Health Systems Improvement
Comparative efficiency of health systems, corrected for selected lifestyle factors: Final report – European Union – 11 February 2015Read Full Post | Make a Comment ( Comments Off on Comparative efficiency of health systems, corrected for selected lifestyle factors: Final report – European Union – 11 February 2015 )
The Antidote to Fragmented Health Care – Harvard Business Review – 15 December 2014Read Full Post | Make a Comment ( Comments Off on The Antidote to Fragmented Health Care – Harvard Business Review – 15 December 2014 )
The reconfiguration of clinical services. What is the evidence? – The King’s Fund – 25 November 2014
“The reconfiguration of clinical services continues to generate public and political controversy, locally and nationally. Given significant financial and workforce constraints, now and in the future, pressure to reconfigure services is only likely to increase. But what are the key drivers of reconfiguration and what is the evidence to underpin it?
This paper aims to help those planning and implementing major clinical service reconfigurations ensure that change is as evidence-based as possible. It investigates the five key drivers – quality, workforce, cost, access and technology – across 13 clinical service areas, summarising the research evidence and professional guidance available in each. It builds on a major forthcoming analysis of reviews of service reconfigurations commissioned by the National Institute of Health Research and conducted by the National Clinical Advisory Team (NCAT). “Read Full Post | Make a Comment ( Comments Off on The reconfiguration of clinical services. What is the evidence? – The King’s Fund – 25 November 2014 )
What is the evidence on the economic impacts of integrated care? – Integrated Care Summit – The King’s Fund, 14 October 2014
Ellen Nolte, Emma PitchforthRead Full Post | Make a Comment ( Comments Off on What is the evidence on the economic impacts of integrated care? – Integrated Care Summit – The King’s Fund, 14 October 2014 )
Hospital-based Strategies for Creating a Culture of Health – Robert Wood Johnson Foundation – October 2014
“Hospital-based Strategies for a Creating Culture of Health provides background on the Robert Wood Johnson Foundation’s vision to build a Culture of Health and discusses how hospitals are contributing to community health improvement.
The guide reports the findings of HRET’s review of 300 community health needs assessments, provides strategic considerations for hospital engagement in community health improvement and offers a model of the hospital’s role in building a culture of health.”Read Full Post | Make a Comment ( Comments Off on Hospital-based Strategies for Creating a Culture of Health – Robert Wood Johnson Foundation – October 2014 )
The NHS Five Year Forward View – NHS England – 23 October 2014
“The NHS Five Year Forward View was published on 23 October 2014 and sets out a vision for the future of the NHS. It has been developed by the partner organisations that deliver and oversee health and care services including NHS England, Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority. Patient groups, clinicians and independent experts have also provided their advice to create a collective view of how the health service needs to change over the next five years if it is to close the widening gaps in the health of the population, quality of care and the funding of services.
The purpose of the Five Year Forward View is to articulate why change is needed, what that change might look like and how we can achieve it. It describes various models of care which could be provided in the future, defining the actions required at local and national level to support delivery. Everyone will need to play their part – system leaders, NHS staff, patients and the public – to realise the potential benefits for us all. It covers areas such as disease prevention; new, flexible models of service delivery tailored to local populations and needs; integration between services; and consistent leadership across the health and care system.
The Five Year Forward View starts the move towards a different NHS, recognising the challenges and outlining potential solutions to the big questions facing health and care services in England. It defines the framework for further detailed planning about how the NHS needs to evolve over the next five years.”Read Full Post | Make a Comment ( Comments Off on The NHS Five Year Forward View – NHS England – 23 October 2014 )
Specialists in out-of-hospital settings: Findings from six case studies – King’s Fund – 22 October 2014
“Demographic changes, technological advances and the changing pattern of disease are pushing up the numbers of patients with complex needs who require treatment in the community. But outside hospital, the resources and expertise are often not available to treat them, and patient care can be disjointed as different parts of the system fail to understand each other. In response, consultants in some areas of England are developing services that link secondary, primary, community and social care professionals.
The King’s Fund visited six services where consultants are delivering or facilitating care outside hospital. This report presents the findings from those visits as case studies. It identifies key characteristics and challenges to this way of working and seeks out evidence of the benefits to patients and the NHS more broadly.”
Case studies and interviews
Portsmouth and South East Hampshire diabetes service
Leeds interface geriatrician service
Imperial child health general practice hubs
Sunderland dermatology and minor surgery service
Haywood rheumatology centre
Whittington respiratory service
A formative evaluation of Collaboration for Leadership in Applied Health Research and Care (CLAHRC): institutional entrepreneurship for service innovation – Health Serv Deliv Res Sept 2014;2(31)
A formative evaluation of Collaboration for Leadership in Applied Health Research and Care (CLAHRC): institutional entrepreneurship for service innovation – Health Serv Deliv Res Sept 2014;2(31) “Background Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) are a time-limited funded initiative to form new service and research collaboratives in the English health system. Their aim is to bring together NHS organisations and universities to accelerate the translation of evidence-based innovation into clinical practice. In doing so, CLAHRCs are positioned to help close the second translation gap (T2), which is described as the problem of introducing and implementing new research and products into clinical practice. Objectives In this study, we draw on ideas from institutional theory and institutional entrepreneurship to examine how actors may engage in reshaping existing institutional practices in order to support, and help sustain efforts to close the T2. Our objective was to understand how the institutional context shapes actors’ attempts to close the T2 by focusing on the CLAHRC initiative. Methods The study employed a longitudinal mixed-methods approach. Qualitative case studies combined interview data (174 in total across all nine CLAHRCs and the four in-depth sites), archival data and field notes from observations, over a 4-year period (2009–13). Staff central to the initiatives were interviewed, including CLAHRC senior managers; theme leads; and other higher education institution and NHS staff involved in CLAHRCs. Quantitative social network analysis (SNA) employed a web-based sociometric approach to capture actors’ own individual (i.e. ego) networks of interaction across two points in time (2011 and 2013) in the four in-depth sites, and their personal characteristics and roles. Results We developed a process-based model of institutional entrepreneurship that encompassed the different types of work undertaken. First, ‘envisaging’ was the work undertaken by actors in developing an ‘embryonic’ vision of change, based on the interplay between themselves and the context in which they were situated. Second, ‘engaging’ was the work through which actors signed up key stakeholders to the CLAHRC. Third, ‘embedding’ was the work through which actors sought to reshape existing institutional practices so that they were more aligned with the ideals of CLAHRC. ‘Reflecting’ involved actors reconsidering their initial decisions, and learning from the process of establishing CLAHRCs. Furthermore, we employed the qualitative data to develop five different archetype models for organising knowledge translation, and considered under what founding conditions they are more or less likely to emerge. The quantitative SNA results suggested that actors’ networks changed over time, but that important institutional influences continued to constrain patterns of interactions of actors across different groups. Conclusion The development of CLAHRCs holds important lessons for policy-makers. Policy-makers need to consider whether or not they set out a defined template for such translational initiatives, since the existence of institutional antecedents and the social position of actors acted to ‘lock in’ many CLAHRCs. Although antecedent conditions and the presence of pre-existing organisational relationships are important for the mobilisation of CLAHRCs, these same conditions may constrain radical change, innovation and the translation of research into practice. Future research needs to take account of the effects of institutional context, which helps explain why many initiatives may not fully achieve their desired aims.”Read Full Post | Make a Comment ( Comments Off on A formative evaluation of Collaboration for Leadership in Applied Health Research and Care (CLAHRC): institutional entrepreneurship for service innovation – Health Serv Deliv Res Sept 2014;2(31) )
Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering [Report to the President] – President’s Council of Advisors on Science and Technology – May 2014
“Dear Mr. President,
We are pleased to send you this report by your Council of Advisors on Science and Technology, Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering. This report comes at a critical time for the United States. Health-care costs now approach a fifth of the U.S. economy, yet a significant portion of those costs is reportedly “unnecessary” and does not lead to better health or quality of care. Millions more Americans now have health insurance and therefore access to the health care system as a result of the Affordable Care Act (ACA). With expanded access placing greater demands on the health-care system, strategic measures must be taken not only to increase efficiency, but also to improve the quality and affordability of care.
This report, which was informed by the deliberations of a working group comprised of PCAST members and prominent health-care and systems-engineering experts, identifies a comprehensive set of actions for enhancing health care across the Nation through greater use of systems-engineering principles. Systems engineering, widely used in manufacturing and aviation, is an interdisciplinary approach to analyze, design, manage, and measure a complex system in order to improve its efficiency, reliability, productivity, quality, and safety. It has often produced dramatically positive results in the small number of health-care organizations that have incorporated it into their processes. But in spite of excellent examples, systems methods and tools are not yet used on a widespread basis in U.S. health care.”
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Guidance for Taking Responsibility: Accountable Clinicians and Informed Patients – Academy of Medical Royal Colleges [London] – 12 June 2014
“The Francis Report made a number of recommendations on the need for there to be a named clinician who is accountable for a patient’s care whilst they are in hospital. In addition the Secretary of State for Health in England has supported the concept of having an accountable consultant and nurse with their “name over the bed”.”Read Full Post | Make a Comment ( Comments Off on Guidance for Taking Responsibility: Accountable Clinicians and Informed Patients – Academy of Medical Royal Colleges [London] – 12 June 2014 )
Reforming the NHS from within: beyond hierarchy, inspection and markets – King’s Fund – 11 June 2014
“Politicians’ role in the running of the National Health Service (NHS) needs to be better defined to counter interventionist and centralising tendencies that have hampered effective reform to date, says a new report published today by The King’s Fund.
The report, Reforming the NHS from within: beyond hierarchy, inspection and markets, argues that a new political settlement is needed that clarifies the strategic role of ministers in determining funding, establishing priorities and providing accountability to Parliament, and leaves local NHS leaders with the space to innovate and lead service change. This settlement should reflect lessons learnt from the experience of the present government’s health reforms, which have failed to distance ministers from the operational management of the NHS as originally intended.
The report challenges the dominant approaches to NHS reform over the past 20 years – targets and performance management; inspection and regulation; and competition and choice. It argues for a fundamental shift in how the NHS is reformed. The NHS needs to move on from prescriptive, top-down approaches to change by progressing from:”
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Healthcare in Australia 2012-13: Five years of performance – final report of the COAG Reform Council – 11 June 2014Read Full Post | Make a Comment ( Comments Off on Healthcare in Australia 2012-13: Five years of performance – final report of the COAG Reform Council – 11 June 2014 )
Can we improve the health system with pay-for-performance? – Deeble Institute Issues Brief no. 5 – 28 May 2014Read Full Post | Make a Comment ( Comments Off on Can we improve the health system with pay-for-performance? – Deeble Institute Issues Brief no. 5 – 28 May 2014 )
Can we improve the health system with performance reporting? – Deeble Institute Issues Brief no. 6 – 29 May 2014Read Full Post | Make a Comment ( Comments Off on Can we improve the health system with performance reporting? – Deeble Institute Issues Brief no. 6 – 29 May 2014 )
“Within the NHS there are many pockets of good practice and examples of successful innovation and improvement. Sometimes these good ideas are not adopted by the wider system, or take a long time to spread.
