Innovating Healthcare

Many policy and strategy documents describe patient centric strategies: the active participation of patients in planning, managing and deciding their care and treatment using self care, personalisation and care planning. Simon Stevens, CEO of NHS England, in his accession speech. In October 2014 he said:

‘We need to tear up the design flaw in the 1948 NHS model where family doctors were organised entirely separately from hospital specialists and where patients with chronic health conditions are increasingly passed from pillar to post between different bits of health and social services.’

And on making technology based services available to patients pointing in the same direction:

‘… the importance of active patient transactions with their practice, including online access to their medical record by spring ‘15, and participation in planning, managing and deciding their care and treatment using self-care and personalisation utilising ‘kite-marked’ mobile apps and monitoring devices to support healthy lifestyles’.

Policy and Strategy pointing.jpg

Monitor, the sector regulator for health services in England, set out the financial challenge and solution direction very well:

For younger people living with long term conditions for whom lifestyle adjustment is required to attain quality of life, engagement is essential as the ability to do damage to one’s health far outweighs the capability of the NHS to cure or limit. Conversely, a person’s contribution to health through lifestyle adjustment in many cases contributes substantially to health, in particular when done as part of a jointly worked care plan.

We believe that getting better “health value” for patients with each pound spent is a realistic prospect and by far the best strategy for closing the funding gap. Getting better health value for patients means improving productivity. But improving productivity doesn’t mean dedicated doctors, nurses and managers working even longer and harder. It means everyone working differently and smarter. It means altering or completely reshaping services so they give patients the same or better quality and experience of care for less money.”

For younger people living with long term conditions for whom lifestyle adjustment is required to attain quality of life, engagement is essential as the ability to do damage to one’s health far outweighs the capability of the NHS to cure or limit. Conversely, a person’s contribution to health through lifestyle adjustment in many cases contributes substantially to health, in particular when done as part of a jointly worked care plan.

Healthcare goggles diagram 1

At DHS  we’ve analysed the challenge facing health and social care and like to summarise it in a “goggles” diagram above. Internal challenges conflated by patient expectations create an unsustainable service environment.

Better outcomes & patient experience for more patients

Professor Willett, also quoted above, gives the perspective of a solution from the acute sector in his review:

“For those people with urgent but non-life threatening needs we must provide highly responsive, effective and personalised services outside of hospital, and deliver care in or as close to people’s homes as possible, minimising disruption and inconvenience for patients and their families.

For those people with more serious or life threatening emergency needs we should ensure they are treated in centres with the very best expertise and facilities in order to maximise their chances of survival and a good recovery”

When including the whole professional health care delivery system, this improvement perspective considers the services as episodic care, delivered with ingredients of staff, organisation, location, and the phone to connect them, supported by in the best case the electronic health record or its cut down summary care record. It does not give a forward actionable view of a Care plan for a patient who is undergoing long term or complex care.

And so solutions are sought where care must take place in a location, rearranging care delivery and organisations to bring professional staff into the community and closer to patients’ homes.

But rearranging people in different departments and locations does not introduce a major new ingredient for productivity improvement, and therefore at best only deliverers incremental improvements. Not addressed when seeking solutions in this direction are the following:

  • That many people have a longitudinal relationship with care, not episodic, and that these people represent 70% of the cost of the NHS. Cancer patients who go on to become survivors under surveillance have a very similar long-term relationship but often, due to costs, this is downgraded to a regularly recurring GP appointment.
  • That in these situations the patient can be a very important co-creator of the care service and that others can be co-opted in this co-creation, to complement NHS professionals.
  • The necessary engagement and empowerment and activation of the patient to achieve co-creation of care.
  • The provision of a transactional working environment that connects all people together, patient, carer, professional, social services, charities, volunteers, not just for viewing a care history, but where actions can be planned, and plans can be actioned and followed up.
  • That care services do not have to be delivered in an identical fashion to every individual for them to be ‘fair’. Many people prefer digital, some don’t.

The essay goes on to argue that taking the patient perspective makes one consider the almost 8000 hours per year that a patient typically spends away from healthcare professionals and in the community. Including this same community in the co-creation of health, often made up of willing persons such as family, friends, charities and volunteers and not to forget, social services, brings into the fray an entirely new source of capability that happily lies outside the budget of the NHS.A much more fruitful direction of seeking productivity improvement to transform health service delivery and patient experience is presented in a recently published essay in the BMJ: “Flipping Healthcare[ii] that describes that flipping the service “puts the person, not the disease or the condition, at the centre of improving health and healthcare.” That “truly patient centred healthcare must consider and seek to understand the entire spectrum of social and economic factors that affect a person’s health, not merely a narrow slice of how or why a patient presents at the hospital or clinic.” And this is an important pointer to how to engage the patient and achieve co-creation of health.

The answer lies in the creation of a different conversation between healthcare teams and patients. A slight clinicians’ adjustment in attitude towards patients and an effort to engage patients with their health, both enabled by the VitruCare platform, demonstrates excellent results time after time. This creates a positive upwards spiral, illustrated by a new “goggles diagram”, shown below.

Healthcare goggles diagram 2

To find out more, please contact DHS and start a dialogue on how your organisation can join those who do much better by leveraging a digital health platform.

[ii] Flipping Healthcare; Bisognano & Summers; British Medical Journal; 1 November 2014.