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Redesigning hospital systems

Redesigning hospital systems. Nigel Edwards Policy Director, NHS Confederation, UK Hon. Visiting Professor LSHTM. Pressures for change - external. Consumerism Workforce shortages Cost inflation Epidemiology Demography. Pressures for change - internal. Increased specialisation

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Redesigning hospital systems

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  1. Redesigning hospital systems Nigel Edwards Policy Director, NHS Confederation, UK Hon. Visiting Professor LSHTM

  2. Pressures for change - external • Consumerism • Workforce shortages • Cost inflation • Epidemiology • Demography

  3. Pressures for change - internal • Increased specialisation • A link between quality and volume of work • Concerns about safety, in particular about small or isolated hospitals • Policy to shift care out of hospital • Changes in the position of hospitals in the system

  4. Complexity of care situation All care situations Care situations ordered by complexity

  5. Complexity of care situation Typical structure of traditional delivery system All care situations Care situations ordered by complexity

  6. Complexity of care situation Situations handled by an under qualified or overloaded system All care situations Situations handled by an overqualified and too costly system

  7. Pressures for change - internal • Use of small hospitals for training • Working hour restrictions • Increased multidisciplinary working – requiring larger teams • Using trainees to staff hospitals • Consultants firmly based in hospitals • MMC

  8. Standard strategic responses • Ignore & hope for the best • Centralisation

  9. Centralisation • Too slow • Costly • Politically tough • Does not solve the problem of emergency medicine • Local access • Frequent users and social care require local links

  10. Standard strategic responses • Ignore & hope for the best • Centralisation • Mergers

  11. Mergers • Costly • Often don’t deliver or very slow • Integration of different organisations very tough • Don’t get to the heart of some of the pressures on hospitals

  12. Standard strategic responses • Ignore & hope for the best • Centralisation • Mergers • Market development • Cost reduction & efficiency improvement

  13. A recent strategy: Redesign • Capacity and demand • Advanced access • Theory of constraints • Process improvement • BPR • Leanthinking • Workforce • New roles • Substitution

  14. Key questions • How do we create a sustainable model • What is the role of the hospital? • What is its relationship to primary care? • Could changes in the way that staff work provide some new answers? • Could technology assist with this?

  15. Role • Different approaches for large centres and for small and medium sized hospitals • Is the hospital a facility or at the centre of the system? • Component producer or responsibility for a defined population? • Beds – cost centre or profit centre?

  16. Primary / secondary care • Is this division helpful any more? • The role of specialists • Where specialists work • Who they work for and with • Vertical integration • Where do some key resources sit? • Diagnostics • A&E • Social care

  17. Specialisation and generalism • Have we got the balance right? • Some services need specialist centres • Increase in patients with multiple diagnoses • Rise of hospitalists • Multi-site networks

  18. Clinical interdependences • Are the assumptions we make about these still correct? • Can we provide enough locally to be able to deal with the high volume local emergencies? • Internal medicine • #NoF, Acute abdomen, etc. out of hours • Sick children • Could a different approach to the way specialists work help with this?

  19. Conclusions • The hospital needs to be seen as an integrated part of the healthcare system in which it sits • The most significant obstacle to change is the absence of a vision for the future which is meaningful for clinicians

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