Healthcare)) Reform) · challenges)across)health)systems) Science)and)technology)...

19
Healthcare Reform Ara Darzi FRS

Transcript of Healthcare)) Reform) · challenges)across)health)systems) Science)and)technology)...

Page 1: Healthcare)) Reform) · challenges)across)health)systems) Science)and)technology) Unrelen:ng)technological)change) Lifestyle) Explosion)of)lifestyle)diseases) Aging People)are)geng)older)and

Healthcare    Reform  

Ara  Darzi  FRS    

Page 2: Healthcare)) Reform) · challenges)across)health)systems) Science)and)technology) Unrelen:ng)technological)change) Lifestyle) Explosion)of)lifestyle)diseases) Aging People)are)geng)older)and

challenges  across  health  systems  

Science  and  technology   Unrelen:ng  technological  change  

Lifestyle   Explosion  of  lifestyle  diseases  

Aging   People  are  ge@ng  older  and  sicker  

Informa:on   Explosion  in  breadth  and  depth  

Wealth  and  funding  Con:nually  expanding  sector  of  economy  

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responses  

Improve  access  through  beHer  coverage  and  investment  in  primary  care  

ShiI  delivery  model  to  accountable/integrated  care  models  for  chronic  disease  

Invest  in  informa6on  technology  to  improve  transparency,  involve  pa:ents,  and  reduce  opera:onal  costs  

Try  and  get  ahead  of  the  problem  by  increasing  efforts  for  preven6on  (not  terribly  successfully)  

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Pace  of  change  in  the  healthcare  has  been  slow  to  date    

Physician’s  office  –  then  vs.  now  1948  

Modern  medicine  is  s:ll  using  fairly  primi:ve  technology  

2012  

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ACHIEVING  IMPACT  REQUIRES  ATTENTION  TO  A  SET  OF  CORE  PRINCIPLES  

Successful  Health  System  Transforma6on  And  Reform  

Take  a  holis:c  view  of  the  health  

system    

Focus  change  on  the  target  end  state  

Follow  the  pa:ent’s  journey  

Develop  leadership  at  every  level  

Use  a  mul:-­‐stakeholder  

partnership  to  drive  change  

•  All  relevant  aspects  of  government  •  Integra:on  of  care  •  Social  and  Health  sector  

•  Public  health  outcomes    •  Pa:ent  Outcomes  •  Interna:onal  goals  (e.g.,  MDGs*)  

•  Pa:ent  journeys  through  the  health  system  

•  Key  clinical  pathways  

•  Top  level  Ministry  leadership    

•  Mid  level  system  leadership    

•  Clinical  leadership  

•  Governments  

•  Donors  and  bi/mul:-­‐laterals  

•  Public  and  Private  sector  

•  Social  sector  and  NGOs  

Engage  the  system  from  within  

Page 6: Healthcare)) Reform) · challenges)across)health)systems) Science)and)technology) Unrelen:ng)technological)change) Lifestyle) Explosion)of)lifestyle)diseases) Aging People)are)geng)older)and

Quality  Metrics  Pa:ent  experience  and  pa:ent-­‐related  outcomes    Clinical  dashboards  for  teams  Ini:al  metrics  being  developed  for  the  2009/10  NHS  Opera:ng  Framework    Work  with  other  OECD  countries  to  agree  interna:onally  comparable  measures  

Quality  accounts    Providers  of  NHS  services  will  publish  ‘Quality  Accounts’  from  April  2010    Compara:ve  informa:on  on  NHS  choice  

New  Commissioning  for  Quality  and  Innova:on  (CQUIN)      Fee  for  Outcomes      New  tariff  for  mental  health  

Regula:on  extended    Strong  role  for  regula:on  by  the  Care  Quality  Commission.  Annual  report  to  Parliament    Regula:on  to  be  extended  to  primary  care  for  first  :me,  in  :me  extended  to  dental  prac:ces  

Stronger  clinical  engagement  in  service  design    Medical  Director  &  Clinical  Advisory  Board  at  every  Region    Quality  Observatory  in  every  region      Na:onal  Quality  Board  

Programmes    Best  Prac:ce  Tariffs  from  2010/11    Health  Authori:es    to  promote  innova:on,  a  new  fund  and  prizes    Health  Innova:on  &  Educa:on  Clusters    Academic  Health  Science  Centres  

Standards    NICE  expands  to:    Change  the  way  standards  are  created  and  set    Select  the  best  standards  available    Fill  the  gaps    Run  a  new  NHS  Evidence  service  

Focus  on  the  end  state  –  The  Quality  Con:nuum  

Approach  to  deliver  high-­‐quality  care  throughout  the  NHS  

Innovate  Publish   Rewards   Improve   Regulate  Measure  Define  

High  Quality  for  All  Darzi  et  all  White  Paper  2008  –  Quality  Con6nuum  

