HSJ: Human centred systems - the case for [disintegrated] integration

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Listening, communication slip ups YOU! are a - “bed blocker” “frequent flyer” My purpose Valuable or Vulnerable person? “PROTECT the Person”	Services, Teams, Silos Repeated doubling up, duplication Threshold raising simplify the steps 1940s style factory production line model ? 5-year cycle, interventions, (budget) ? Place-based
Neighbourhoods Anthropology of Communities PUBLIC - 'shared purpose' lived experience - develop a more flexible multidisciplinary workforce coproduction :: purchaser provider led model of commissioning social scaffolding in neighbourhoods -	initiatives Organisation 'INTEGRATE' Sovereignty, governance structures, pooled budgets “PROTECT the NHS” Public Service reform:  local government, dept of work and pensions,  police, housing and community and voluntary organisations.  - joint investment models

 

Human centred systems - the case for integration, By Donna Hall, 15 February 2021. HSJ. https://www.hsj.co.uk/service-design/human-centred-systems-the-case-for-integration/7029472.article 

 

My source: https://twitter.com/antlerboy/status/1392547724201971716?s=20

Nursing Now: Triple Impact Report

"The International Council of Nurses (ICN) is a federation of more than 130 national nurses’ associations representing the millions of nurses worldwide. Operated by nurses and leading nursing internationally, ICN works to ensure quality care for all and sound health policies globally.

Nursing Now is a three-year global campaign run in collaboration with the International Council of Nurses and the World Health Organization. It is based on the findings of the Triple Impact report, which concluded that as well as improving health globally, empowering nurses would contribute to improved gender equality – as the vast majority of nurses are still women – and build stronger economies.

The World Health Assembly is the decision-making body of the World Health Organization, which determines its policies, appoints its Director General and approves and oversees its budget."

https://www.icn.ch/news/international-council-nurses-and-nursing-now-welcome-2020-international-year-nurse-and-midwife

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Empowering nurses  as individual (and collective)  practitioners will ...	... improve Health Globally ...
... improve gender equality	... and build stronger economies.

Dear McKinsey and Company, Re. "The era of exponential improvement in healthcare?"

Re. Your article:

The era of exponential improvement in healthcare?

(By Shubham Singhal and Stephanie Carlto)

Technology-driven innovation holds the potential to improve our understanding of patients, enable the delivery of more convenient, individualized care—and create $345 billion to $420 billion in value by 2025.

Healthcare advances have delivered great benefits to society, bringing material improvements in average life spans and quality of life.¹ Yet these improvements have come at a cost—an ever-expanding portion of the US GDP is being consumed by healthcare expenses.² Could technology, enabling delivery of healthcare advances while improving affordability, be part of the solution? We have reviewed the evidence, done the math, and identified technology-enabled use cases that could create between $350 billion and $410 billion in annual value by 2025 (out of the $5.34 trillion in healthcare spending projected for that year³ ).

Read more ...

<>

But how would we recognise the era of exponential improvement in healthcare?

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The exponential benefits realised 'elsewhere' in global, local and glocal health and healthcare systems finally sees the achievement of parity of esteem with mental health not only fully funded, but designated as the key that must be turned 4 happiness. Despite the diametrical opposition of this domain to the political domain, there is a breakthrough in policy makers and the body politic prioritising "The Long Now"

"Predictions of an exponential increase in people living with dementia in the coming 30 years require evidence-based strategies for advancing dementia care and maximizing independent living. However, the evidence required to inform priorities for enabling improvements in dementia care is rarely presented in a way that stimulates and sustains political interests."  Martin, O’Connor, & Jackson (2018).

Community-based healthcare becomes  the norm and the educational, preventive and sustainable ethos for health and healthcare systems is adopted globally. Look at the readiness and response-to potential epidemic crises, plus  interventions in population health.  Exponential benefits are accrued. Evidence - look at the number of  (new) hospital beds. The community IS the market.

Exponential growth in global healthcare funding, health information for all, access to universal health care.  Social Determinants of Health not just a vision: but enacted and ongoing #SDoH-X. Evidence - climate change slowing, air quality improving - the 21st Century truly begins ...

Martin, A., O’Connor, S., & Jackson, C. (2018). A scoping review of gaps and priorities in dementia care in Europe. Dementia. https://doi.org/10.1177/1471301218816250

My source:
email - McKinsey Insights

Infographic: What does the UK spend on health and social care?

c/o John Appleby and BMJ


The political impact of this spending have huge ramifications for many individuals 
in terms of efficiency, effectiveness, equity and equality.

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	John Appleby: Infographic - What does the UK spend on health and social care?

