Transforming health care

1. Transforming health care Transferable learning from Kaiser Permanente Mary Burrows

2. Translating the Kaiser experience Three key themes • Clinical leadership • Patients as primary care providers • Integrated care through patient pathways

3. Kaiser’s model of Customized, Coordinated Medical Care P E R F O R M A N C E QualityMedicine S T R U C T U R E Self Management Permanente/Patient Relationship Self Governance Resource Management Group Responsibility Clinical leadership • Kaiser Clinical Leadership in Practice (KCLIP) • Academic and project based programme with personal learning, CEO sponsorship with guarantee

4. Northampton Clinical Leadership Project Overview Programme Induction Module 1 Module 2 Module 3 Module 4 Module 5 Module 6 •Aims •Ground rules •Team identity established •Process Mapping & Improvement Skills •Personal objectives •Identify & Agree Project Programme Review & presentation of Action Plan to Sponsors & Guests Working with Teams NHS Structure Leadership Strategic Development Organisational Behaviour Corporate & Clinical Governance Clinical Pathway Improvement Project. Clinical Pathway Improvement Project Pt 1 Clinical Pathway Improvement Project Pt 2 Clinical Pathway Improvement Project Pt 3 Clinical Pathway Improvement Project Pt 4 Clinical Pathway Improvement Project Pt 5 Clinical Pathway Improvement Project Pt 6

5. Outcome of KCLIP • Detailed pathway and implementation plan for obesity and osteoporosis & falls prevention • Use of PbR and nGMS enhanced services to deliver clinical change • Obligation and commitment to drive forward changes

6. Integrating care : Kaiser • No distinction between primary & secondary care • Clinicians work and learn together • Healthy competition between clinicians • Problem solving & quality improvement is clinician led • They understand their ‘market’

7. Integrating care: Northampton • 2 Lead LTC physicians with project manager to co-ordinate and support work • Stratified approach to chronic disease applied using Kaiser model with public health data • Set in motion projects that apply the ‘bang for buck’ theory as the driver for change • Development of managed clinical networks for LTC • Implemented case management as part of basket of strategies

8. Integrating care and services • Improving preparation for elective surgery to reduce ALOS • Case managers in A&E • Patient pathway team with health and social care to case manage medical patients in and out of hospital • Case managers in community within managed clinical networks and linking with acute services

9. Integrating care and services • Development of integrated care centres as the physical manifestation of integrating care and breaking down boundaries - LIFT and PFI batch secured with first centre in 2007 • Agreed models of care with acute sector (inc mental health) and social care that bring services together over time - foundation community

10. Patients as primary care providers • Drivers for change – customer led & information rich society, Patient Choice • Moving from paternalism to equal partner status – the clinician as guide (Choice) • Emerging evidence that involvement in own care improves outcome • Intellectual contracts: compliance to concordat/ rights and responsibilities

11. Patients as primary care providers • Using diabetes, patient education and self-management pack introduced (Desmond) • LTC team tasked with developing models for empowering patients (e.g. patient run group clinics) through use of expert patient groups • Making use of the media to bring about change • Practices using techniques to encourage self management

12. Future work • Phased implementation of managed clinical networks commencing April 05 • Grounding of a foundation community through health and social care community leaders • Evaluation of networks and other methodologies employed to indicate if outcomes are as expected • Further involvement of patient and user groups with social care