Care by the Quarter*

individual

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INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group - population

	"A review of almost 1,000 audits by a professional accounting body has found that about a quarter were substandard."

 

*5ths really - the spiritual and never an after-thought...

When we talk of achieving 'balance', 'leverage', being 'on message' and other c-speak, this is clearly never straightforward.

Source:

Louisa Clarence-Smith, Inspectors find a quarter of audits are substandard, The Times, September 29, 2020, p.42.

See also:

Bloomfield, B. P., & Danieli, A. (1995). THE ROLE OF MANAGEMENT CONSULTANTS IN THE DEVELOPMENT OF INFORMATION TECHNOLOGY: THE INDISSOLUBLE NATURE OF SOCIO-POLITICAL AND TECHNICAL SKILLS*. Journal of Management Studies, 32(1), 23–46. https://doi.org/10.1111/j.1467-6486.1995.tb00644.x 

Leys, C. (1999). Intellectual Mercenaries and the Public Interest: Management consultancies and the NHS. Policy & Politics, 27(4), 447–465. https://doi.org/10.1332/030557399782218353

Oliver, D. (2014). Stop wasting taxpayers’ money on management consultancy for the NHS. BMJ: British Medical Journal, 349. Retrieved October 9, 2020, from https://www.jstor.org/stable/26519046

Kirkpatrick, I., Sturdy, A J, Alvarado, N, Blanco-Oliver, A and Veronesi, G. ‘The impact of management consultants on public service efficiency’ Policy & Politics: doi.org/10.1332/030557318X15167881150799. 

http://www.bristol.ac.uk/media-library/sites/policybristol/PolicyBristol_Briefing_54_2018_management_consultancy_inefficiency_in_the_NHS.pdf

Begley, P., & Sheard, S. (2019). McKinsey and the ‘Tripartite Monster’: The Role of Management Consultants in the 1974 NHS Reorganisation. Medical History, 63(4), 390-410. doi:10.1017/mdh.2019.41

https://twitter.com/barry_halverson/status/1314255088874127360?s=20

 

Squaring circles: Compressed patient care pathways = rich(er) patient experiences?

The use of Lean and Six-Sigma, their combination and other service improvement approaches has resulted in much more effective patient care pathways. A shining example is that of diagnostic medicine and subsequent out-patient appointments, apparently patients can attend for diagnostic services such as imaging and on the same day also attend for their first out-patient appointment. This saves time for all, with expensive imaging technology also proving its worth and RoI by working from 0700-2200.

Trust Boards are well pleased with such progress, but there is no such thing as a free lunch. Managers and execs know the lunch (diagnostics and imaging) isn't free, but quantitative aspects aside what does does this mean in terms of quality and assurance? Quality in the sense of:

• patient (and carer) experience;
• staff capacity to find and take advantage of patient learning (self-care, patient health career management) opportunities;
• assessment and evaluation of patient (carer) comprehension;

There is a circle to be closed by relating quality to quantitative aspects; such as, re-referral rates, re-admission, medication / treatment concordance, plus the infusion of intelligence from local and national patient related outcome measures [PROMS] to new patient journeys.

In information science there is the concept of information compression, taking out the redundancy - repetitive data in an image or text to save on processing, transmission, and storage. As Lean Six Sigma assists teams to remove tasks, processes that do not 'add value' then the result is a richer experience. The patient journey has in this sense been compressed. The patient has fewer hospital and clinic visits with fewer bus, taxi journeys, or they pay less in car park fees. Health personnel and specialists are primed to help and deliver services that really count.

What does this compressed - 'denser' experience - mean though? Does it mean that:

• patient's are exposed to more information (2-3 significant interviews / leaflets / instructions)?
• there is less time available for education, health promotion, info Px giving?

- or alternately:

• does this 'value packed' patient journey help by providing rapidly successive hooks - experiential threads to integrate patient (carer and staff!) learning?

It will be interesting to see answers to these questions and how extensive the scope of benefits are of these patient experiences across different care contexts.

Is there an optimal number for 'clinical encounters' before things start to go awry?

PROMS are quite specific (as they need to be initially), but amid richer and varied patient journeys there will be a need for other (national and local) measures. What about the extent and level of 'care complexity' and 'holistic care'?

Image source: http://www.navyenterprise.navy.mil

CARE = Plastic + Paper + Packages

The commodification of health seems to be a new phenomena and yet of course the search for 'cures' and 'spells' to ease this universal aspect of human existence has been with us for millennia. Now though the world of pyramid selling has ramped things up. The world at large has stepped on the gas. Plastic may well rule as the means to pay for the COS-plas-ME-tic surgery and presents a public face to the digital world of bits and bytes.

Now as we've seen the superstores and global IT players are getting in on the act (is that an unfortunate turn of phrase?) with Tesco, Google and Microsoft on board the bus with their respective partners. Health tourism clearly extends the notion of 'package holiday' AND 'care package'.

So - 'global health' anyone?

There must be a risk that the real messages of global health will get lost in the fog of contrails and business transactions.

In the meantime the heady interplay of plastic and paper and getting the biometrics to fit just right - points to the need for vigilance. As this blog and website makes clear I'm an ICT champion. I'm also a community mental health nurse. This means with fellow champions that two perspectives need to taken into account and monitored for risks and opportunities. I just wonder whether the move from paper to paperless records opens the door to the dilution of high standards of care?

Look at it this way: there we are in our care sectors with our care packages. In health we are trying to get leaner, stripping out redundant processes, delays, duplication, trying to magnify real purposes and strengths. As for the superstores well they (and we!) still need to get to grips with packaging. I hope this does not just prove to be a straight swap - variously labelled -

'FRAGILE'
'THIS WAY UP'

Fragile tape: image source http://adifferentvoice.wordpress.com/2007/09/18/labels/