great innovations of the first and second healthcare revolutions

Great innovations of the first and second healthcare revolutions

• MRI and CT scanning• Anti psychotics• Antibiotics• Genetics• Hip and knee

replacement• Chemotherapy• Antidepressants• Randomised controlled

trials• Systematic reviews

Gower Street - Doll & Hill

Broad Street - John Snow

The First The Second

- BUT the NHS still faces 5 major problems• SAFETY -Errors and mistakes

• QUALITY - sub standard clinical practice and poor patient experience

• FAILURE TO MAXIMISE VALUE– Waste– Overenthusiastic adoption of interventions of low value and failure to get new evidence into practice

• INEQUALITIES • FAILURE TO PREVENT

AND new, additional challenges are developing

• RISING EXPECTATIONS• INCREASING NEED due to

– population aging – obesity due to too much food and too little exercise– new technology

• CLIMATE CHANGE which will create health problems and health emergencies and lead to Carbon constraints

• FINANCIAL CONSTRAINTS

We need to do the right things and, every year, do them•Better,•Safer,•Greener, and•Cheaper

We need to do the right things and, every year, do them•Better,•Safer,•Greener, and•Cheaper

Commissioning

QIPP

High Value

Low Value

The economic meaning in the Shorter English Dictionary is‘that amount of some commodity, medium of exchange, etc. which is considered to be an equivalent for something else’, and it gives as an example of the meaning of the term the use in 1806,‘we could hardly be said to have value for our money’.

Waste

Value

ValueWaste

We hate muda

High High Carbon Value

Low Low Value Carbon

High High Carbon Value

Low Low Value Carbon

Information Knowledge Technology

Citizens

The Drivers of the Third Industrial Revolution (Manuel Castells)

21st C leadership

The management of culture is one of the responsibilities of the leader

If you were to ask all the commissioners to write down the difference between the

meanings of productivity and efficiency what would they write?

If you asked them to describe Donabedian’s theory of optimality

The law of diminishing returns

BVHP The Better Value Healthcare Programme

Benefits

Investment of resources

Harmful effects increase in direct proportion to the resources invested

BVHP The Better Value Healthcare Programme

Harmful orSide effectsOf care

Investment of resources

After a certain level of investment the health gain may

start to decline

BVHP The Better Value Healthcare Programme

Benefits

Investment of resources

Harms

Benefits - harm

At the point of optimality value is maximised

BVHP The Better Value Healthcare Programme

Investment of resources

Benefits - harm

Optimality

BVHP The Better Value Healthcare Programme

cancer

cardiac

mental health

Manage.&IT Prevention

Diagnosis

Complicatedeg Trauma,Very old people

ChronicHealthProblems

Res& Ed

Evidence

The values of the population served

The other needs of the population(opportunity costs)

Choice Decision

DECISION MAKER(OFFICIAL)

11 Total Problems of the Respiratory System 3,539,634

11 A Obstructive Airways Disease 576,008

11 B Asthma 849,076

11 X Problems of the Respiratory System Other 2,114,551

792,000 tonnes of carbon

23 X Other Areas of Spend/Conditions 22,596,181

23 a • General Medical Services/Personal Medical Services 7,256,778

23 b • Strategic Health Authorities (including WDCs) 3,514,197

23 x • Miscellaneous 11,825,209

Evidence

The values of the Patients served

The other needs of that group ofpatients

Choice Decision

BVHP The Better Value Healthcare Programme

cancer

cardiac

mental health

Breast

bowel

lung

The Oxford Healthcare System

Objectives Criteria Standards Performance Minimal Achievable Excellent (Annual Report)

•To diagnose rheumatoid arthritis quickly & accurately•To slow the process of the disease by effective and safe treatment•To help the individual adapt to the challenges•To control symptoms and the effects of disabilities•To involve patients, both individually and collectively, in their care

This is an example of a national service set upas a system

Knowledge System

Patient

Clinician

Ideas and Information

Ideas and Information

Information

HIERARCHY

NETWORK

“A business organisation should have a nonhierarchical, self-organizing structure working in tandem with its hierarchical formal structure…..As business organisations grow in scale and complexity they should simultaneously maximise both corporate level efficiency and local flexibility…the most appropriate name is the ‘hypertext’ organisation” IkujiroNonaka and Hirotaka TakeuchiThe knowledge creating company OUP 1995

21st C leadership

Volunteer to take a lead on a systemShare your work through the Optimising Value BriefingsVolunteer to be the Value Improvement Lead

The PHCN will offer A culture clubTraining on system development