The healthcare providers who have demonstrated dramatically positive results with challenging patient populations recognize that there are two main care approaches. In a setting such as a hospital, many leading hospitals have adopted a manufacturing-based model borrowed from Toyota. However, with chronic disease, a service-based approach is necessary to effect behavioral change. In a manufacturing setting, with enough practice a machine will do what it is intended to do and doesn’t have a mind of its own. However, as anyone who has been in a service-based business knows, human interaction and a partnership-oriented approach leads to the best outcomes.
Source: Dave Chase in Forbes Magazine 23.4.12
Locality Clinical Partnerships
Locality Clinical Partnerships at the Counties Manukau District Health Board will deliver Better, Sooner, More Convenient Healthcare according to the following objectives:
gregorcoster.net is back
My three websites are now running again after some changes. The two others can be found at:
In just 17 months Dr Don Berwick left a legacy of health improvement and quality at Medicare. I like his comment: health care reform is “an important moral step toward universal health care.” As he put it when [we] spoke: “Because of it, our country is, at last, making health care a basic human right. It is a majestic thing.”
Measurement of health outcomes
Measurement of health outcomes has been described by Michael Porter – see previous blogs and refer to his paper:
Source: Michael Porter (2010). What is Value in Healthcare? The New England Journal of Medicine 363; 26.
Cost measurement systems in health
We need an accurate cost measurement system in healthcare in order to understand where costs are generated. Alongside this should be an accurate and systematic measurement of health outcomes. Then we can determine value through the relationship of quality (health outcomes, quality of patient experience) to costs of delivering that care.
Value of Healthcare
Healthcare systems must be focussed on delivering value to the patient – including making services better, sooner and more convenient, and improving the outcomes on the basis of dollar cost. If we are to manage value, then we will need to measure both health outcomes and cost. Both of these are part of the Institute of Health Improvement Triple Aim, which has been adopted by the Counties Manukau DHB.
Why better information systems?
If we are to create value within a system, then we need to know quality and cost since they are both variables for Value. If we can measure value, then we can improve it. We need to link cost to process improvements or outcomes enabling us to make systemic and sustainable improvements on the cost line. It is clear that in order to manage the system, clinicians and managers alike need better information systems for quality (patient experience and health outcomes) as well as cost of item of service.
Improving Value
If we want to improve Value (= Quality / Cost) then we can either improve Quality or reduce Cost, or both. We can measure quality by referring to patient experience and patient outcomes, but costs have eluded us thus far. We need to focus on the costs of treating individual patients across the full cycle of care, not just fee-for-service billings. In other words, we need to fully understand and cost the components of service within secondary and primary care if we are to understand the underlying costs. Then we can understand where the opportunities lie for savings by asking health professionals to redesign processes to provide care differently and more efficiently.
Multispecialty partnerships
A multispecialty partnership may consist of general practitioners, specialists, nurses from both primary and secondary care, physios, OTs, pharmacists and many other health professionals. It would also include community representatives and consumers. Such a group could make recommendations to a JV between a PHO(s) and the Counties Manukau DHB. This group could then undertake joint commissioning of services for both primary and secondary care. That would be interesting.
