Forecasting the Future of Health Care:Challenges and Opportunities for Leaders in Risk Management

MedHealth 2013

Content

• Common healthcare challenges• Qatar’s health system• Evidence on current and emerging risks• Challenges and opportunities for risk

managers – a perspective from Hamad Medical Corporation

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Countries around the world face similar healthcare challenges

Cost Effective /

Value

Better

Faster

Technologically empowered customers

Ageing Population

Chronic Illness

Rising Costs

Equal Access for equal need

New Science / Personalised Treatments

Expectations for Quality Care

Patient-Centric System

Health Policy Reform

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Healthcare

Care is shifting towards personalisation throughout the healthcare system

Wellness

Yesterday’s System

Healthy Vulnerable Affected SickPrevention Prediction Prognosis

HealthcareWellness

Today’s System

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A pen picture of Qatar

The extraordinary population boom is set to continue

Population

In ten years population grown from 740,000 to 1,900,000

Much of the growth is in the expatriate workforce from South and South East Asia, MENA, Europe and North America

75% of the population is male due to the imported workforce

The population is also overwhelming of working age

Nearly half of the population live in the capital city Doha

With the growth in the economy and large infrastructure projects, the population will continue to increase rapidly (2.4m by 2030)

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Health challenges

The diversity of the population means that we suffer from a double burden of disease – communicable diseases associated with the developing world and those associated with modern lifestyles in developed countries

Some of the greatest burden of disease in the population is from chronic diseases, including metabolic diseases, obesity, cardiovascular and hypertension, and respiratory diseases such as asthma.

There is a particularly high incidence of diabetes at 16-17% of the adult population

The incidence of cancer is not high but is expected to grow as the comparatively young population ages and grows, and that is being addressed through a new and comprehensive national cancer strategy

Similarly, there is a new mental health strategy which will seek to build primary and community services rather than relying too heavily on inpatient models of care

Qatar also faces the challenge of high rates of trauma injuries, with road traffic accidents and work related injuries accounting for a large proportion of cases

Our overall challenge is to transition from a health system that treats acute patients, to being one that predicts and prevents ill health, particularly for chronic and lifestyle diseases, with high quality acute and tertiary care for those patients that need it.

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National Health Strategy – Model of Care

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Hamad Medical Corporation (HMC)

Embarking on one of the most ambitious master facility plans ever seen in international healthcare

Only public provider outside US with all hospitals accredited by the Joint Commission International.

Established the first Center for Healthcare Improvement in the Arab world.

State funded national provider Provides 90% of acute services in

Qatar Large employer with c.20,000 staff and

a diverse, multi-national workforce Manages eight general and specialist

hospitals with over 2000 beds and the ambulance service

3 new hospitals opening in 2014 Aims to be internationally recognized

integrated healthcare system acclaimed for excellence in healthcare, education and research

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Growth in population significantly outpaces growth in our bed numbers

Note: Bed numbers and population indexed to a value of 1 in 1957;Health expenditure (derived from World Bank data) indexed to be equal to bed numbers in 1995

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A Fast Developing System under Pressure

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Evidence from Patient Safety Research

1. “At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented.”

- US Institute of Medicine, November 1999

2. “Unsafe patient care is common and associated with significant morbidity and mortality throughout the world… much of the harm is likely amenable to intervention. Studies from the US suggest that approximately 3% to 4% of hospitalized patients suffer a serious adverse event. Studies from other developed nations found that between 8% and 16% of hospitalized patients suffered an adverse event. Between 30% and 50% of such adverse events are preventable.”

- A.K. Jha et al, Quality and Safety in Healthcare, 2010

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Types of Errors

The Quality of Health Care in America Committee of the Institute of Medicine (IOM) concluded that it is not acceptable for patients to be harmed by the health care system that is supposed to offer healing and comfort--a system that promises, “First, do no harm.”

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Systemic migration to boundaries

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Hamad Medical Corporation

Vision

To be an internationally recognized integrated healthcare system acclaimed for excellence in healthcare, education and research and play a premier role in the sustainability of health in Qatar.

Unifying Purpose To deliver safe and effective health care and the best possible experience for every patient.

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Hamad Medical Corporation

Quality Goals• Reduce Avoidable Deaths• Reduce Patient Harm• Improve Outcomes• Reduce Length of Stay• Improve Patient Experience• Improve Access to Care

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A Risk is………..

……..the chance of anything happening that would have a

negative impact upon our ability to deliver our strategic objectives and

our vision for health care

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Good risk management is important because it…..

Ensures the organization is aware of its strategic risks i.e. those which have the greatest impact on its ability to deliver its strategic objectives

Ensures the organization has a plan for managing those risks

Minimises the impact of the risks to a level which is acceptable i.e. risk appetite

Provides individuals and departments with a framework for reporting risks

Underpins essential culture change in the organisation

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Error reduction Overview: Hierarchy of Controls

Policies, Training, Inspection

Minimize consequences of errors

Make errors visible

Make it easy to do the right thing

Make it hard to do the wrong thing

Eliminate the opportunity for error

HumanFactors

Eliminate

Facilitate

Mitigate

Standardization & Simplification

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Types of Culture

BLAME •Seeks to address mistakes and apportions blame•WHO IS TO BLAME

BUREAUCRATIC •Over reliance on rules, regulations and policies at the jeopardy of individual personal judgment•WHAT POLICY WAS NOT FOLLOWED

MISTRUST •Over competitive and seeks to embarrass departments and individuals•IT WASN’T ME, IT WAS THEM

REACTIVE •Short term, dealing with the immediate problem•THAT’S THAT ISSUE RESOLVED

PROACTIVE •Encouraging, learning and forward thinking•WHAT CAN WE LEARN, LET’S LOOK AT WHAT COULD HAPPEN

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The Required Culture Change

1. From : It couldn’t happen here!

To: It is happening here, it is likely to happen again, we need to re-design care delivery so that harm does not reach the patient.

2. From: Who made the error?

To: What happened, why and what can we do to preventing it happening again.