This evidence scan provides examples from the published empirical literature of techniques for spreading innovation and improvement. The focus is on identifying practical things that teams and organisations can do to publicise and spread new ideas and ways of working.
The scan addresses two key questions:
What research evidence is there about the best ways to spread health care innovations and improvement?
What does the research evidence suggest contributes to the successful spread of a health care improvement or innovation?
The scan draws on the empirical research to present a number of tips for spreading good practice.”Read Full Post | Make a Comment ( Comments Off on Spreading improvement ideas: Tips from empirical research – The Health Foundation – May 2014 )
Avoiding unplanned admissions: enhanced service: proactive case finding and care review for vulnerable people: guidance and audit requirements – NHS England – April 2014
A programme of action for general practice and clinical commissioning groups
“Unplanned admissions to hospital are distressing and disruptive for patients, carers and families. Many unplanned admissions are for patients who are elderly, infirm or have complex physical or mental health and care needs which put them at high risk of unplanned admission or re-admission to hospital.
This enhanced service (ES) is designed to help reduce avoidable unplanned admissions by improving services for vulnerable patients and those with complex physical or mental health needs, who are at high risk of hospital admission or re-admission. The ES should be complemented by whole system commissioning approaches to enable outcomes of reducing avoidable unplanned admissions.”
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“This report, published by the Nuffield Trust and the Health Foundation, assesses the performance of the NHS on the quality of patient care in all four UK countries since devolution.
Since political devolution in 1999, there has been increasing policy divergence between the health systems of the four countries of the United Kingdom (UK). This report attempts to update earlier comparisons of the publicly financed health systems of England, Scotland, Wales and Northern Ireland in terms of funding, inputs and performance before and since devolution.
It also includes comparisons with the North East of England, which has been chosen as a better comparator with the three devolved nations than England as a whole.”
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Skilled for improvement? Learning communities and the skills needed to improve care: an evaluative service development – The Health Foundation – March 2014
“This report tells the story of the Learning Communities Initiative, in which an experienced research team used an action approach (combining action research and action learning) to study four improvement projects across two sites, while working with participants to facilitate the flow of knowledge and learning.
The report provides a graphic and illuminating description of the difficulties and barriers which arise in improvement work.
Key lessons identified by the authors include the following:
Applying the techniques of improvement science alone is unlikely to be sufficient to deliver sustained quality improvements in healthcare.
Any organisation wishing to improve quality – whatever its starting point – must invest in developing the three sets of skills: ‘technical’, ‘soft’ and ‘learning’ skills.
Developing these skills must be a central part of managers’ and practitioners’ roles – not just a marginal ‘add on’.
Strong and sustained institutional support is necessary to create an organisational environment that is conducive to improvement.
Improvement work should not underestimate the influence of key individuals who can either drive projects forward or hold them back.
Strong leadership is vital.
Improvement projects require in-built flexibility to adapt to changing realities.
Differences or lack of engagement and partnership working between various sectors and disciplines can determine the success of improvement interventions.
It is generally easier to move forward with an improvement project when it coincides with existing work streams.
The improvement skills pyramid
The authors identify three sets of skills – ‘technical’, ‘soft’ and ‘learning’ skills – that they found were essential for successful implementation of improvement. They use the analogy of a three-sided pyramid: to reach the point of sustained improvement (the apex of the pyramid), the organisational base (environment, culture, structures and resources) should be broad and solid enough to support the construction of the three ‘walls’ (each of the three sets of skills) to the same (maximum) height.”
… continues on the site – including a model of the improvement skills pryamid
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On effective, accessible and resilient health systems – Communication from the European Commission – 4 April 2014
“Capitalising on experience and work carried out over recent years, and with a view to further developing approaches at EU level, this Communication focuses on actions to:
1. Strengthen the effectiveness of health systems
2. Increase the accessibility of healthcare
3. Improve the resilience of health systems”
A Diagnostic Tool for Assessing Organisational Readiness for Complex Change – Australian and New Zealand School of Government – 2013
Blackman, D., O’Flynn, J. and Ugyel, L. (2013) “A Diagnostic Tool for Assessing Organisational Readiness for Complex Change”, paper presented to the Australian and New Zealand Academy of Management conference, Hobart, 4-6 December
Much is made of the best way to manage change, including a large body of work that argues that there is no point in undertaking such programs unless the organisation is actually ready and able to adopt these new ways of working. In this paper we focus, in particular, on the issue of organisations working together in more ‘joined-up’ ways across government – an example of complex change. We contribute to this literature, arguing that in cases of complex change, not only does there need to be readiness in terms of the change itself, but that there also needs to be readiness in the capacity of the organisation to work together, both within and across organisations. The paper outlines the development of a new diagnostic tool that combines macro and micro levels of analysis in order to enable organisations to gauge their preparedness for complex change.”
Innovillage tools for sustainable change – National Institute for Health and Welfare [Finland] – 2014
Juha Koivisto, Kristel Englund, Merja Lyytikäinen, Niina Peränen, Niina Pitkänen, Pasi Pohjola & Kati Virtanen. Innovillage tools for sustainable change. National Institute for Health and Welfare (THL). Discussion paper 5/2004. 32 pages. Helsinki, Finland 2014. ISBN 978-952-302-128-0 (printed); ISBN 978-952-302-129-7 (online publication)
“This report presents an open, national innovation environment, called Innovillage, developed in the welfare and health field in Finland. The report starts with a short development history of Innovillage and then presents and discusses the innovation model of Innovillage. The co-development tools of Innovillage are then presented and their workability discussed. Finally, the further development of Innovillage and matters related to the scaling of its innovation culture are considered.
Innovillage began in 2007 at a time when similar observations were being made by different stakeholders in the social and health field in Finland. The ageing population, the threatened availability of skilful professionals, and a recession within the public sector are challenging the existing modes of service production. New models and solutions are needed to meet these challenges. The Ministry of Social Affairs and Health and the other authorities in the field have funded numerous development projects over the recent decades, but the models and solutions developed have only seen limited scaling-up within the sector, with very little development activities working across the sectors. Separate development projects have developed similar solutions over and over, without knowing of each other. New tools and practices are needed for co-development and for boundary-crossing that would strengthen the scaling-up and implementation of new models and solutions. Earlier the key organizations in the field, such as the National Research and Development Centre for Health and Welfare, the Association of Finnish Local and Regional Authorities, and different third-sector organizations, each developed their own databases for ‘good practices’. They were typically ‘passive’ systems, where the developers described the models and/or the local practices developed in their projects. A unified and more interactive platform enabling and supporting real time co-development processes was recognised as necessary in the sector.
According to the Innovillage innovation model, innovation activity is an open, transparent, and collaborative activity that adopts and adapts models already developed by someone else or develops totally new solutions and models. The innovation model consists of three iterative and mutually constitutive sections: Stimulate, Incubate, and Enact. Each section should be worked on to achieve successful solutions and sustainable change in a local site. The sections are not phases that should be worked through in a linear order; they rather include different development tasks that are performed simultaneously and interactively; a change in one thing may generate change in another thing. In addition, the innovation model includes an activity for generalising from a local solution to arrive at a general enactment model that can be applied in
any other innovation activity.
The tools for co-development within Innovillage consist of both web-based tools and face-to-face tools, where actors meet in person. The tools are as follows: Networks Tool for the different networks to collaborate; a Project Database to design and report on development projects; a Development Environment to carry out development activities; Innoworkshops to co-develop face-to-face; Events, to offer a meeting point for the developers (peers), a place where ideas, practices and models can be discussed, marketed and scaled-up; and finally the Innotutor training for developers to practice the innovation culture and learn how to use the Innovillage tools.
One of the key tasks of Innovillage in the near future is to scale-up the Innovillage-like development culture to other sectors. Different sectors typically develop their solutions and models in silos, though often a good solution would entail co-development and collaboration between different actors and practitioners across sectors and organizations.”Read Full Post | Make a Comment ( Comments Off on Innovillage tools for sustainable change – National Institute for Health and Welfare [Finland] – 2014 )
Challenges and improvements in diagnostic services across seven days – NHS Improving Quality – 7 March 2014
“Across the country, hospitals and primary and community care organisations are working together to look at ways of delivering safe and effective care over seven days a week. This helps address the link between poorer outcomes for patients and the reduced levels of service provision at the weekend.
Diagnostic and scientific services underpin all models of care irrespective of settings and most clinical pathways. Nationally, the seven day service forum, led by Sir Bruce Keogh, Medical Director for NHS England, has set out a plan to drive seven day services across England in the next three years1, as part of a transformational improvement programme. For this plan to be successful diagnostic and scientific services must be at the centre of service transformation. There are therefore huge opportunities for these services to contribute to delivery of this plan and to improve patient experience and outcomes.”
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Ripping off the sticking plaster: Whole-system solutions for urgent and emergency care – NHS Confederation – 10 March 2014
Extract from the Executive Summary
“In Emergency care: an accident waiting to happen? the NHS Confederation noted concerns from members that only sticking plaster solutions were being offered.
This follow-up report acts as a roadmap to the fundamental changes required to create a sustainable and high-quality urgent and emergency care system that can meet the needs of patients now and in the future. While this destination is clear, the public and politicians will need to recognise that the journey to get there may vary in each area, according to the resources, needs and priorities in different communities. As the NHS Confederation’s 2015 Challenge campaign sets out, we must ensure the health and care system has the freedom and flexibility it needs to develop solutions that will deliver the best possible outcomes for patients and the public.
The report draws on a review of the literature and evidence commissioned from the University of Sheffield’s School of Health and Related Research (ScHARR), and on the knowledge and experience of our members as shared through a programme of forum events, visits and steering group meetings.”Read Full Post | Make a Comment ( Comments Off on Ripping off the sticking plaster: Whole-system solutions for urgent and emergency care – NHS Confederation – 10 March 2014 )
“It’s All About Me”: The Personalization of Health Systems – Ivey International Centre for Health Innovation – February 2014
“The purpose of this paper is to examine the personalization of health systems in a way that goes beyond the clinical consideration of personalization at the cellular/genetic level, and begin to consider personalization that is focused around individual and population-level health goals enabled through greater access to
information technologies. To do so, we consider the following questions:
1. What matters to individuals in regard to health personalization?
2. What are the emerging trends in technology and consumer behaviour that are contributing to and inﬂuencing the personalization of health systems?
