng for killer diseases Real- :me weighing and diagnosis Franchise network of stores for deadly diseases Social marke:ng program of PSI Low cost eye care solu:on

18 POLICY INTERRUPTIONS ALWAYS HELPS TO COLLABORATE

19 It Is Not The Strongest Of The Species That Survives, Not The Most Intelligent, But The One Most Responsive To Change. Charles Darwin ( ) REBELS WITH A CAUSE