New approaches to measurement and management for high integrity health systems
BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1401 (Published 30 March 2017) Cite this as: BMJ 2017;356:j1401
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What a waste this article is. I hope the authors talked to one another by SKYPE or FACE TIME and did not go flying across the Atlantic for meetings, conferences.
New Approaches?
We need to ho back to the old approaches.
Why are all the churches (I use the term broadly, to encompass ALL organised religions) so passionate about setting up schools? Why don't they return to health and home care?
The Americans can do what they want. The Indians can do what they want.
As far as the United Kingdom is concerned - the Churches of England, Wales, Scotland and Ireland can take over the running of our hospitals. I will happily contribute a tithe.
Capitalism is the new religion. The TATAs founded plenty of hospitals in India. They could set up hospitals for their staff and families wherever they have factories. Barts in London ought to be run by the City of London with funding from the City.
The Kingdom of Saudi Arabia could set up hospitals serving halal, in Birmingham and Bradford, possibly in Manchester.
In my life time there was a Jewish Hospital in London. Bring it back.
Competing interests: No competing interests
Health care economies of whether first world or third world all are in crisis. High income countries or low income countries all are facing trouble in terms of providing health care to its citizens respectively. May be their problems and the magnitude of the problems are different but yes there is an immediate need of changing the current health care providing system prevailing around the world.
High income countries like US and UK where health care is market driven are facing the problem of unceasingly intense demand for more services that is increasing cost of deliverance. Low and middle income countries like INDIA and SRILANKA are facing the problem of allocating the scarce resources for optimal use and equitable distribution. There is a great variation in prices of diagnostic and therapeutic procedure around the globe and primary care which can solve 80% of the health care problem at initial level are being ignored which lead to 40% waste in the health care expenditure.
When this kind of waste is recognised all over the world , all th concern authorities are in the urge of bringing health care reformed in the policies. They want to change the system of heath care which is centre on providers to the system which lay emphasis on patients need. Countries like china have followed the model but system has been sufficiently successful to raise the concern about the personalised need .
So this paper has identified three prevailing health care assumption that obstruct or bring hindrances in changing of the system
-more service delivers more health
-clinical evidence is sufficient to determine its best treatment and delivery
- health care can be effectively delivered by only health care professionals and no support is required
These three assumptions need to be change to bring the change in health care need. Principles for the health care reforms should be designed in a such a way that they should be different fron national health system previously prevailing in any country and should be based on need and demand of the people.
There are certain countries which have tried to bring reforms in the health care like
: Affordable care act and new care model in the US
: The health and social care act and new care model in the UK
Both of these model focus on providing full primary health care to its citizen with full patient engagement but strategies are different from each other
In US Accountable care organisation ( ACOS) and Patient centred medical home (PCMH )would be accountable for the quality and cost of health care.
In UK Multispecialty care provider (MCPs) and Integrated primary and acute care provider (PACs) would be responsible for closing health, quality, and finance gaps by achieving the triple integration and improving patient and community engagement. Triple integration concept was of integrating primary care with acute care, physical health with mental health and health care with social care.
Both of these model were relatively successful in starting but face difficulty and had certain flaws. Like UK model has faced certain financial constraints
So none of these health system has succeeded in learning what patient need and want and how to allocate the scarce resources.
So implementation of this paper is to make people understand the urgency required to bring the health care reforms and to learn the patient need and want. To learn from the new model existing in the first world and learn from their flaws and implying that rectified models in India.
By:
Surbhi Bhatia
Smita Asthana (NICPR-ICMR)
Satyanarayana Labani (NICPR-ICMR)
Competing interests: No competing interests
Well identified and detailed ! High integrity health system is a felt need in the diverse global healthcare scenario characterised by shortages and difficulties of access on one side and an exponentially rising health expenditure without returns and patient satisfaction on the other. It need not be reiterated that more money does not necessarily buy better health. The tension between treating a single patient and caring for the health needs of the community is sufficiently known. Suffice to say that there is no end to human hope for a positive outcome in a clinical situation and also to the entire gamut of the wide ranging diagnostics and a host of modalities of therapeutics and procedures that Medicine has to offer. Measurement and management of high integrity health systems is therefore crucial and vital. BMJ s approach in identifying three sub categories and inviting wider participation is welcome and appreciated. Dr M E Yeolekar , Mumbai .
Competing interests: No competing interests
Re: New approaches to measurement and management for high integrity health systems
Angkor Hospital for Children (AHC) would welcome the opportunity to further share our experiences in improving paediatric health and wellbeing in Cambodia at the managerial and professional levels.
AHC provides an example of the actors you describe in a low income setting – we are a non-profit paediatric teaching hospital in Siem Reap, Cambodia, providing free healthcare to approximately 90,000 children every year. We allocate our resources though building “Centres of Excellence”; each designed to deliver quality care in aspects of healthcare which are not available elsewhere in Cambodia.
In developing a five-year organisational strategy in 2015 AHC identified an opportunity to explore in depth the measurement and meaning of ‘quality’ in the healthcare it provided. Our initial literature review of quality assurance theory and other organisational models identified a lack of documented and defined quality assurance programmes in low-resource settings [1].
During 2016 AHC developed an organisational quality assurance programme (OQA). Put in context, through this process AHC aimed to improve the level of healthcare provided [i.e. Table one, assumption one].
The organisation-wide model that AHC adopted assumed a patient centered approach. This model was presented to staff and followed up with change management and quality improvement activities throughout the year.
Senior management defined eight organisational indicators with targets based on international best practice (where available). These were designed to provide overarching benchmarks for quality healthcare and included waiting times, healthcare associated infections and medication prescribing errors.
An OQA committee of local staff was formed, providing a focal point for quality assurance work throughout the organisation. Their activities were framed in participatory rapid quality audit cycles and examined existing practices that staff identified as “problem areas”.
Subsequently senior management tasked units to each commit to one Key Performance Indicator (KPI) and to manage and monitor implementation. This was designed to empower staff to self-manage and prioritise quality improvements within the organisational framework.
Through the above process, we have been able to successfully implement an OQA programme in a non-profit paediatric hospital in Cambodia. Overall, AHC’s experience identifies local staff buy-in as fundamental to generating effective tools to elevate care. Monitoring over time will measure the OQA programme’s effectiveness in instigating continuous quality improvements and in mitigating short term risks to quality of care before they occur.
Elsewhere AHC is exploring innovative tools to improve information exchange and equity. For example, AHC regularly holds “Science Cafés” designed to link less educated caregivers with medical professionals. These provide the basis for ongoing research exploring the barriers and rights of caregivers in Cambodia to access medical information about their child’s treatment.
[1] Leatherman S, Ferris TG, Berwick D, Omaswa F, Crisp N. The role of quality improvement in strengthening health systems in developing countries. Int J Qual Health Care. 2010 Aug;22(4):237–43.
Competing interests: No competing interests