3. What are the key personalization strategies that have been successfully used by industries and organizations outside of healthcare?
4. What could a personalized health system look like?
5. What are the necessary steps health systems must undertake to achieve personalization?
We begin by considering the philosophical motivation for personalization as a necessary and important building block for the personalization of health systems. We then examine existing trends in personalization among consumers as well as lessons learned from other industry sectors and organizations that have achieved personalized models of service delivery. Using this data, we suggest a model for a personalized health system, illustrating the transition from the current system to a potential personalized end state. Finally, we propose 10 steps individuals, health providers, health system, and policy makers need to undertake in order to create and accelerate the personalization of health systems.”Read Full Post | Make a Comment ( Comments Off on “It’s All About Me”: The Personalization of Health Systems – Ivey International Centre for Health Innovation – February 2014 )
“Our fragmented health and care system is not meeting the needs of older people, who are most likely to suffer problems with co-ordination of care and delays in transitions between services. This report sets out a framework and tools to help local service leaders improve the care they provide for older people across nine key components.”
John Oldham to lead Labour ‘commission’ on integration – 23 April 2013
“Labour will set up an independent commission to examine how health and social care can be integrated to meet what Ed Miliband claims is the biggest challenge in the history of the NHS.
The Labour leader will highlight the gap between NHS and care demand which is expected in coming years, and current funding.
HSJ revealed in January that shadow health secretary Andy Burnham was developing plans for the vast majority of NHS funding to councils.
Mr Miliband will today claim integration is being damaged by the government’s “free market ideology”.
An Independent Commission on Whole-Person Care will be set up and led by former Department of Health clinical lead for efficiency and productivity Sir John Oldham, who is a GP.
Launching the commission on a visit to Lancashire today, Mr Miliband was expected to say: “The NHS is facing the biggest challenge in its history. The toughest financial pressures for 50 years are colliding with our rising need for care as society gets older and we see more people with chronic illnesses like cancer, diabetes and dementia.”
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“This learning report presents the lessons from an evidence review and case study work undertaken by McKinsey Hospital Institute. The review drew on the literature and empirical evidence about effective networks to describe the component parts of a successful improvement network.
While the review found no ‘one size fits all’ formula for successful network design, it did identify five core features of effective networks. These are:
These features are interdependent, and interact to give a network energy and momentum. They ensure a clear direction, credibility and increased scale and reach, while enhancing knowledge, encouraging innovation and creating meaningful relationships. All five features are mutually reinforcing, and their combined effect enables quality improvement, learning and change to happen.”
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Measuring the Outcomes of Case Managed Community Care. Towards a practical instrument for Australian home support – 2013
Sarah Redshaw & Michael Fine
Centre for Research on Social Inclusion, Department of Sociology, Macquarie University, Sydney
Extract from the executive summary:
“The research has been designed to test, document and apply standard measures for the determination of client outcomes in case managed community care for older people. Stage One, the first year of the research program, completed in 2012-2013, was a rigorous pilot study undertaken in the three well established and experienced case management services in New South Wales: KinCare, Community Care Northern Beaches, and the Benevolent Society. In Stage Two, to be conducted in years two and three, the successful approaches identified in the first stage will be further trialled through case managed and other suitable services for older people across the State and the larger data sets used to examine the outcomes of case managed care and assess the effectiveness of the tools developed. The project and continuation of funding was subject to quarterly reviews by the university and annual reviews by the research partners.”Read Full Post | Make a Comment ( Comments Off on Measuring the Outcomes of Case Managed Community Care. Towards a practical instrument for Australian home support – 2013 )
Many to many: How the relational state will transform public services – IPPR – 12 February 2014
“This landmark report sets out a new ‘relational state’ agenda for public service reform that would address complex problems holistically, provide more intensive and personalised engagement at the frontline of service delivery, and empower and engage citizens.
We need a radical reconfiguration of our public services to make them better able to tackle the complex challenges – such as antisocial behaviour, chronic ill-health, and long-term unemployment – that are consuming a growing proportion of public expenditure. In the past, public service reform has relied too heavily on bureaucratic and market-based tools that are ill-equipped to deal with these problems.
In this publication, the authors set out how we can build a more relational state in practice, and consider how the lessons offered by some cutting-edge initiatives could help reshape mainstream services. By managing public services as interconnected and decentralised systems, promoting deep relationships and neighbourhood-based approaches in key services, and designing institutions that enable citizens to tackle shared problems together, we can make those services fit for the more complex times that we live in.”Read Full Post | Make a Comment ( Comments Off on Many to many: How the relational state will transform public services – IPPR – 12 February 2014 )
Capacity development in health systems and policy research: a survey of the Canadian context – Health Research Policy and Systems 7 February 2014
Health Research Policy and Systems 2014, 12:9 doi:10.1186/1478-4505-12-9
Over the past decade, substantial global investment has been made to support health systems and policy research (HSPR), with considerable resources allocated to training. In Canada, signs point to a larger and more highly skilled HSPR workforce, but little is known about whether growth in HSPR human resource capacity is aligned with investments in other research infrastructure, or what happens to HSPR graduates following training.
We collected data from the Canadian Institutes of Health Research, Canada’s national health research funding agency, and the Canadian Association for Health Services and Policy Research on recent graduates in the HSPR workforce. We also surveyed 45 Canadian HSPR training programs to determine what information they collect on the career experiences of graduates.
No university programs are currently engaged in systematic follow-up. Collaborative training programs funded by the national health research funding agency report performing short-term mandated tracking activities, but whether and how data are used is unclear. No programs collected information about whether graduates were using skills obtained in training, though information collected by the national funding agency suggests a minority (<30%) of doctoral-level trainees moving on to academic careers.
Significant investments have been made to increase HSPR capacity in Canada and around the world but no systematic attempts to evaluate the impact of these investments have been made. As a research community, we have the expertise and responsibility to evaluate our health research human resources and should strive to build a stronger knowledge base to inform future investment in HSPR research capacity.”
Reducing Overuse and Misuse: State Strategies to Improve Quality and Cost of Health Care – Robert Wood Johnson Foundation – 14 January 2014
“Overuse and misuse of health care services are problems that affect both quality and cost of care. Experts estimate that perhaps one-third of all U.S. health care spending produces no benefit to the patient–and some of it actually results in harm.”
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Service transformation: Lessons from mental health – The King’s Fund – 4 February 2014
” Mental health services have undergone radical transformation in the past 30 years. A community-based care model has largely replaced the acute and long-term care provided in large institutions.
Similar change – from hospital to community-based alternatives – is a long-standing policy objective for physical health care in the United Kingdom. How far the two can be compared has been remarkably under-explored. This paper seeks to correct this by examining the transformation of mental health services in England and the relevance to current policy. Drawing on workshops with those involved in the changes and a review of published literature, the paper explores the context and factors that enabled change to happen in mental health. It includes 10 lessons for service transformation based on these experiences.”
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Your Hospital’s Path to the Second Curve: Integration and Transformation – American Hospital Association – January 2014
“Environmental pressures are driving hospitals and care systems toward greater clinical integration, more financial risk and increased accountability. To provide high-quality, efficient and integrated care, hospitals and care systems must explore and pursue transformational paths that align with the organization’s mission and vision and cater to patients and communities. Hospital leaders need to develop strategies that move their organizations from the first curve, or volume-based environment, to the second curve, in which they will be building value-based systems and business models.
To navigate the evolving health care environment, the 2013 AHA Committee on Research developed the report Your Hospital’s Path to the Second Curve: Integration and Transformation. This report outlines must-do strategies, organizational capabilities to master and 10 strategic questions that every organization should answer to begin a transformational journey. The report’s “guiding questions” will help hospitals and care systems reflect and gain new perspectives on the benefits and value of integration. A comprehensive assessment, also found in the report, may lead health care organizations toward a customized path or series of paths to successfully transform for the future. Five paths for hospitals and care systems to consider are:”
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The Diseconomies of Queue Pooling: An Empirical Investigation of Emergency Department Length of Stay – Harvard Business School – 31 January 2014
“Improving efficiency and customer experience are key objectives for managers of service organizations including hospitals. In this paper, the authors investigate queue management, a key operational decision, in the setting of a hospital emergency department. Specifically, they explore the impact on throughput time depending on whether an emergency department uses a pooled queuing system (in which a physician is assigned to a patient once the patient is placed in an emergency department bed) or a dedicated queuing system (in which physicians are assigned to specific patients at the point of triage). The authors measured throughput time based on individual patients’ length of stay in the emergency department, starting with arrival to the emergency department and ending with a bed request for admission to the hospital or the discharge of a patient to home or to an outside facility. The findings show that, on average, the use of a dedicated queuing system decreased patients’ lengths of stay by 10 percent. This represented a 32-minute reduction in length of stay—a meaningful time-savings for the emergency department and patients alike. The authors argue that physicians in the dedicated queuing system had both the incentive and ability to make sure their patients’ care progressed efficiently, so that patients in the waiting room could be treated sooner than they otherwise would have. Key concepts include:”
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“The arduous process that small technology vendors must go through in order to contract with government agencies is preventing government innovation when we need it most. As the CEO of 12-person tech firm that recently went through the process, I have experienced this first hand.
While a partnership with the federal government is unusual for a company of our size, we got lucky. We were introduced early on to an internal advocate who saw the value of our solution to transform paper backlogs into digital data at the Food and Drug Administration — performing weeks of manual entry in hours to update a critical drug safety database. As we learned, even with a strong advocate, the procurement hurdles were significant. After getting proof of concept in two short weeks, it took two more months to prepare the paperwork for a security authorization to operate (ATO) and five months for a stop-gap contract. Even after clearing the original paper jam, we are without a contract to handle the additional demand that is now flooding our way.
So where should government begin when thinking about how to streamline the process? Here are three observations:”
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Small Ideas for Saving Big Health Care Dollars – RAND – January 2014
“A focused review of recent RAND Health research identified small ideas that could save the U.S. health care system $13 to $22 billion per year, in the aggregate, if successfully implemented. In the substituting lower-cost treatments category, ideas are to reduce use of anesthesia providers in routine gastroenterology procedures for low-risk patients, change payment policy for emergency transport, increase use of lower-cost antibiotics for treatment of acute otitis media, shift care from emergency departments to retail clinics when appropriate, eliminate co-payments for higher-risk patients taking cholesterol-lowering drugs, increase use of $4 generic drugs, and reduce Medicare Part D use of brand-name prescription drugs by patients with diabetes. In the patient safety category, ideas are to prevent three types of health care-associated infections: (1) central line-associated bloodstream infections, (2) ventilator-associated pneumonia, and (3) catheter-associated urinary tract infections; use preoperative and anesthesia checklists to prevent operative and postoperative events; prevent in-facility pressure ulcers; use ultrasound guidance for central line placement; and prevent recurrent falls.
