Great innovations of the first and second healthcare revolutions

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Great innovations of the first and second
healthcare revolutions
The First
The
Second
Broad Street - John Snow

• MRI and CT scanning
• Anti psychotics
• Antibiotics
• Genetics
• Hip and knee replacement
• Chemotherapy
• Antidepressants
• Randomised controlled trials
• Systematic reviews

Gower Street - Doll Hill
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- BUT the NHS still faces 5 major problems

• SAFETY -Errors and mistakes
• QUALITY - sub standard clinical practice and poor
  patient experience
• FAILURE TO MAXIMISE VALUE
• Waste
• Overenthusiastic adoption of interventions of low
  value and failure to get new evidence into
  practice
• INEQUALITIES
• FAILURE TO PREVENT
• AND new, additional challenges are developing
• Rising expectations
• Increasing need due to
• population aging
• obesity due to too much food and too little
  exercise
• new technology
• Climate change which will create health problems
  and health emergencies and lead to Carbon
  constraints
• Financial constraints

3

• We need to do the right things and, every year,
  do them
• Better,
• Safer,
• Greener, and
• Cheaper

4

• We need to do the right things and, every year,
  do them
• Better,
• Safer,
• Greener, and
• Cheaper

Commissioning QIPP
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High


Value Low

Value

The economic meaning in the Shorter English
Dictionary is that amount of some commodity,
medium of exchange, etc. which is considered to
be an equivalent for something else, and it
gives as an example of the meaning of the term
the use in 1806, we could hardly be said to have
value for our money.
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Value
Waste
Value
Waste
We hate muda
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High High

Carbon
Value Low
Low
Value
Carbon
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High High

Carbon
Value Low
Low
Value
Carbon
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Citizens
Information Knowledge
Technology
The Drivers of the Third Industrial Revolution
(Manuel Castells)
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21st C leadership
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The management of culture is one of the
responsibilities of the leader If you were to
ask all the commissioners to write down the
difference between the meanings of productivity
and efficiency what would they write? If you
asked them to describe Donabedians theory of
optimality
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The law of diminishing returns
Benefits
Investment of resources
BVHP The Better Value Healthcare Programme
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Harmful effects increase in direct proportion to
the resources invested
Harmful or Side effects Of care
Investment of resources
BVHP The Better Value Healthcare Programme
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After a certain level of investment the health
gain may start to decline
Benefits
Benefits - harm
Harms
Investment of resources
BVHP The Better Value Healthcare Programme
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At the point of optimality value is maximised
Optimality
Benefits - harm
Investment of resources
BVHP The Better Value Healthcare Programme
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cancer
cardiac
mental health
BVHP The Better Value Healthcare Programme
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Manage. IT
Res Ed
Prevention
Complicated eg Trauma, Very old people
Chronic Health Problems
Diagnosis
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The values of the population served
Choice Decision
Evidence
The other needs of the population (opportunity
costs)
DECISION MAKER (OFFICIAL)
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792,000 tonnes of carbon
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The values of the Patients served
Evidence
Choice Decision
The other needs of that group of patients
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Breast
bowel
cancer
lung
cardiac
mental health
BVHP The Better Value Healthcare Programme
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The Oxford Healthcare System
Objectives Criteria
Standards Performance

Minimal Achievable Excellent
(Annual Report)
To diagnose rheumatoid arthritis quickly
accurately To slow the process of the disease by
effective and safe treatment To help the
individual adapt to the challenges To control
symptoms and the effects of disabilities To
involve patients, both individually and
collectively, in their care
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This is an example of a national service set
up as a system
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Ideas and Information
Patient Clinician
Knowledge
System
Information
Ideas and Information
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HIERARCHY
NETWORK
A business organisation should have a
nonhierarchical, self-organizing structure
working in tandem with its hierarchical formal
structure. .As business organisations grow in
scale and complexity they should simultaneously
maximise both corporate level efficiency and
local flexibility the most appropriate name is
the hypertext organisation  IkujiroNonaka and
Hirotaka Takeuchi The knowledge creating company
OUP 1995
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21st C leadership
Volunteer to take a lead on a system Share your
work through the Optimising Value
Briefings Volunteer to be the Value Improvement
Lead The PHCN will offer A culture
club Training on system development
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