SOURCE:  High  Quality  Care  for  All,  Darzi  A.,  2008  

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Focus  on  the  pa:ent  journey…………..  The  Experience  

WITH  FALSE  STARTS    

AND  DEAD  ENDS  

Pa6ent  Pathway  A  Maze  

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Quality  -­‐  Pathway  and  evidence  based  Quality  Improvement  at  a  popula:on  level  

High  level  across  a  care  pathway  

Disease  area  or  popula:on  segment  

Stroke  care  pathway  :  Best  prac1ces  

Preven6on   Managed    primary  care  

Ac6ve    treatment    of  TIA  

Ini6al    diagnosis  

Immediate    treatment   Rehabilita6on  

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The  2010  Na:onal  Sen:nel  Stroke  Audit  has  shown  huge    improvements  in  stroke  care  in  London  

   

•  5  of  the  6  top  stroke  services  were  in  London  •  All  HASUs  in  London  were  in  the  top  quar:le  of  na:onal  performance  

%  trusts  by  SHA  all  acute  criteria  for    hyper  acute  stroke  care  

0%  

10%  

20%  

30%  

40%  

50%  

60%  

70%  

80%  

London   South  Central  

South  West   East  of  England  

North  West   East  Midlands  

North  East   South  East  Coast  

West  Midlands  

Yorkshire  &  The  Humber  

Source:  Na1onal  Sen1nel  Stroke  Audit  2010  

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Industrializa:on  of  healthcare  

“Typical”  Hospital  

Addressable  waste:  

$10-­‐25  MM/yr  

Capacity  U6liza6on  65%  

Target  85%  

Industry  65%  

You  50%  

45%  Asset  U6liza6on  

Target  70%  

Industry  45%  

You  18%  

1.  Asset  Op:miza:on  

2.  Pa:ent    Flow  

3.  Pa:ent    Safety  

4.  Whole  Hospital  Op:miza:on  

Hospital  Opera:ons  

is  the  

Pursuit  of  

A  “Fric:onless  Pa:ent  Experience”  

Hospital  O

pera:ons  Managem

ent  

Bed  Occupancy  

70%  

Infusion  Pump  U:liza:on  

18%  

Hand  Hygine  Compliance  

45%  

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Building  capabili:es  in  our  organisa:ons  

           

 Founda6onal  capabili6es  

Evidence-­‐based  decision-­‐making  

Commissioning  

Performance  assessment  

Planning  and  resource  alloca:on  

Educa:on  and  training  

Clinical  research  

Technology  enablement  

Financial  sustainability  

Innova:on  

Next-­‐genera6on  capabili6es  

Page 12: Healthcare)) Reform) · challenges)across)health)systems) Science)and)technology) Unrelen:ng)technological)change) Lifestyle) Explosion)of)lifestyle)diseases) Aging People)are)geng)older)and

Qatar Cancer Reform - Work Packages and support structure

Qatar  Cancer  Strategy  and  Cancer  Research  

Strategy  

SCH-­‐  QF  

Dialogue,  Transforma:on  and  implementa:on  

HMC,  PHC,  SCH  

Performance  monitoring  

SCH  

Sponsored  through  HMC  with  6  FTE  local  and  equivalent  of  4  FTE  in  London  

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MDTS FOR MAJOR CANCERS

•  The Cancer Strategy requires all patients with cancer to be discussed in an MDT meeting in accordance with international best practice.

•  MDTs are now established for breast, gastrointestinal, uro-oncology, hepatobiliary, leukaemia, head and neck, neurosurgery and pediatrics.

•  The Palliative care MDT, which is broader than just cancer, discussed 413 cases in 2011.

0  

100  

200  

300  

400  

500  

600  

700  

800  

2008   2011  

0  

738  

Number  of  pa6ents  discussed  at  a  cancer  specific  MDT  

1  

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PATIENT PATHWAY COORDINATORS TO SUPPORT AND GUIDE PATIENTS WITH CANCER

•  The cancer strategy introduced the role of Patient Pathway Co-ordinators. These staff (who have a clinical background) support patients in their journey through treatment, helping to co-ordinate their care.

•  The first patient pathway co-ordinators began work in November 2011.

•  A team of 12 will eventually support all tumor sites.