Source:

This data vis piece in @bmj_latest apparently in the 99th percentile of all 13m+ research outputs ever tracked by Altmetric for online attention. #Whichisnice. @will_s_t https://t.co/meT0HBG1hO https://t.co/mbA2ZvwMdn

— John Appleby (@jappleby123) April 12, 2019

Person-centred care [PCC]: is it really happening? c/o National Voices

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PCC = what’s important to the individual, is co-ordinated around their needs and involves them in decisions. "To be person-centred, that care needs to work together to wrap around all the needs of the individual in a holistic way. Sadly, our report found that neither the NHS nor adult social care can demonstrate co-ordination of care, despite ‘integrated care’ being a key goal of all national and local leaders over the past five to 10 years. The way health and care services work must change to reflect the needs of the population. It would be a start to recognise that co-ordination of care is an important factor, and that we need to be measuring whether it is happening."	(many) Definitions = 5 key indicators of pcc:  good information, good communication, involvement in decisions,  care co-ordination  and care planning. Service user reported data from 19 nat. surveys NHS:  in primary care, only 39% of patients said their GP was ‘very good’ at involving them in decisions. What’s more, personalised care planning doesn’t really happen. Only 3% of GP patients with one or more long-term conditions reported having a written care plan, suggesting that opportunities to deliver personalised care in the NHS are being missed.
"Personalisation of care is more advanced in adult social care than in the NHS, with 89% of adult social care users reporting that the care and support they received helped them to have control over their daily life. Similarly, 63% of people using a social care personal budget said that this had improved their ability to make everyday decisions. Participation and control of decisions is well-established in adult social care, with just over 90% of those using community adult social care saying they were involved in decisions about their care and support needs." (See original post - report for important additions)	20+ years policy  England Care Act 2014 National Voices coalition of health and care charities  report ‘Person-centred care in 2017' No National data on this... "It is clear from our report that a strategic overhaul of how care is measured is needed. Rather than single-service, single-setting, activity measures, more credence needs to be given to the experiences of the people who rely on services. Only then can we help local systems succeed in offering personalised, integrated and holistic care. Whilst there have been some advances in the delivery of person-centred care, there is still a long way to go before the policy rhetoric matches the reality experienced by people."

Paper: "Defining Health in the Era of Value-based Care ..." mapped to Hodges' model

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Q. What is value? Demand (Individual) freedom to lead lives they have reason to value [Why we need a global generic conceptual framework:  Self care =  transformation of Demand into Supply] Patient Reported Outcome Measures (PROMs) 'benefit' across Hodges' model? 'harm done' across Hodges' model? Shared Decision Making -  patient centred care,  choice, autonomy,  Right Care, Right Time, Right Place?*

A's.  Value = outcomes achieved – money spent (Porter) 1.Allocative value – how to allocate resources equitably in such a way that maximum value for the whole population is obtained 2.Technical value – increased value associated with improvements in quality and safety of healthcare 3.Personalised value – individual patient values, in combination with best evidence and assessments of the person’s condition. (Gray) Supply - Outcomes PROMS: hip replacement, knee replacement, groin hernia and varicose veins Right Care, Right Time, Right Place Chronic disease Improving medical technology

Demand Social determinants of health "Unlimited healthcare intervention provision may lead to increased harm." Friends and Family Test Person- and community-centred approaches, such as peer support, self-management education, health coaching, group activities and asset-based approaches. Local - Community - National Porter recommends classification of outcomes in three tiers [16]. Tier one is ‘Health status achieved or retained’, including measures such as survival at one or five years, or for those with life-limiting conditions, the degree of health or recovery achieved or maintained. Tier two, ‘Process of recovery’, includes the time taken to return to normal activities and disutility of care, such as errors and adverse events in care, incorrect diagnosis, and discomfort. Tier three is ‘Sustainability of health’ and includes recurrence and long-term consequences of treatment.

"The definition proposed by Gray ... defines value in healthcare as ‘the net benefit, that is the difference between the benefit and the harm done by a service, taking into account the amount of resources invested’" Supply - Outcomes Health Economics limited healthcare budgets Governments - Industries Relationships demand - drug costs Moving FROM: cost-effectiveness and pay for performance TO: Value-based pricing Healthcare-associated harm Value-based healthcare has the potential to be used in local and national priority setting and policy development.

*This brief paper provides a very good outline of value-based care. 'Mental' in this paper is mentioned early on in a definition of health, thereafter you will find 'mental' in funda-mental, environ-mental plus incre-mental. 'Mental health' and values-based care will no doubt be discussed elsewhere. This brief paper suggests however, that we really do need a generic conceptual framework for health and social care. To be fully-realised value-based care must also reach, encompass and incorporate mental health and public mental health.


Gentry S, Badrinath P (March 06, 2017) Defining Health in the Era of Value-based Care: Lessons from England of Relevance to Other Health Systems. Cureus 9(3): e1079. DOI 10.7759/cureus.1079

Place-based systems of care: The King's Fund

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individual workers mindset Leadership placEmotion	'place': physical & virtual? estates, buildings technology, e-health? travel - efficiency
Local need - availability "Home" "Hospital" "Community" Social Care : Health Recovery, Rehabilitation, Reablement	King's Fund Place-based systems of care leadership, commissioning, organisations, budgets, integration, populations, strategic budgets,

My source:
Ham, C., & Alderwick, H. (2015) Take a place-based approach to care, Health Service Journal. 125:6469, 16-17.

