What is a Potentially Preventable Hospitalisation?

• Is this why we integrate – to reduce PPHs?

Transparency/Connectivity and Economic Performance

www.imf.org/external/pubs/ft/fandd/2013/12/brandao.htm

OECD Observer

• A basic message has emerged: investments in health and the design of health financing policies should be addressed in terms of the interaction between health and the economy. Just as growth, income, investment and employment are a function of the performance and quality of the economic system, its regulatory frameworks, trade policies, social capital and labour markets, etc, so health conditions (mortality, morbidity, disability) depend not just on standards of living, but on the actual performance of health systems themselves.

• Well-performing health systems make Europe 'politically stable'

Leutz’s 5 Laws of Integrated Care

1. You can’t integrate all of the services for all of the people

2. Integration costs before it pays

3. Your integration is my fragmentation

4. You can’t integrate a square peg in a round hole

5. The one who integrates calls the tune

Multi morbidity increases with age

Barnett, Mercer, Norbury, Watt, Wyke, Guthrie: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study; Lancet 380:9836, 7-12 July 2012, pp. 37-43

Multi morbidity correlated with socio-economic status

Barnett, Mercer, Norbury, Watt, Wyke, Guthrie: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study; Lancet 380:9836, 7-12 July 2012, pp. 37-43

Do we integrate simply to address avoidable admissions?

• Or are we building a connected, transparent, navigable health system

• Are we building a health system that is more equitable and accessible

• Are we building health system that contributes to the overall well being and capability of our community?

Raj VermaDirector, Clinical Program Design & Implementation

Agency for Clinical Innovation

Patient reported outcome and experience measures –

PROM and PREM

6 November 2014

PROM Short term

Feedback on immediate

individual care

PROM Long term

Feedback on longer term

clinical outcomes

PREM Short term

Feedback on current

integration of care

PREM Long term

Feedback on system of

integrated care

PROM Short term

Feedback on immediate

individual care

PROM Long term

Feedback on longer term

clinical outcomes

PREM Short term

Feedback on current

integration of care

PREM Long term

Feedback on system of

integrated care

Most PROM work internationally focussed

here - mainly surgical procedure outcomes (eg

knee replacement, cataracts).

Clinical and functional outcomes for the

patient.

PROM Short term

Feedback on immediate

individual care

PROM Long term

Feedback on longer term

clinical outcomes

PREM Short term

Feedback on current

integration of care

PREM Long term

Feedback on system of

integrated care

This is the emerging area of PROMs (or PRMs), and CI are

running a pilot now, including an IT system

that feeds in to Mosaic, and has tablet device

input.Immediate clinical care

issues – incl anxiety, confidence, pain, etc.

PROM Short term

Feedback on immediate

individual care

PROM Long term

Feedback on longer term

clinical outcomes

PREM Short term

Feedback on current

integration of care

PREM Long term

Feedback on system of

integrated care

ACI currently has PETs that could capture this, but not linked to PROM

or to eMR.

PROM Short term

Feedback on immediate

individual care

PROM Long term

Feedback on longer term

clinical outcomes

PREM Short term

Feedback on current

integration of care

PREM Long term

Feedback on system of

integrated care

This will feedback at the system level, but not be

as high level or extensive as the NSW

Patient Survey.

One option for anonymous feedback is

Patient Opinion

Innovating for Integration

• Making Integrated Care Happen at Scale and Pace

• 16 Lessons from Experience

Soft Diplomacy vs Structure

• Narrative• Vision• Leadership• Priorities• Trust• Time and Space

• Shared Governance• Pooled Funding • Shared Information and

Data Systems

Heroic Leadership vs Structure

Communication Joint working but marginal to organisational goals. Frequent interactions and sharing of information as it applies to users whose needs cross boundaries; a nominated person is responsible for liaison.

CooperationExchange of information; altering activities for a common purpose; joint working but marginal to organisational goals

Coordination Time-limited activities with some joint responsibility and shared outcomes that requires only enough trust to give and receive help from one another

Collaborative practice = Longer term and more deliberate efforts of organisations and groups to undertake shared planning and take joint responsibility and with equal commitment, for joint activities and shared vision of the outcomes, with high level of trust and power sharing based on knowledge and expertise

Integrated partnership working = Separate identities of the partners or agencies no longer as significant as the outcome.

Networking = A loose arrangement of contact (or encounter) for the purposes of information sharing; divergent organisational goals and perceived rivalry

Isolation = Agencies are separate from others with little or no communication

Partners move up and down these levels and relationships intensify as there is movement from one level to the next

How Have We Got Here?

• Relationships

• Trust

• Kumbaya

My version

Innovation

Move from Relationships to Systems

• And build your systems to replicate and reinforce your relationships.