Small ideas do not require systemic change; thus, they may be both more feasible to operationalize and less likely to encounter stiff political and organizational resistance.”Read Full Post | Make a Comment ( Comments Off on Small Ideas for Saving Big Health Care Dollars – RAND – January 2014 )
Planning and delivering service changes for patients – NHS England – 20 December 2013
“This guidance outlines a good practice framework for clinical commissioning groups (CCGs) and NHS England to use when developing plans for major service change to improve the quality and sustainability of services for patients. The framework outlines how NHS commissioners should work together, and with communities, providers and local authorities, to ensure that proposals and plans have effective preparation, robust evidence and are based on extensive engagement with staff, patients and the public. ”
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“Gaps are often found between how healthcare should be delivered, as defined by high-quality evidence, and the care that patients actually receive. Closing these gaps is an important priority for health systems everywhere. But finding the right structures to facilitate improvement is not easy.
This report introduces an approach – the clinical community – used by the Health Foundation’s Closing the Gap through Clinical Communities programme to support and secure improvements in health systems across multiple sites. The programme supported 11 clinical communities to come together around shared goals, to learn from each other but with the latitude to develop and apply local solutions. The programme has led to a range of improvements in the quality of care which continue to be sustained today.
Drawing on the evaluation of the programme, the report outlines ten key lessons for getting the approach to work in practice and avoiding potential pitfalls:”
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Reassessing existing funded health services and products to support appropriate care – Canadian Foundation for Healthcare Improvement – 29 November 2013
“In Ontario, new healthcare services and technologies coming into the system must undergo a rigorous evidence-based assessment. But what about existing services and technologies that are already in use? Which of those should be subjected to new evidence-based analyses to determine if they add value and are appropriate? Without a framework to identify priorities for reassessment from the thousands of existing funded services and products, the prospect of determining which services to scale back, focus or discontinue would be problematic at best.”
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Strengthening people-centred health systems in the WHO European Region: a roadmap – WHO – 22 October 2013
“WHO/Europe is developing the Framework for the European Region, and launched the work plan for it at the conference “Health systems for health and wealth in the context of Health 2020”, held on the fifth anniversary of the signing of the Tallinn Charter in Estonia.
The Framework’s goal is to support countries with policy options and recommendations that target key areas for strengthening the coordination/integration of health services. These changes are in line with the vision of Health 2020 and the values of universal health coverage, as the delivery of care must be of high quality and people centred to secure improvements in health and equity.
Discussions throughout the conference called attention to the importance of moving health-service delivery towards more people-centred care, with the coordination/integration of delivery being a key approach.
A WHO/Europe roadmap explains the process of developing the Framework for Action towards CIHSD, setting out the phases from now to 2016. It gives particular attention to ensuring the participation of partners, including a network of focal points in Member States, external experts and leading organizations in the field, such as the International Foundation for Integrated Care.”Read Full Post | Make a Comment ( Comments Off on Strengthening people-centred health systems in the WHO European Region: a roadmap – WHO – 22 October 2013 )
Implementation Research in Health: A Practical Guide – WHO – Alliance for Health Policy and Systems Research – 9 October 2013
ISBN 978 92 4 150621 2
Extract from the executive summary
“A key challenge faced by the global health community is how to take proven interventions and implement them in the real world. Affordable, life-saving interventions exist to confront many of the health challenges we face, but there is little understanding of how best to deliver those interventions across the full range of existing health systems and in the wide diversity of possible settings. Our failure to effectively implement interventions carries a price.”Read Full Post | Make a Comment ( Comments Off on Implementation Research in Health: A Practical Guide – WHO – Alliance for Health Policy and Systems Research – 9 October 2013 )
Organizational Factors that Contribute to Operational Failures in Hospitals – Harvard Business School – 1 October 2013
by Anita L. Tucker, W. Scott Heisler, and Laura D. Janisse
“Executive summary – Despite a pressing need to do so, hospitals are struggling to improve efficiency, quality of care, and patient experience. Operational failures—defined as instances where an employee does not have the supplies, equipment, information, or people needed to complete work tasks—contribute to hospitals’ poor performance. Such failures waste at least 10 percent of caregivers’ time, delay care, and contribute to safety lapses. This paper seeks to increase hospital productivity and quality of care by uncovering organizational factors associated with operational failures so that hospitals can reduce the frequency with which these failures occur. The authors, together with a team of 25 people, conducted direct observations of nurses on the medical/surgical wards of two hospitals, which surfaced 120 operational failures. The team also shadowed employees from the support departments that provided materials, medications, and equipment needed for patient care, tracing the flow of materials through the organizations’ internal supply chains. This approach made it possible to discover organizational factors associated with the occurrence and persistence of operational failures. Overall, the study develops propositions that low levels of internal integration among upstream supply departments contributed to operational failures experienced by downstream frontline staff, thus negatively impacting performance outcomes, such as quality, timeliness, and efficiency. Key concepts include:”
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Better health, better care, better value for all: Refocusing health care reform in Canada – Health Council of Canada – September 2013
“This report looks back on the last decade of health care reform, identifies what worked and what didn’t, and recommends a
better path to achieving a high-performing health system for Canada into the future.”
Review of Ornge Air Ambulance Transport Related Deaths – Office of the Chief Coroner for Ontario – July 2013
“It is our privilege to submit this report on the review of deaths in which concerns related to air ambulance transport were identified. The Expert Panel makes 25 recommendations in the areas of:
• Decision Making
• Response Process
• International Transports
• Paramedic Training/Education/Certification
• Investigation/Quality Assurance
This Review arises from concerns expressed by Ontarians regarding our air ambulance system, and specifically, whether operational issues related to air transport might have caused or contributed to a fatal outcome in some cases. The motto of the Office of the Chief Coroner is, “We Speak for the Dead to Protect the Living;” therefore, these concerns were reviewed and addressed with the utmost diligence by the Office of the Chief Coroner.”
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Measuring National Well-being – Health, 2013 – Office for National Statistics [UK] – 19 June 2013
This article analyses by age and other variables two of the current measures of national wellbeing: ‘satisfaction with health’ and ‘evidence of mental ill-health (GHQ)’ and their relationship to well-being. There is also contextual information about other variables related to health which may affect an individual’s well-being. The data used are from Understanding Society, the UK Household Longitudinal Study (UKHLS) 2010–11.”Read Full Post | Make a Comment ( Comments Off on Measuring National Well-being – Health, 2013 – Office for National Statistics [UK] – 19 June 2013 )
Integrated Care: Our Shared Committment – Gov.UK – 13 May 2013
“A framework that outlines ways to improve health and social care integration.
This framework document on integration, signed by 12 national partners, sets out how local areas can use existing structures such as Health and Wellbeing Boards to bring together local authorities, the NHS, care and support providers, education, housing services, public health and others to make further steps towards integration.”Read Full Post | Make a Comment ( Comments Off on Integrated Care: Our Shared Committment – Gov.UK – 13 May 2013 )
“There is a growing consensus that NHS trusts in general, and the acute sector in particular, are about to enter a new phase of organisational consolidation.
A combination of system pressures may mean a wave of mergers, as trusts look to increased scale as a means of weathering staffing pressures, declining tariff payments, long-term shifts in demand and, for some, the foundation trust pipeline.
Seeking an alternative, a number of acute providers have in recent years pursued more targeted alliances – often termed ‘groups’ – to get the benefits of collaboration without the upheaval or loss of autonomy required by a merger.
With some of these arrangements now showing real promise, and leaders looking with interest to see what might be replicated, this Briefing summarises key learning from those who have already had involvement in developing healthcare groups and considers what might be done to take the concept further.”Read Full Post | Make a Comment ( Comments Off on Healthcare groups: an alternative to merger-mania? – NHS Confederation – 1 May 2013 )
ISBN: 0 85801 286 3Read Full Post | Make a Comment ( Comments Off on Healthcare: Reform or ration – ceda – committee for economic development of australia – April 2013 )
Design for public good – Design Council – April 2013
“We have published a new report for the European Commission, in partnership with Denmark, Finland and Wales called Design for Public Good. The report describes the key benefits of design thinking for governments across the European Union. In anticipation of the report, we held Responsive State, a Design Forum which gathered government representatives, academics and designers together to discuss the role of design in the public sector.”Read Full Post | Make a Comment ( Comments Off on Design for public good – Design Council – April 2013 )
The NHS hospital complaints system. A case for urgent treatment? – Parliamentary and Health Service Ombudsman – 29 April 2013
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Rights, risks and responsibilities in service redesign for vulnerable groups – Royal College of Nursing Guidance – April 2013
Extract from the background:
“In 2012 RCN Congress debated the issue of service redesign. The debate addressed the implications of redesign: the potential loss and fragmentation of specialist knowledge, expertise and staff, and the consequent effect on delivery of high quality services for vulnerable groups such as children, older people and those with learning disabilities or mental health conditions.
This document is designed to support RCN members engaged in service redesign to identify issues and mitigate against risks. While aimed primarily at nurses working with vulnerable groups, the core principles identified in this guidance may be helpful for any member going through any process of service redesign.
Although service redesign may be required to improve patient pathways, move care closer to home, maximise efficiency or centralise specialist services, it needs to be undertaken in the context of planned and managed networks of care which preserve the specialist knowledge, skills and expertise required. The RCN believes that the NHS needs systems in place to spread good practice and encourage real, well-planned service redesign and better collaboration between all organisations involved in delivering health and social care, rather than short-term, financially driven redesign.”
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Exploring the Dynamics of Physician Engagement and Leadership for Health System Improvement: Prospects for Canadian Healthcare Systems – 4 April 2013
Prepared for the Saskatchewan Ministry of Health Also published on the Canadian Foundation for Healthcare Improvement site.
Extract from the key messages:
“Physician leadership and physician engagement are essential elements of high-performing healthcare systems, contributing to higher scores on many quality indicators. Likewise, physician participation in hospital governance can improve quality and safety.
Although much of the literature on healthcare reforms suggests the importance of physician engagement and leadership, this literature is less explicit about the processes by which health systems and organizations can convert physicians’ autonomy, knowledge and power into resources for health system performance and improvement.
Physician leadership is important at the apex of the organization, but leadership occurs at all levels of the system. Increasing attention is being paid to high-performing clinical microsystems as well as new leadership modalities (e.g. dyads of physician and manager leaders and other forms of distributed leadership) and processes (e.g. physician “compacts”) that are fostering what some refer to as “organized professionalism.”
