Better value in healthcare

We were joined by one of our advisory board members Sir Muir Gray at our recent CHKS Annual Surveyor Conference. Sir Muir talked to our group of 80 healthcare quality, management and clinical professionals about the issues facing today’s health service and how we can address these to deliver better value healthcare. We share some of his thoughts below.

Tremendous progress has been made over the last forty years due to the second healthcare revolution, with the first healthcare revolution having been the public health revolution of the nineteenth century. Hip replacement, transplantation, and chemotherapy are examples of the high tech revolution funded by increased investment and, in the last twenty years, optimised by improvements in quality, safety and evidence based decision making.

However there are still three outstanding problems which are found in every health service no matter how they are structured and funded: One of these problems is huge and unwarranted variation in access, quality, cost and outcome, and this reveals the other two:

1. Overuse which leads to:

  • waste, that is anything that does not add value to the outcome for patients or uses resources that could give greater value if used for another group of patients
  • patient harm, even when the quality of care is high

2. Underuse which leads to:

  • inequity and
  • failure to prevent the diseases that healthcare can prevent, stroke in atrial fibrillation for example.

In addition the services will have to cope with rising need and demand without additional resources. More of the same, even better, quality, safer care is not the answer. The focus has to be on value, on better value for individuals and populations. To achieve this we need:

  • Personalised services for all the people affected in the population
  • Optimal allocation of resources
  • Development of collaborative systems and networks with patients & carers as equal partners
  • Faster adoption of high value interventions and technologies
  • Clinicians acting the stewards of the population’s resources

A new paradigm is needed not a new structure. In an era in which there will be insufficient money to meet need and demand we need to harness the forces driving the third healthcare revolution – citizens, knowledge and the smartphone.

We need a transformation with the new focus on triple value. This will not be brought about by more money, even if more money were available. Nor will it result from structural reorganisation because the bureaucracies which are necessary are organisations that operate in a linear fashion whereas health and healthcare issues are complex or ‘wicked’ problems and require new types of intervention.

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