Nursing the Research Councils

It seems incredible the way the years have flown by since 2006, the year this blog started. So many changes personal, technical, learning ... along the way.

That year I attended a research grants event in Bath, UK. An Ideas Factory organised by one of the research councils. Writing about the fraught, hard, emotionally demanding and yet very rewarding experience it struck me back then how duplication between organisations could creep in.

All those acronyms! There was in a way a lot of support for Hodges' model, with the disciplinary divides in evidence. Whether it's a 'market' view, policy or other perspective it seems innovation, serendipity, creativity and interdisciplinary progress (that might also become transdisciplinary?) might be assisted by some 'slack resource' in the system. Some opportunities, avenues for cross-fertilization of ideas to occur. Sometimes this is done deliberately, such as the Ideas Factory.

Now with austerity ongoing, UK research has been reviewed:

Sir Paul Nurse’s independent review of the UK research councils

I hope that some capacity for mixing things up will remain.

Non-Cartesian points, opposing corners and capital redux

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"I felt capital Patient?
	Patient capital? like  the  mad man  in the corner,"

a senior NHS figure said of recent top level meetings discussing the financial travails and sliding performance of the provider sector. ... The delineation between these two camps is becoming clearer. ... p.3 

Source: McLellan, A. (2015) Leader: Modernisers must cut the deficit to keep their side of the deal. Health Service Journal, 3 June. 125;6449:p.3.

See also:
Capital 'p': Patient, Person, Person-centred, Personhood

HSJ Editorial 22 March 2007: Finance

Before my son's bike race at Darley Moor on Saturday*, I picked up the latest Health Service Journal and flask of coffee. Reading the editorial I was struck by the sequence of the two items and my experience or lack of it.

The first item 'Consistency and agreement are needed to spread success' concerned the Commons Public Accounts Committee report on financial management and its conclusions. These included the need to share lessons learned from successful financial turnaround programmes plus (paraphrased):

The performance of the finance function is too patchy, inadequate in more than a quarter of organisations. There are recurring problems with recruitment, training and development with the central issue being the role of clinicians in financial management.

The much desired engagement here is between senior clinicians and management. The recent BBC 2 series Can Gerry Robinson Fix The NHS? demonstrated the all-to frequent gulf between managers and senior clinicians.

Returning to the HSJ editorial: payment by results - the much vaunted tipping point for clinical engagement in finance has (thus far) not tipped. For mental health there's still time, but then déjà vu kicked in. Quite a few years ago I remember getting ready to catch micro-commissioning and run with it, but the pass never came. It is happening in some places, with big brother macro-commissioning. I was pleased and yet disappointed. Pleased because at the time I was Team Leader for a Community Mental Health Team for Older People and I - quite typically then and now for such posts - also had a caseload. The disappointment followed from recognition that not only had a learning opportunity been lost, but a management learning opportunity to boot.

Amid the taste of coffee irony filtered through: that missing tipping point, the need for wider cultural changes (service line accounting) and clinically in mental health (and elsewhere) the focus on risk. People 'at risk' must not fall through the net. Well I don't know the details of service line accounting and the like, but I do know that while planting trees provides instant results, it is labour intensive and risky compared with sowing seeds. After all - never rely on one prong when several can help get your point across...

Mr Robinson's series revealed that other clinicians can act as change agents. Shifting the risk context to finance, how many clinicians fall through the management net? OK, hands up, if like me seeing a bottom-line makes you blush? My 1st line management course was some twenty five years ago. Six, or seven years later saw me on a not-quite-a-middle-management-course. Then I listened out for him, but LEO (Leading Empowered Organisations) never knocked on my door. Yes, I could have chased this. ... If clinicians are soft-wired to take detours around financial centers, somebody had better make sure those seeds are carrots.

The second item concerned joint working - asset-sharing between the NHS and local government and the journal's features on patient-public involvement, population health-NHS-Local Authority, joint strategic needs assessments. It just struck me that there's so much we don't understand about the functioning of these distinct organisations. Will integration help, or is it creating another layer of complexity? I'm all for encouraging and nourishing new ideas, but how does your garden grow with too much nitrogen?

Up to a few years ago I had something in common with Alan from TRON:

"I don't even balance my checkbook on downtime."

Finances looked after themselves. Not any more: cue pension wake up call and we are all tax-payers...

Seriously though, where do we want our intelligence to be in 10-20 years time?

Imagine financial reports that also relate to local public (mental) health outcomes. Maybe these exist in some places? Now that's a code disc that really would summon in a new order. Make financial information relevant to the clinical practitioners who make up the [ holistic ;-) ] multidisciplinary team then the trees will start walking.

*Punctured!

Nick Edwards (2007) Comment, HSJ, 22 March, p.3