Physician engagement does not happen on its own. Organizations must use diverse strategies and initiatives to strengthen physician engagement and leadership, including (but not limited to):”
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The Business Case for People Powered Health – Nesta – April 2013
“The Business Case for People Powered Health describes the specific investments required to create services with a People Powered Health approach, and the practical benefits that can be achieved as a result.
The NHS in England could realise savings of at least £4.4bn a year if it adopted People Powered Health innovations that involve patients, their families and communities more directly in the management of long term health conditions. These savings are based on the most reliable evidence and represent a 7% reduction in terms of reduced A&E attendance, planned and unplanned admissions, and outpatient admissions..
There is therefore both a social and financial imperative to scale the People Powered Health approach.
The People Powered Health approach involves five areas of practice: More than medicine (new services), People helping people (peer support), Redefining consultations, networks and partnerships, and user co-design and co-delivery. The most robust research literature focuses on two of these – redefining consultations and peer support – and suggests these types of interventions can improve health outcomes in all the most common long-term conditions, with patients more stable, less prone to exacerbation and demonstrating improvements in their core clinical indicators. As a result, there is a reduction in the cost of delivering healthcare of approximately 7 per cent of the commissioning budget – through decreasing A&E attendances, reducing hospital admissions, reduced length of stay and decreased patient attendances. Putting this into practice would save the NHS £4.4 billion across England.
However, we think that the People Powered Health approach could achieve even higher savings. This is both because the median of all available evidence, including less robust studies, suggests the cost of managing patients with long-term conditions could be reduced by up to 20 per cent, and the experience of the six sites suggests People Powered Health interventions are enablers of each other at scale.”
“People Powered Health is an approach that can improve quality of life and save the NHS money
The health system is going through significant upheaval and crisis provoked by the combined impact of the NHS reforms and the Francis Inquiry. The result is a sense of unease and uncertainty despite the NHS ranking excellently in international terms. At a recent Lord Darzi discussion on primary care, the mood was summed up as: ‘Why does it feel so bad, if we’re actually doing so well?’
Part of the answer is that the NHS is good at dealing with acute and infectious disease, but is still finding its way towards a model that effectively manages long-term conditions. Another element is the challenge of nurturing compassion in large, formal institutions, where staff are under considerable financial pressure.
People Powered Health is an approach to health and care that addresses both issues.”
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Accelerating Healthcare Improvement in Canada: A Review of Policy Options to Sustain, Improve and Transform Healthcare – Canadian Health Services Research Foundation – 13 March 2013
Extract from the Key Messages:
“In Canada and around the world, health expenditures have been rising at a faster rate than GDP growth. The rate of growth in health care spending has raised concerns in policy discourse about the financial sustainability of Canada’s publicly-financed healthcare systems and other public healthcare spending.
The Canadian Health Services Research Foundation (CHSRF) – now known as the Canadian Foundation for Healthcare Improvement (CFHI) – embarked on an initative commissioned by Health Canada referred to as Healthcare FiT (Financing, innovation and Transformation) in 2011 to synthesize evidence on cost drivers, options to improve efficiency, extend financing and to examine health system transformation in Canada. The information contained in this report is meant to provide a preliminary overview and analysis of options that can be further explored and advanced to support improvement initiatives that aim to change the ways in which healthcare in Canada is organized, financed, managed and delivered.
The analysis of the Healthcare FiT inititative suggests that there are many unique policy options available at different levels of decision-making. This report focuses on four areas of health system design covered by the analysis: physician remuneration, hospital funding, pharmaceutical pricing and reimbursement, and options to extend financing where gaps exist in public insurance coverage.”
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Prepared by: Boston University for AHRQ – Agency for Healthcare Research and Quality
“A variety of forces are pushing hospitals to improve their discharge processes to reduce readmissions. Researchers at the Boston University Medical Center (BUMC) developed and tested the Re-Engineered Discharge (RED). Research showed that the RED was effective at reducing readmissions and posthospital emergency department (ED) visits. The Agency for Healthcare Research and Quality contracted with BUMC to develop this toolkit to assist hospitals, particularly those that serve diverse populations, to replicate the RED.”Read Full Post | Make a Comment ( Comments Off on Re-Engineered Discharge (RED) Toolkit – Agency for Healthcare Research and Quality – March 2013 )
Changing Mindsets – Strategy on Health Policy and Systems Research – WHO – 1 November 2012
“The World Health Organization has launched the first global strategy on health policy and systems research (HPSR) at the Second Global Symposium on Health Systems Research. This document represents a unique milestone in the evolution of health policy and systems research and has three broad aims.
First, it seeks to unify the worlds of research and decision-making and connect the various disciplines of research that generate knowledge to inform and strengthen health systems. Second, the strategy contributes to a broader understanding of this field by clarifying the scope and role of HPSR. It provides insight into the dynamic processes through which HPSR evidence is generated and used in decision-making. Finally, it is hoped that this strategy will serve as an agent for change and calls for a more prominent role for HPSR at a time when the health systems mandate is evolving towards broader goals of universal health coverage and equity.
This strategy on health policy and systems research is intended to augment and amplify WHO’s previous affirmations on the importance of health research, by explaining how this evolving field is sensitive and responsive to the needs of those who are responsible for the planning and performance of national health systems – decision-makers, health practitioners, citizens and civil society. By doing so, it does not move away from the field of health research – it aims to move the field ahead.”Read Full Post | Make a Comment ( Comments Off on Changing Mindsets – Strategy on Health Policy and Systems Research – WHO – 1 November 2012 )
Extract from the executive summary
“The GP Super Clinics Program was one part of the health reforms, including primary care reforms, implemented by a newly-elected Labor government in 2007. The localities of the GP Super Clinics were based on criteria relating to need. The program provided grant funds to the value of $181.7 million for the construction or refurbishment of existing infrastructure for the first 36 GP Super Clinics, across 37 localities.
This evaluation addressed three aspects of the GP Super Clinics Program 2007-2008:
Implementation: administration of the Program by the Department of Health and Ageing
Establishment: the planning and construction of the 36 GP Super Clinics over 37 sites established in the 2007-2008 tranche
Operations: service delivery in the seven clinics which were operational for a minimum of six months prior to the commencement of the evaluation.
In the context of these three aspects, the evaluation aimed to describe the historical context and processes for the implementation and the processes and influences which impacted on the construction of the GP Super Clinics. In the operational aspect it aimed to identify the short term impacts, and the activities being implemented to achieve the GP Super Clinics Program objectives. Learnings were also identified with regard to the three aspects of the program and the potential for informing further investment in primary health care infrastructure and services.
Methods for the evaluation were tailored to each of the aspects of the GP Super Clinics Program. Common methods across each aspect included desk reviews, surveys and interviews with representatives of key stakeholder groups. A value-for-money assessment tool was also developed for the establishment aspect.”Read Full Post | Make a Comment ( Comments Off on Evaluation of the GP Super Clinics Program 2007-2008 – CONSAN Consulting – August 2012 )
Health for the EU in 33 success stories. A selection of successful projects funded by the EU Health Programmes – September 2012
1. Health threats
– ASHT II – An effective cross-border system for chemical and poison alerts
– CIE Toolkit – Preparing health professionals to deal with chemical incidents
– PHBLM – Increasing public health safety along the EU borders
– SHIPSAN TRAINET – Healthier cruising in Europe
– EQADeBa – Testing the limits of specialised laboratories
– ORCHIDS – Quick and effective mass decontamination
2. Blood and organs
– SOHO V&S – Vigilance and surveillance of substances of human origin
– EFRETOS – Pan-European registry of the evaluation of organ transplants
3. HIV/AIDS and STDs
– SIALON – Quick and easy HIV test for MSMs
– Correlation II – Spreading information, not infection
– BORDERNETwork – Protecting vulnerable groups against sexually transmitted diseases
4. Chronic diseases
– EUBIROD – Sharing knowledge on diabetes
– EuroHeart – An active and healthy heart for life
– AURORA – Cervical cancer screening for all women
– EuroSun – Mapping UV exposure in Europe
– WELAS – Understanding the causes and effects of smoking in women
– CRC Screening – Better quality screening for colorectal cancer
– EPAAC – Taking care of cancer right across Europe
6. Rare diseases
– Orphanet Europe – Online knowledge on rare diseases
7. Nutrition and healthy lifestyle
– EPODE European Network – Preventing childhood obesity
– FOOD – Promoting a healthy diet at work
– Healthy Stadia – Sport and community health
8. Health inequalities
– DETERMINE – Reducing health inqualities across Europe
– EUREGIO III – Helping EU regions to use Structural Funds for health effectively
– AVERROES – Equal access to healthcare
– Smoking in Movies – Protecting young people from addiction
10. Health information
– Aphekom – Air pollution continues to kill thousands, costing billions
– EHR-IMPLEMENT – A potential new innovation in eHealth across Europe
– EHLEIS – Adding a dimension of quality to the quantity of life lived
– EUGLOREH – The report on the status of health in the European Union
– PHGEN II – Preparing the way for personalised medicine
– EURO-PERISTAT Action – Learning more about the health of mothers and babies
– EuroNeoStat II – Better care for premature babies
“Context: An evidence base that addresses issues of complexity and context is urgently needed for large-system transformation (LST) and health care reform. Fundamental conceptual and methodological challenges also must be addressed. The Saskatchewan Ministry of Health in Canada requested a six-month synthesis project to guide four major policy development and strategy initiatives focused on patient- and family-centered care, primary health care renewal, quality improvement, and surgical wait lists. The aims of the review were to analyze examples of successful and less successful transformation initiatives, to synthesize knowledge of the underlying mechanisms, to clarify the role of government, and to outline options for evaluation.
Methods: We used realist review, whose working assumption is that a particular intervention triggers particular mechanisms of change. Mechanisms may be more or less effective in producing their intended outcomes, depending on their interaction with various contextual factors. We explain the variations in outcome as the interplay between context and mechanisms. We nested this analytic approach in a macro framing of complex adaptive systems (CAS).
Findings: Our rapid realist review identified five “simple rules” of LST that were likely to enhance the success of the target initiatives: (1) blend designated leadership with distributed leadership; (2) establish feedback loops; (3) attend to history; (4) engage physicians; and (5) include patients and families. These principles play out differently in different contexts affecting human behavior (and thereby contributing to change) through a wide range of different mechanisms.
Conclusions: Realist review methodology can be applied in combination with a complex system lens on published literature to produce a knowledge synthesis that informs a prospective change effort in large-system transformation. A collaborative process engaging both research producers and research users contributes to local applications of universal principles and mid-range theories, as well as to a more robust knowledge base for applied research. We conclude with suggestions for the future development of synthesis and evaluation methods.”Read Full Post | Make a Comment ( Comments Off on Large-System Transformation in Health Care: A Realist Review – Milbank Quarterly 2012 )
Hospitals on the edge? The time for action A report by the Royal College of Physicians – September 2012
“All hospital inpatients deserve to receive safe, high-quality, sustainable care centred around their needs and delivered in an appropriate setting by respectful, compassionate, expert health professionals. Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population and increasing hospital admissions.
