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The Medical Team of the Future

The Medical Team of the Future. IHCA October 2010. The Medical Team of the Future. PLAN: Address health issues in the developed world looking into the future Look at what's happening in Ireland Identify some of the drivers of the Medical Team of the Future. IHCA October 2010.

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The Medical Team of the Future

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  1. The Medical Team of the Future IHCA October 2010

  2. The Medical Team of the Future PLAN: Address health issues in the developed world looking into the future Look at what's happening in Ireland Identify some of the drivers of the Medical Team of the Future IHCA October 2010

  3. 200 interviews with leaders in 25 countries • 3,700 consumers in 7 countries • Care in the future will be customized to the • individual • Models of care are struggling to keep up with • volumes • Change is being driven by three key issues: • Chronic diseases • Their associated behavioural, socio-economic, and genetic factors • Digitisation

  4. Health will be customized around five vectors • Incentive-based payment • Doctors to follow best practice • Funding. • Redistributed from sickness to wellness • Patient communication improvement • To engage individuals in their own health • Electronic medical records (EMRs) • By 2020 • Workforce • Systems more efficient. More primary care physicians

  5. Individuals’ relationships with health delivery models are changing. Consumers now want: • Better coordination of care • Coordinated care teams • Fluent navigators • Chronically ill patients need help to navigate the health system • Their experiences to be benchmarked • To access innovation sooner • Availability of medical tourism to increase • Care-anywhere networks • Redefined by the ubiquity of mobile devices

  6. Ireland – the Future • In next 30 years: • Population ↑ 16-67% • Age>65 from 15.9% to 40% Last Census - 400,000 chronic health condition or disability (60% > 60yrs) • Age + increasing risk factor prevalence – obesity, physical inactivity, alcohol • ↑Diabetes 4.7% to 5.7-7.4% • ↑Cancer by 2020 by 15% in women; 8.5% in men ............curtailed resource.

  7. Have we started to anticipate trends identified by PWC? A new direction of travel The service should be designed for Users - not Providers How far are we down the road to transformation? 250 Primary Care Teams established Hospitals have been “re-shaped” Performance measures are driving change 4. Developed Clinical Leadership 5. Changed organizational structure to deliver integrated care 6. Improved value for money 7. Information technology to support integration -little achieved so far

  8. The stated objectives of Irish health policy • The patient must be central to any planning process • The right services must be delivered with the right • skills in the right facilities at the right places • The service must be fair, equitable and focused on • greatest needs • The service must be efficient, sustainable, joined up • and fit for purpose How will the Medical Team of the Future enable this to happen? Will the Medical Team be the driver of change or will it evolve as the result of change imposed upon us?

  9. The Medical Team of the Future DRIVERS

  10. The Medical Team of the Future DRIVERS

  11. UNDERSTANDING TEAMWORK Widely accepted by business schools, corporations, aviation, nuclear industry, military services and emergency responders The 20th Century Physician The 21st Century Physician ● Accumulated knowledge ● Must continually acquire and use knowledge ● Supported in autonomous pursuits ● Must be collaborative ● Cooperated ● Must share accountability ● Individual achievement ● Interdisciplinary team achievement ● Solo experts (physician-centered) ● involved in coordination of care (patient-centered) “The Team is the Medicine of the Future”

  12. The Medical Team of the Future DRIVERS

  13. HISTORY OF ATTEMPTS AT HOSPITAL RECONFIGURATION • 1968 Fitzgerald Report • 1993 Tierney Report • 2001 Quality and Fairness • 2003 Hanly Report • 2007 National Cancer Control Programme • not a model on which to shape a Medical Team

  14. HOSPITAL RECONFIGURATION Contemporary: “Re-shaping” of Hospitals Acute Medical Programme HSE/DQCC/RCPI

  15. DEFINE MEDICAL TEAMS INTEGRATED SERVICE AREA

  16. The Medical Team of the Future DRIVERS

  17. Hospital Teams • HANLY • Meet requirements of EWTD • Achieve consultant provided service • HANLY • Anticipated numbers ° Public Sector 20, 284 Acute Sector 2,300 specialist & advanced practitioner role * Training = 3,600; Non-training = 1,200 Contracts of indefinite duration = 7-800; Taken up = 75

