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Great innovations of the first and second healthcare revolutions

MRI and CT scanning Anti psychotics Antibiotics Genetics Hip and knee replacement Chemotherapy Antidepressants Randomised controlled trials Systematic reviews. Great innovations of the first and second healthcare revolutions.

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Great innovations of the first and second healthcare revolutions

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  1. MRI and CT scanning Anti psychotics Antibiotics Genetics Hip and knee replacement Chemotherapy Antidepressants Randomised controlled trials Systematic reviews Great innovations of the first and second healthcare revolutions The First The Second Broad Street - John Snow Gower Street - Doll & Hill

  2. 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 - BUT the NHS still faces 5 major problems

  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

  5. 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’.

  6. Value Waste Value Waste We hate muda

  7. High High Carbon Value Low Low Value Carbon

  8. High High Carbon Value Low Low Value Carbon

  9. Citizens Information Knowledge Technology The Drivers of the Third Industrial Revolution (Manuel Castells)

  10. 21st C leadership

  11. 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 Donabedian’s theory of optimality

  12. The law of diminishing returns Benefits Investment of resources BVHP The Better Value Healthcare Programme

  13. 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

  14. 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

  15. At the point of optimality value is maximised Optimality Benefits - harm Investment of resources BVHP The Better Value Healthcare Programme

  16. cancer cardiac mental health BVHP The Better Value Healthcare Programme

  17. Res & Ed Manage. & IT Prevention Complicated eg Trauma, Very old people Chronic Health Problems Diagnosis

  18. The values of the population served Choice Decision Evidence The other needs of the population (opportunity costs) DECISION MAKER (OFFICIAL)

  19. 792,000 tonnes of carbon

  20. The values of the Patients served Evidence Choice Decision The other needs of that group of patients

  21. Breast bowel cancer lung cardiac mental health BVHP The Better Value Healthcare Programme

  22. Objectives Criteria Standards Performance Minimal Achievable Excellent (Annual Report) The Oxford Healthcare System •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

  23. This is an example of a national service set up as a system

  24. Ideas and Information Patient Clinician Knowledge System Information Ideas and Information

  25. 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

  26. 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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