Overview of challenges facing acute hospitals
The pressures on the acute service are relentless and intense:
Increasing clinical demand.
Increasing clinical demand.
Out-of-hours care breakdown
Looming workforce crisis in the medical workforce.
Managing the performance of the health care system – FlagPost – 6 August 2012Read Full Post | Make a Comment ( Comments Off on Managing the performance of the health care system – FlagPost – 6 August 2012 )
Aligning forces for quality: improving health and health care in communities across America – Robert Wood Johnson Foundation
” Health care is a national problem, but it is solved locally
Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s (RWJF) signature effort to lift the overall quality of health care in targeted communities, reduce racial and ethnic disparities and provide models for national reform.
AF4Q asks the people who get care, give care and pay for care to work together toward common, fundamental objectives to lead to better care. The Foundation has made an unprecedented commitment to improve health care in 16 geographically, demographically, and economically diverse communities that together cover 12.5 percent of the U.S. population.”
Care Across Settings
Cost & Efficiency
Measurement & Reporting
Improving Language Services
Transforming Care at the Bedside (TCAB)
Strategic clinical networks [NHS] – 26 July 2012
“The NHS Commissioning Board Authority has set out its plan for a small number of national networks to improve health services for specific patient groups or conditions.
Called strategic clinical networks, these organisations will build on the success of network activity in the NHS which, over the last 10 years, has led to significant improvements in the delivery of patient care.”
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From innovation to action: the first report of the Health Care Innovation Working Group – The Council of the Federation [Canada] – 26 July 2012
“Premiers received the report of the Council of the Federation Working Group on Health Care Innovation, From Innovation to Action. The working group, chaired by Premier Wall and Premier Ghiz and composed of all provincial and territorial health ministers, was established in January.
This work focuses on practical innovations that each province and territory can put to use to enhance patient care and improve value for taxpayers. The recommendations presented today to Premiers, that provinces and territories intend to implement as they deem appropriate to their health care system, include:”
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“This toolkit offers a way of improving productive working between doctors and managers in your Trust. It does this in a series of steps that require you to have conversations between doctors and managers that identifies any development required.
Where doctors are engaged in management we know that quality improves for patients. Moreover, we have found that it is the partnership between doctors and managers that makes the difference – where they have a productive working relationship.
The National Inquiry into Management and Medicine found that doctors and managers work best together when the following conditions exist:
A clear focus on the clinical business
space is created for local innovation by managing upwards
decisions are devolved to the right level
there is continuity over time
complacency is avoided by seeking internal and external challenge
interests are aligned through rewards, information, and performance management.
doctors and managers make sense of the external environment together
there is frequent dialogue to build a shared purpose
differences are seen as an asset – conflict is used positively
managers and doctors understand each other
there is investment in organisational change, doctors and managers learn together, and locally relevant performance management systems are developed.
This toolkit is a series of questions for you to answer in the Trust. The process of answering the questions will develop a better shared agenda, a better understanding of how to work together and a better working relationship between doctors and managers.”
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“The Health Innovation and Education Clusters (HIECs) initiative was launched in 2009/10 as an attempt to promote innovation in the NHS by combining the expertise of industry, health and education at a local level.
The initial funding for most of the 17 HIECs set up across England is due to finish this year, although most have secured continuing funds to manage the transition to new structures. Following research and interviews with all of the HIECs, this Briefing looks at their work to date, what impact it has made and what lessons can be learned from their experience of trying to spread innovation through partnerships.”Read Full Post | Make a Comment ( Comments Off on Lessons from Health Innovation and Education Clusters – NHS Confederation – 19 June 2012 )
“The NHS’s ability to harness innovation to improve patient outcomes is more important than ever in a tough financial climate. Uniquely among the organisations supporting this agenda, the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) have integrated research and implementation to ensure findings improve practice in real time.
They carry out high-quality applied health research and support getting research evidence into practice in the NHS. It has been said that getting research into practice takes 17 years; CLAHRCs have shown that it’s possible within three years through collaborative partnership working. They provide a powerful model to connect innovation, evidence and implementation.
The NHS Confederation has been closely involved in the work of CLAHRCs and continues to host their national support function. This Briefing describes the CLAHRC approach and their impact to date as well as the factors that continue to contribute to their successes.”Read Full Post | Make a Comment ( Comments Off on Integrating research into practice: the CLAHRC experience – NHS Confederation – 19 June 2012 )
Academic Health Sciences Networks: engaging with innovation and improvement – NHS Confederation – 19 June 2012
“This Briefing provides an update on the development of Academic Health Sciences Networks (AHSNs) – a new tier of organisations to improve the identification, adoption and spread of innovation in the NHS.
It explores some of the forms that AHSNs could take, what contributions different sectors need to make and, building on the experience of other local innovation partnerships, how AHSNs will need to be supported as they emerge.
This Briefing is part of a series on the NHS innovation landscape. It is accompanied by “Lessons from Health Innovation and Education Clusters” and “Integrating research into practice: the CLAHRC experience”. Later this year a summing up paper will be released, updating our 2009 publication “Making sense of the new innovation landscape”.”Read Full Post | Make a Comment ( Comments Off on Academic Health Sciences Networks: engaging with innovation and improvement – NHS Confederation – 19 June 2012 )
Extract from the foreword:
“What we call the Canadian health care system is, in reality, 14 different health care systems, each governed individually to meet the needs of its citizens. The 2003 First Ministers’ Accord on Health Care Renewal and the 2004 10-Year Plan to Strengthen Health Care were attempts to identify common priority areas shared by federal, provincial, and territorial governments, and to set out steps that needed to be taken to help improve the Canadian health care system as a whole.
Part of the Health Council of Canada’s mandate is to report on the progress made by the federal, provincial, and territorial governments since these accords. In this year’s report, we examine progress for five specific priority areas: home and community care, health human resources, telehealth, access to care in the North, and comparable health indicators. Another important part of our mandate is sharing innovative practices, so that governments, organizations, and the public can better understand what approaches are working, and why. In this report we have shone a spotlight on a number of innovative practices that reflect the spirit of innovation across the country.”
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Valuing Health Care: Improving Productivity and Quality – Ewing Marion Kauffman Foundation [US] – 19 April 2012
“Cost trends in U.S. health care consistently increase at about 2.5 percentage points faster than the general rate of inflation – clearly an unsustainable rate. To address what it called “America’s most urgent public policy problem,” the Ewing Marion Kauffman Foundation released a report at The Atlantic’s fourth annual Health Care Forum in Washington today that focuses on improving the cost-benefit balance in American health care through open access to medical data….
The report, “Valuing Health Care: Improving Productivity and Quality,” is based on the recommendations of 31 experts from related fields, whom the Kauffman Foundation convened to reframe thinking around the question, “How can the productivity and value of American health care be increased, in both the short-term and long-term?”
Specifically, the report recommends:
Unleashing the power of information by breaking down silos and encouraging data sharing between research centers, medical offices, pharmaceutical companies, insurance firms and others; and that a new corps of data entrepreneurs be incentivized to collect and analyze existing medical data to discover and then disseminate new therapies.
Funding more translational, cross-cutting research, with larger average grants made available to larger teams, many of them with participants from multiple institutions; and requiring collaboration across research institutions.
Reforming medical malpractice systems to streamline new drug approvals and remove counter-productive restrictions on health insurance premiums.
Empowering patients by, among other means, providing unbiased information on treatment options’ benefits and drawbacks, and helping them make choices about the relevant lifestyle implications and risk-reward tradeoffs.
Further, the task force contends, health care delivery deserves its own national research program, one focused on comparative efficiency research. More efficiency (with acceptable quality guidelines) leads to profitability, and corrects the easy practice of simply passing costs down the health care stream.”Read Full Post | Make a Comment ( Comments Off on Valuing Health Care: Improving Productivity and Quality – Ewing Marion Kauffman Foundation [US] – 19 April 2012 )
Ensuring Access to After-Hours Care – Commonwealth Fund – 4 April 2012
by David Squires
“Urgent care needs are not confined to weekdays and work hours. Nonetheless, patients often have difficulty accessing care after hours without going to the emergency department, which in many circumstances can be an inappropriate and inefficient use of health care resources. Ensuring that patients have timely access to the appropriate level of care on nights and weekends has the potential to reduce unnecessary emergency department use; it can also ensure that patients receive patient-centered, efficient care.
According to past Commonwealth Fund International Surveys, after-hours care is particularly difficult to obtain in the U.S. without going to the emergency department. In recent years, several countries, including the Netherlands, Denmark, and Germany, have sought to expand access to after-hours care—often by transitioning from the traditional approach, in which practices designate someone to be “on-call,” to group-based or regional approaches. As the U.S. seeks to strengthen primary care, particularly through the development of patient-centered medical homes, it has a great deal to learn from these international models.”
… continues on the site
“30 lung cancer teams across England have been working together to improve care for patients. The Improving Lung Cancer Outcomes Project (ILCOP), based at the Royal College of Physicians (RCP), and involving eight partner organisations*, brought the teams together to work collaboratively and share practice to improve the quality of care and patient experience for lung cancer patients.
Data from the National Lung Cancer Audit (NLCA) had previously revealed variations in lung cancer outcomes across England. ILCOP was established to identify reasons for the variation in clinical (NLCA) outcomes as well as patient experience outcomes, which were collected through a specifically designed lung cancer patient questionnaire. The project used proven quality improvement measures to support the teams to make improvements and came up with an educational programme to spread the learning across the 30 teams and the wider lung cancer clinical community.
The project paired hospitals and multi-disciplinary teams, and encouraged them to visit each others’ services and review their processes. This collaborative approach allowed lung cancer teams to share practice, resulting in a variety of practical improvements to processes, the patient pathway, and patient experience, as detailed in the attached booklet.
Practical examples of quality improvement projects undertaken by ILCOP teams include the following:”
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Background Paper on Conceptual Issues Related to Health Systems Research to Inform a WHO Global Strategy on Health Systems Research – 29 February 2012
Steven J. Hoffman et al
“This paper was commissioned to provide a conceptual underpinning for the WHO Global Strategy on Health Systems Research that is currently under development. It reviews existing definitions, terms, conceptual models, taxonomies, standards, methods and research designs which describe the scope of health systems research as well as the barriers and opportunities that flow from them. It addresses each of the five main goals of the WHO Strategy on Research for Health, including organization, priorities, capacity, standards and translation.1 Any feedback would be greatly appreciated and can be sent by email to Steven Hoffman (firstname.lastname@example.org).”
