Laszlo Sajtos, Paul Rouse, Julie Harrison, and Matthew...
Transcript of Laszlo Sajtos, Paul Rouse, Julie Harrison, and Matthew...
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Laszlo Sajtos, Paul Rouse, Julie Harrison, and Matthew Parsons
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Governments worldwide are facing the challenges of ageing populations. ◦ Europe – population aged >65 expected to rise
from 17% (2008) to 30% (2060) (Eurostat, 2008) ◦ NZ – population aged >65 expected to rise from
12.1% (2010) to 25% (2050) More elderly and fewer people to support
them (Dunstan & Thomson, 2006) Spending: 65+ (double), 75+ (triple), 85+
(8x) (OECD 2001)
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“...people should be able to continue living in their own place of residence in their later years...” (Jorgensen et al. 2009)
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New Zealand District Health Boards contract for support services to be provided to older people in their own homes based on their level of need
Traditional view ◦ Fee for service ◦ Output has been identified with inputs i.e.
resource provision (hours of care) ◦ Clinicians’ view – everyone is unique
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The major problem in health care is to manage complexity (i.e. variety)
Therefore, our task was to identify factors that help reduce (or amplify) complexity in the context of Home-based Support Services.
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…is a system that classifies patients into groups that are homogeneous in their use of resources (Palmer, 1996; Zbylot, Job, McCormick, Boulter, & Moore, 1995)
Case mix complexity - Diagnosis Related Groups (DRGs) (Fetter et al. 1980). DRGs were designed to be homogeneous units of hospital
activity (e.g. nursing, diagnostic services, procedures) the best-known classification system that are used in the
case-mix funding model
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Qualitative interviews with regulators and providers ◦ Differing views on case mix complexity Severity & need for intervention (clinician) Resource intensity (regulator)
Collected quantitative data for 1,101 clients Holistic assessment tool ◦ ADL (e.g. bathing), Instrumental ADL (e.g. Ordinary
housework) Collection of activity and cost data
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Attenuators – reduction of variety using typologies
Amplifiers – technology, information and
networks
Law of requisite variety for homeostasis
Informal carers, telemedicine, social
networks
Capacity Capabilities
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The amount of appropriate selection that can be performed is limited by the amount of information available. More information might be wasted but less information results in arbitrary decisions. ◦ the greater the variety within a system, the greater
its ability to reduce variety in its environment through regulation. ◦ Only variety can destroy variety (in the system being
regulated).
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‘Housework’ masks ‘shopping support’ (unable to drive, growing disability, risk of loneliness/isolation)
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Demonstrate that homecare settings are potentially fruitful avenues for research on service provision and co-creation
“going to someone’s home and preparing a breakfast meal would be a relieving process (direct service provision), while providing a toaster so that the customer can provide self-service is an enabling (indirect service provision) process.” (Vargo & Lusch, 2007)
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We draw on cybernetics and the law of requisite variety to identify and manage (attenuators and amplifiers) variety ◦ Influence on resource use and integration ◦ Influence the shape of the market
Role of informal helpers: a person co-creates on-going experiences with a patient. ◦ Various roles ◦ Mediated value proposition ◦ Reiterates the process of voluntary exchange
through collaborative relationships that create reciprocal value through the application of complementary resources.
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Using Customer Networks to Shape Markets for Health Care DeliveryMotivation...ageing in place...Home-based Support ServicesResearch objectiveCase mix and DRGsMethodologyCybernetic perspective on managing complexityLaw of requisite variety (Ashby 1956)Slide Number 10Managing variety (chromosomes, products)SummarySummaryThank you for your attention!Slide Number 15