  18. CAREER PATH Student Student MEDICINE NURSING 4yrs 4-6yrs RGN Doctor 2-5yrs CNM 1 5-8yrs 6-9yrs 2-3yrs CNS CNM 2 Specialist Consultant CNM 3 ANP Assistant Director ? Prescribing, IV cannulation, Examination newborns and sexual assaults Minor skin procedures and Endoscopy etc

  19. CAREER PATH Student MEDICINE 4-6yrs Doctor 6-9yrs Specialist Consultant ?

  20. CAREER PATH Student NURSING 4yrs RGN 2-5yrs CNM 1 5-8yrs 2-3yrs CNS CNM 2 CNM 3 ANP Assistant Director Prescribing, IV cannulation, Examination newborns and sexual assaults Minor skin procedures and Endoscopy etc

  21. ANOTHER GRADE ? “To continue to staff our hospital system with nothing but consultants and junior doctors in training posts is absolutely impractical,” Prof Brendan Drumm …… he had in mind the UK staff grade doctor, or the specialty doctor grade that replaced the staff and associate specialist grades (SAS) in 2008, but he was not sure if the UK model had worked particularly well.

  22. A NEW CAREER PATH Student MEDICINE 4-6yrs • Advantages • This provides an incentivised career structure • Earlier appointments as consultants • Fostered within the team concept • New and lower starting salary • Significant bonus for achieving ‘Seniority’ • Avoids the use of demeaning titles • Sustains the concept and virtues of a consultant • provided service Doctor 6-9yrs Specialist/ Consultant Complex care Management Education Research Senior Consultant

  23. NCHDs and EWTD • Physician Assistant • Developed in ‘60s in USA; Vietnam (60,000) • Australia, Canada, Netherlands, Sth Africa, UK • Graduate entry programme • 3 years; Classroom and lab; in medical & behavioural sciences • Programmes accredited internationally • Model designed to complement Medical training • After graduation work and learn within a clinical team • Extensive range of clinical activities under supervision • Permanence

  24. The Medical Team of the Future DRIVERS

  25. New Clinical Programmes • Twenty created in response to: • Hospitals overloaded with acute medicine & chronic diseases • Poor capacity for elective surgery • Inefficient use of resources • Inconsistent practice • Poor data • Solutions • Programmes for acute medicine & chronic diseases • Program for elective surgery Access Quality Cost

  26. Critical Care Gynaecology Medical Obstetrics Other Paediatrics Surgical Average length of Stay Ireland Vs UK: Even though Ireland has a younger population, patients spend up to almost 2 days longer in hospital for the same procedures 2.5 2.0 Average length of stay is among the longest in OECD. 1.9 1.8 1.5 1.4 1.4 1.2 UK AND IRELAND (AGE ADJUSTED) WEIGHTED DIFFERENCE IN ALOS BETWEEN 1.0 0.7 0.7 0.6 0.5 - COSTS; Bed €995/day (€ 160=variable) Theatre €2,558,421/yr (50%=variable) Source: HIPE 2005 & UK Department of Health

  27. Acute Medicine Programme • Acute Medicine Physician • Case Managers • Elective Surgery Programme • To address the blocks • Poor access to out-patient investigations • Inconsistent or poor • Day surgery services & practice • Pre-admission assessment clinics • Day of surgery admissions • Access to ring-fenced beds • Acute Surgery Programme • Acute General Surgeon?

  28. The Medical Team of the Future DRIVERS

  29. IT SYSTEMS; AUDIT; ACCURATE DATA CASE MANAGERS DEFINE MEDICAL TEAMS UNIQUE PATIENT IDENTIFIER, ELECTRONIC MEDICAL RECORDS

  30. DO WE HAVE A CHOICE?

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