Health systems research is widely recognized as essential for strengthening health systems, getting cost-effective treatments to those who need them, and achieving better health status around the world. However, there is significant ambiguity and confusion in this field’s characteristics, boundaries, definition and methods. Adding to this ambiguity are major conceptual barriers to the production, reproduction, translation and implementation of health systems research relating to both the complexity of health systems and research involving them. These include challenges with generalizability, comparativity, applicability, transferability, standards, priority-setting and community diversity. Three promising opportunities exist to mitigate these barriers and strengthen the important contributions of health systems research. First, health systems research can be supported as a field of scientific endeavour, with a shared language, rigorous interdisciplinary approaches, cross-jurisdictional learning and an international society. Second, national capacity for health systems research can be strengthened at the individual, organizational and system levels. Third, health systems research can be embedded as a core function of every health system. Addressing these conceptual barriers and supporting the field of health systems research promises to both strengthen health systems around the world and improve global health outcomes.”
Guidance for Evidence-Informed Policies about Health Systems – PLoS Medicine – series of articles – 2012
Bosch-Capblanch X, Lavis JN, Lewin S, Atun R, Røttingen J-A, et al. (2012) Guidance for Evidence-Informed Policies about Health Systems: Rationale for and Challenges of Guidance Development. PLoS Med 9(3): e1001185. doi:10.1371/journal.pmed.1001185
Weak health systems hinder the implementation of effective interventions; policies to strengthen such systems need to draw on the best available evidence.
Health systems evidence is best delivered in the form of guidance embedded in policy formulation processes, but health systems guidance is poorly developed at present.
The translation of research on problems, interventions, and implementation into decisions and policies that affect how systems are organised is one challenge facing the development of health systems guidance.
The development of guidance that is timely and usable by the broad range of health systems stakeholders, and of methods to appraise the quality of health systems guidance, are additional challenges.
Further research is needed to adapt existing approaches (e.g., those used in clinical guidelines) to produce meaningful advice that accounts for the complexity of health systems, political systems, and contexts.
This is the first paper in a three-part series in PLoS Medicine on health systems guidance.
Lavis JN, Røttingen J-A, Bosch-Capblanch X, Atun R, El-Jardali F, et al. (2012) Guidance for Evidence-Informed Policies about Health Systems: Linking Guidance Development to Policy Development. PLoS Med 9(3): e1001186. doi:10.1371/journal.pmed.1001186
Contextual factors are extremely important in shaping decisions about health systems, and policy makers need to work through all the pros and cons of different options before adopting specific health systems guidance.
A division of labour between global guidance developers, global policy developers, national guidance developers, and national policy developers is needed to support evidence-informed policy-making about health systems.
A panel charged with developing health systems guidance at the global level could best add value by ensuring that its output can be used for policy development at the global and national level, and for guidance development at the national level.
Rigorous health systems analyses and political systems analyses are needed at the global and national level to support guideline and policy development.
Further research is needed into the division of labour in guideline development and policy development and on frameworks for supporting system and political analyses.
This is the second paper in a three-part series in PLoS Medicine on health systems guidance.
“Assessing how much confidence to place in different types of research evidence is key to informing judgements regarding policy options to address health systems problems.
Systematic and transparent approaches to such assessments are particularly important given the complexity of many health systems interventions.
Useful tools are available to assess how much confidence to place in the different types of research evidence needed to support different steps in the policy-making process; those for assessing evidence of effectiveness are most developed.
Tools need to be developed to assist judgements regarding evidence from systematic reviews on other key factors such as the acceptability of policy options to stakeholders, implementation feasibility, and equity.
Research is also needed on ways to develop, structure, and present policy options within global health systems guidance.
This is the third paper in a three-part series in PLoS Medicine on health systems guidance.”
Four Hour Rule Program. Progress and Issues Review – WA Health – December 2011
by Professor Bryant Stokes AM
NHS Chief Executive’s Review of Innovation in the NHS Summary of the responses to the Call for Evidence and Ideas – Young Foundation – December 2011
“In June 2011, the Department of Health issued a Call for Evidence and Ideas about how the adoption and diffusion of innovations can be accelerated across the NHS. This was part of the NHS Chief Executive‘s Review of Innovation in the NHS. This report is a summary of the responses submitted to the Call for Evidence which was carried out by the Young Foundation on behalf of the Department of Health.”Read Full Post | Make a Comment ( Comments Off on NHS Chief Executive’s Review of Innovation in the NHS Summary of the responses to the Call for Evidence and Ideas – Young Foundation – December 2011 )
Hospital Engagement Networks. Fact Sheet – US Centers for Medicare and Medicaid Services – 14 December 2011
“On December 14, 2011, the Centers for Medicare & Medicaid Services (CMS) awarded $218 million to 26 State, regional and national hospital system organizations to serve as Hospital Engagement Networks. The contracts were part of the Partnership for Patients, a nationwide public-private collaboration sponsored by the U.S. Department of Health and Human Services (HHS), to keep patients from being harmed while in the hospital and heal without complication once they are discharged.
The Hospital Engagement Networks’ will be funded as part of the $500 million Partnership for Patients initiative from the Centers for Medicare & Medicaid Services Innovation Center. The Center was established by the Affordable Care Act to identify and develop promising new models of care delivery to reduce costs and increase quality.”Read Full Post | Make a Comment ( Comments Off on Hospital Engagement Networks. Fact Sheet – US Centers for Medicare and Medicaid Services – 14 December 2011 )
“NHS organisations are planning for change, so the need for effective portfolio, programme and project management (P3M) is more apparent than ever. This Resource Centre brings together all the support materials and tools needed to improve P3M practice and skills in the NHS.”
How P3M can help your business
Implementing and improving P3M practice
Introduction to P3M
Innovation, health and wealth – Department of Health [UK] – 5 December 2011
“Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS, sets out an integrated set of measures that together will support the adoption and diffusion of innovation across the NHS and sets a delivery agenda that will significantly ramp up the pace and scale of change and innovation.”Read Full Post | Make a Comment ( Comments Off on Innovation, health and wealth – Department of Health [UK] – 5 December 2011 )
Towards integrated care in Trafford – Nuffield Trust – 10 November 2011
by Dr Sara Shaw and Ros Levenson
“This study of efforts in Trafford, Greater Manchester, to deliver integrated care provides valuable insights into the challenge of service reconfiguration at a time of financial constraint.”
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“Consultant physicians are at the forefront of delivering care to patients presenting to hospital with medical emergencies. Delivering this care depends on competent and expert clinical staff, organised with optimal working arrangements to match patient demand, supported by the right level of resources and facilities.
This toolkit, the second in a series on acute care, focuses on the delivery of high-quality acute care, looking at current problem areas and factors threatening care delivery, and suggesting a range of recommendations for improving quality.
The toolkit is accompanied by two appendices: the RCP position statement on out-of-hours care, and guidance notes on the provision of 12-hours-per-day, 7-days-per-week consultant care.”Read Full Post | Make a Comment ( Comments Off on Acute care toolkit 2: High quality acute care – Royal College of Physicians – 21 October 2011 )
The Higher Risk General Surgical Patient: towards improved care for a forgotten group – The Royal College of Surgeons of England – 29 September 2011
“The NHS must address the significant variations in care experienced by the 170,000 patients who have major emergency abdominal surgery each year, says a new report published by the Royal College of Surgeons. Poorly designed hospital services, particularly access to emergency operating theatres and radiology treatment, are among the problems highlighted. This results in patients missing out on early diagnosis and rapid life-saving care. In addition, there is a general lack of appreciation of the level of risk in emergency surgical patients – where death rates of 15 to 20 per cent are typical, and can be as high as 40 per cent in the most elderly patients. Surgeons say this imminent risk of death is not being reflected in the priority given to these patients whose chances of survival can more than double, depending on which NHS hospital they are treated in.
The report, The Higher Risk General Surgical Patient: Towards Improved Care for a Forgotten Group makes nine detailed recommendations. If implemented within two years, they will reduce complications and deaths, as well as reduce the cost of treating a group of patients who account for almost 90 per cent of post-operative general surgical deaths. Among the recommendations are:”
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Reformers and wreckers – Reform Research Trust – September 2011
Dale Bassett, Thomas Cawston, Andrew Haldenby, Patrick Nolan, Nick Seddon, Will Tanner, Kimberley Trewhitt
“This report presents evidence from eight case studies of successful public service reform in the UK and overseas. They show that reform of the workforce is an essential means of improving public services as well as reducing their costs.”Read Full Post | Make a Comment ( None so far )
A Comparative Study of Three Transformative Healthcare Systems: Lessons for Canada – Canadian Health Services Research Foundation – 28 August 2011
“This synthesis examines three high performing healthcare systems and identified the key themes that are relevant to Canadian Jurisdictions. The authors identify how these themes can be applied in the Canadian context and suggest steps forward.”Read Full Post | Make a Comment ( None so far )
Engineering a Learning Healthcare System: A Look at the Future – Workshop Summary – Institute of Medicine – 8 July 2011
“Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system—one that increasingly is more effective, more efficient, safer, and higher quality—is rooted in continuous improvement principles that medicine shares with engineering. As technological advances and new insights into disease and individual variation increase the complexity of medicine, progress will depend on the ability to design healthcare delivery systems in which all of the components are coordinated, streamlined, efficient, and seamlessly interfaced.
As part of its Learning Health System series of workshops, the IOM’s Roundtable on Value & Science-Driven Health Care hosted a workshop, jointly with the National Academy of Engineering, on lessons from systems and operations engineering that could be applied to the organization, structure, and function of health care delivery, monitoring, and change processes. Participant discussions on the promise of, and actions necessary to implement, engineering approaches to healthcare systems improvement are summarized in this report.”Read Full Post | Make a Comment ( None so far )
Enhancing Surgical Care in BC: Improving Perioperative Quality, Efficiency, and Access – A Policy Paper by BC’s Physicians – June 2011
British Columbia Medical Association
Extract from the executive summary.
“In this policy paper, the BC Medical Association (BCMA) proposes that a coordinated initiative to improve the quality, efficiency, and access to surgical care needs to be implemented across British Columbia. There are over 400,000 hospital-based surgical procedures performed each year in the province. The increasing demand for surgical care, a growing emphasis on the quality and safety of care, and the rising costs of delivering health services are driving the need for the health care system to improve the level and quality of surgical care while keeping health care expenditures in check.
The operating room (OR) and the processes that support the OR make up the perioperative system. A considerable amount of planning, preparation, and coordination within the perioperative system is required to ensure that patients receive quality surgical care that is safe and timely. However, quality and efficiency issues can cause surgical delays, cancellations, adverse events, and suboptimal care for surgical patients. These issues affect the experience and outcomes of surgical patients, the satisfaction of perioperative personnel, and the financial budgets of hospitals.