0  

2  

4  

6  

8  

10  

12  

2010   2011   Future  

0  

7  

12  

Number  of  Pa6ent  Pathway                                          Co-­‐ordinators  at  HMC    

 

2  

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Frugal  is  not  Cheap  

Cost  

Performan

ce  

@  Yasser  Bha_  2011  

Frugal   Standard  

Cheap  

Page 16: Healthcare)) Reform) · challenges)across)health)systems) Science)and)technology) Unrelen:ng)technological)change) Lifestyle) Explosion)of)lifestyle)diseases) Aging People)are)geng)older)and

Core  Competencies  in  Engineering  for  the  Developing  World  (Basu,  2010)  

Affordability  

Araving  preventa:ve  eye  care  

Simplifica6on  

Tata  Chemicals  Rice  Husk  water  Filter  

Adap6on  

Nokia’s  Mobile  Phone  Bicycle  Charger  Kit  

Ruggediza6on  

GE’s  Mac  l  400  $800  electrocardiogram  in  a  backpack  

Use  of  Local  Materials/  Manufacturing  

Vortex  Engineering’s  solar  powered  ATMs  for  rural  banking  

Green  Technologies  

Vodafone’s  Solar  powered  Mobile  Handset  

Simple  User  Centric  Design  

Jerry  Can  for  Naandi’s  Safe  Water  Program  

Lightweight  

Cisco  and  NetHope’s  Emergency  Net-­‐Relief  Kit  

Page 17: Healthcare)) Reform) · challenges)across)health)systems) Science)and)technology) Unrelen:ng)technological)change) Lifestyle) Explosion)of)lifestyle)diseases) Aging People)are)geng)older)and

 World  Economic  Forum  iden:fied  and  analysed  case  examples  from  across  the  globe  

1  

2  3  

8  

4   11  

9  

Valencia:  Integrated  HC  

Mini  clinics  in  retail  stores  

Remote  chronic  disease  care  

Remote  triage/referral  

16  

15  

6  Mauritania    complete  low-­‐cost    obstetric  care  

Low  cost  eye  care  solu:on  

Mid-­‐wife  led,  low  cost  maternal  care  

Weighing    children    to  predict  and  prevent  diseases  

7  

Franchise  network  of  stores  for  deadly  diseases  

Social  marke:ng  program  of  PSI  

PDA:  Social    marke:ng  (humorous)  for  reproduc:ve  health  

High-­‐volume,  low-­‐cost  heart  surgery  hospital  

5  

14  

Low  cost  eye  care  solu:on  

Innova:ve  emergency  response  model  

Remote  advice  and  mobile  care  solu:on  

13  

12  

17  

Integrated  primary  care  units  

18  20  

Integrated  care  solu:on  

Veteran’s  Health  Administra:on  

Co-­‐opera:ve  medical  system  

22  

Real-­‐:me  weighing  and  diagnosis  

19  

10  Training  for  reproduc:ve  health  clinics  

50    global  loca:ons:  social  marke:ng  for  killer  diseases  

21  

Page 18: Healthcare)) Reform) · challenges)across)health)systems) Science)and)technology) Unrelen:ng)technological)change) Lifestyle) Explosion)of)lifestyle)diseases) Aging People)are)geng)older)and

POLICY  INTERRUPTIONS  ALWAYS  HELPS  TO  COLLABORATE  

Page 19: Healthcare)) Reform) · challenges)across)health)systems) Science)and)technology) Unrelen:ng)technological)change) Lifestyle) Explosion)of)lifestyle)diseases) Aging People)are)geng)older)and

It  Is  Not  The  Strongest    Of  The  Species  That  Survives,  Not  The  Most  Intelligent,    But  The  One    

Most  Responsive  To  Change.  Charles  Darwin  (1809  –  1882)  

REBELS  WITH  A  CAUSE  


Studio Mini Lt Es Geng

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Geng Remaja

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Fenomena Geng Motor

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Inflammation and metabolic disorders Geng-Ruei Chang2007.1.4.

Inflammation and metabolic disorders Geng-Ruei Chang2007.1.4.

Geng Anok Timun

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Sam Sun GEng

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Slides Royal Bank Geng Ajan Punye

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Geng Motor

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Geng et al. Supplemental Figure 1

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Utm90 Remote Access via SSL Geng

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Yana Geng - Global commerce (ENG)

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Sejarah Awal Adanya Geng Motor Di Indonesia

Sejarah Awal Adanya Geng Motor Di Indonesia

© Xuan Geng 2013 - University of Minnesota

© Xuan Geng 2013 - University of Minnesota

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Geng&Started&with&NVM Programming& · Geng&Started&with&NVM Programming& • NVMemulaon& • File&systems& – BPFS& – PMFS& • Persistentheaps& – Mnemosyne& – libpmem&

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Lec 01 GENG 300 Numerical Methods

Lec 01 GENG 300 Numerical Methods

Operation & Numbering 1 Telecommunication Standardization Bureau Operation and Numbering Presented by Geng-Sheng LI Email: geng-sheng.li@itu.int.

Operation & Numbering 1 Telecommunication Standardization Bureau Operation and Numbering Presented by Geng-Sheng LI Email: [email protected].

DEGRADASI MORAL DAN AGRESIVITAS GENG MOTOR DI …

DEGRADASI MORAL DAN AGRESIVITAS GENG MOTOR DI …

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PERILAKU MENYIMPANG GENG MOTOR DI SINJAI BARAT …

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