To address these issues, hospitals across Canada and in other countries have turned to concepts such as process improvement and system redesign initiatives to enhance the quality and efficiency of the surgical system. Perioperative personnel are being directly engaged. Surgeons, anesthesiologists, nurses, OR coordinators, and others can systematically examine where problems exist and develop solutions to reduce surgical delays and cancellations, eliminate adverse events, and improve the system for patients.
Individual hospitals in BC are beginning to apply process improvement methods to surgical care and other areas of the health care system with some promising results. The BCMA proposes that a provincial framework centered on the principle of continuous process improvement should be developed to support individual hospitals and surgical personnel to implement this initiative. In the spirit of process improvement, this needs to be an undertaking that engages perioperative personnel, is supported by senior management, and is ongoing and measurable—with institutions learning from each other’s challenges and success.”
The BCMA offers 12 recommendations on the design, implementation, and evaluation of performance improvement in surgical care in BC. The following is a working summary, which synthesizes some of the recommendations into six concepts:
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Public Sector Innovation Toolkit released – 29 June 2011
“Tonight the Department of Innovation, Industry, Science and Research has released the Public Sector Innovation Toolkit website.
The website is part of the APS-wide innovation agenda, designed to help public servants develop and apply innovative solutions.
Published under a Creative Commons Attribution license, the Innovation Toolkit is being used to,
•provide information about the innovation process, tools and approaches that can support innovation in public sector organisations
•provide updates on developments in APS innovation
•provide links to relevant information and research
•discuss issues relating to public sector innovation
•ask for input
•highlight examples of innovation in the public sector.
As a living resource I expect to see the toolkit growing and maturing based on the feedback of its users as a world-class tool for public servants.”Read Full Post | Make a Comment ( None so far )
Local adult neurology services for the next decade: Report of a working party – Royal College of Physicians and the Association of British Neurologists – June 2011
Local adult neurology services for the next decade: Report of a working party – Royal College of Physicians and the Association of British Neurologists – June 2011
Royal College of Physicians. Local adult neurology services for the next decade.
Report of a working party. London: RCP, 2011.
Extract from the executive summary:
“Neurological disorders are very common, accounting for about one in ten general practitioner consultations, around 10% of emergency medical admissions (excluding stroke) and disability for one in 50 of the UK population. They include many different conditions of varying severity, some very common and others exceedingly rare, from migraine to motor neuron disease.
Patients require access to different parts of the neurological care pathway at different stages of their illness (acute admission, outpatient care and long-term care). However, these are currently poorly planned and organised. Good management requires better integrated primary, secondary and tertiary resources to achieve a neurology network that is easily accessible, provides local care where appropriate and, when necessary, involves the regional neurosciences centre.”Read Full Post | Make a Comment ( None so far )
Delivery System Reform Tracking: A Framework for Understanding Change – Commonwealth Fund – 2 June 2011
The health care delivery system is changing rapidly, with providers forming patient-centered medical homes and exploring the creation of accountable care organizations. Enactment of the Affordable Care Act will likely accelerate these changes. Significant delivery system reforms will simultaneously affect the structures, capabilities, incentives, and outcomes of the delivery system. With so many changes taking place at once, there is a need for a new tool to track progress at the community level. Many of the necessary data elements for a delivery system reform tracking tool are already being collected in various places and by different stakeholders. The authors propose that all elements be brought together in a unified whole to create a detailed picture of delivery system change. This brief provides a rationale for creating such a tool and presents a framework for doing so.”
Safe and Effective Service Improvement: Delivering the safety and productivity agenda in healthcare using a Lean approach. An Amnis White Paper – May 2011
“This guide is designed to introduce those with a responsibility for safety and productivity working in healthcare organisations to the concept that Lean can, and already is, being used to tackle both of these important agendas. Further than this, we also aim to show that an absence of “Lean Thinking” inside healthcare organisations can lead to increased patient safety risks.”Read Full Post | Make a Comment ( None so far )
Reducing expenditure on low clinical value treatments: A health briefing – Audit Commission [UK] – 14 April 2011
“This health briefing suggests that the NHS could save up to £500 million a year by carrying out fewer ineffective or inefficient treatments.
‘Reducing expenditure on low clinical value treatments’ argues that a single approach to defining these low value treatments could help to reduce the duplication of effort between primary care trusts (PCTs) and help to ensure consistency across the country.
The briefing considers some PCTs’ efforts to decommission treatments of low clinical value. The approaches they took and the list of treatments they targeted varied. The Commission is not advocating any particular list, but the types of low value treatments identified included:
Those considered to be relatively ineffective, eg a tonsillectomy.
Those where more cost-effective alternatives are available, eg not performing a hysterectomy in cases of heavy menstrual bleeding.
Those with a close benefit and risk balance in mild cases, eg wisdom teeth extraction.
Potentially cosmetic procedures, eg orthodontics.
Decommissioning treatments can free up money that could be better spent on other treatments, but decisions can be controversial. The briefing shows how strong leadership within PCTs, as well as good communication between PCTs, and GPs, patients and the public, are crucial success factors.
A simple and easy to use online tool has also been developed that allows the user to identify savings opportunities against the ‘Croydon list’.”Read Full Post | Make a Comment ( None so far )
Authors: Roger K. Resar, Frances A. Griffin, Andrea Kabcenell, Catherine Bones IHI
Within the US and around the world, hospital executives are facing increasing pressure to reduce operating costs and improve quality of care. Hospitals that fare best will be those that become efficient operators and reduce waste in their clinical care. Efforts are underway in many places to reduce waste, improve efficiency, and maintain quality. In December 2009, the Health Foundation in the United Kingdom commissioned the Institute for Healthcare Improvement (IHI) to design and test a tool for identifying clinical waste within the hospital inpatient setting. Through review of existing literature, conversations with experts, and direct input from hospitals engaged in testing, IHI developed the Hospital Inpatient Waste Identification Tool. The Waste Identification Tool was designed to identify clinical and operational waste from the perspective of frontline clinical staff, with the aim of informing strategic decision making for the hospital.” … continues
Evaluation of the National Clinical Handover Initiative Pilot Program – Australian Commission on Safety and Quality in Health Care – 11 April 2011
“In 2010 the Commission engaged Grosvenor Management Consulting to undertake an external evaluation of the National Clinical Handover Initiative Pilot Program.
The aim was to evaluate how successful the Pilot Program (encompassing the fourteen individual projects) has been at meeting its objectives.” … continues on the site
Working paper: Transformation of a mental health system – the case of Scotland and its lessons for Australia – Menzies Centre for Health Policy – February 2011
by Jennifer Smith-Merry
“Executive Summary: the three minute version.
The ability of health systems to successfully transform has become a concern for both policy makers and academic researchers over the past five years. This working paper, based on over 50 interviews, observation and extensive document analysis undertaken over a four year period, reviews the transformation of Scottish mental health policy over the past ten years in order to examine processes which led to transformation. In reviewing the Scottish case we find that between 1999 and 2009 the Scottish mental health policy and legislative frameworks for mental health were completely transformed.” … continues on the site
Developing Strategies for Improving Health Care Delivery: Guide to Concepts, Determinants, Measurement, and Intervention Design – World Bank – 2010
Bradley, E.H., Pallas, S., Bashyal,C., Curry, L., & Berman, P. (June 2010). Developing Strategies for Improving Health Care Delivery: Guide to Concepts, Determinants, Measurement, and Intervention Design. The World Bank: Health Nutrition and Population
“Abstract: This report is a user‟s guide for defining, measuring, and improving the performance of health service delivery organizations. We define six core performance domains: quality, efficiency, utilization, access, learning, and sustainability and provide a compendium of metrics that have been used to measure organizational performance in each of these six domains. The compendium, which includes 116 distinct categories of metrics, is based on a detailed literature review of peer-reviewed empirical studies of health care organizational performance in World Bank client countries. We include a bibliography of studies that have used these measures.
Based on our reading of the literature, we define seven major strategy areas potentially useful for improving performance among health care organizations: 1) standards and guidelines, 2) organizational design, 3) education and training, 4) process improvement and technology and tool development, 5) incentives, 6) organizational culture, and 7) leadership and management. We provide illustrations of facility-level interventions within each of the strategy areas and highlight the conditions under which certain strategies may be more effective than others. We propose that the choice of strategy targeted at organizational level to improve performance should be informed by the identified root causes of the problem, the implementation capabilities of the organization, and the environmental conditions faced by the organization.” …continues on the siteRead Full Post | Make a Comment ( None so far )
Authors: Jill Eden, Laura Levit, Alfred Berg, and Sally Morton, Editors; Committee on Standards for Systematic Reviews of Comparative Effectiveness Research; Institute of Medicine
“Healthcare decision makers-including doctors-increasingly turn to systematic reviews for reliable, evidence-based comparisons of health interventions. Systematic reviews identify, select, assess, and syn thesize the findings of similar but separate studies. In this report, the IOM recommends stan dards for systematic reviews of the comparative effectiveness of medical or surgical interventions.”
Implementing and sustaining change in the contemporary NHS: lessons from the Productive Ward – Policy +, King’s College London – March 2011
Implementing and sustaining change in the contemporary NHS: lessons from the Productive Ward – Policy +, King’s College London – March 2011
“Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one organisation, their systematic spread and sustainability is unpredictable (Berwick 2003.) Given the quality and cost challenge currently facing the NHS, it is critical that improvement programmes are implemented quickly, on a large-scale and assimilated and sustained in routine practice. The NNRU reviewed the theory on the spread of innovations and applied this evidence to their ongoing research into the implementation and assimilation of the Productive Ward. Here we present the findings and consider the implications for policy and practice.”Read Full Post | Make a Comment ( None so far )
An evaluation of the impact of community-based interventions on hospital use: a case study of eight Partnership for Older People Projects (POPP) – Nuffield Trust – 10 March 2011
An evaluation of the impact of community-based interventions on hospital use: a case study of eight Partnership for Older People Projects (POPP) – Nuffield Trust – 10 March 2011
Author: Adam Steventon, Martin Bardsley, John Billings, & Geraint Lewis
“To improve the quality of care and at the same time reduce costs, efforts are being made across the UK to deliver more health and social care in community settings. One recent initiative to address this issue was the Partnership for Older People Projects (POPP) – a series of innovative projects that received ring-fenced funding from the Department of Health over a two-year period.
The Nuffield Trust was commissioned by the Department of Health to evaluate a small but carefully selected set of eight POPP interventions and examine whether these interventions were successful at preventing unplanned hospital admissions.” …continues on the siteRead Full Post | Make a Comment ( None so far )
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