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Professor Anja Tuulonen Director , Tays Eye Centre ( TEC-Fi )

Clinical leadership – an integrative holistic approach of becoming a physician. AEMH Conference 2019, Clinical Leadreship – A European Porejct. Professor Anja Tuulonen Director , Tays Eye Centre ( TEC-Fi ) Tampere University Hospital , Finland. Financial disclosures.

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Professor Anja Tuulonen Director , Tays Eye Centre ( TEC-Fi )

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  1. Clinicalleadership – an integrative holisticapproach of becoming a physician AEMH Conference 2019, ClinicalLeadreship – A EuropeanPorejct Professor Anja Tuulonen Director, TaysEye Centre (TEC-Fi) Tampere UniversityHospital, Finland

  2. Financial disclosures Salaried by Finnish tax-payers Leader of 2 university eye centres for 25 years Numerous national projects e.g. within Ministries of Health and Education No direct personal support from industry, e.g. no advisory boards Unpaid officerships since 2008, e.g. EGS Past President, GRS Treasurer

  3. Trying to improvewell-being at sustainablecosts

  4. How to fostersustainablehealthcare? See the ’Big picture’ Need a clear vision Strongbelief in common good

  5. Vision of EGS • Individuals with glaucoma have • minimal glaucoma-induced visual disability • best possible well-being • within an affordable*healthcare system. Any disease  Outcome  Costs • * Affordable to patients, citizens (tax-payers) and society

  6. In the world of finite (tax) resources How to share the cakeequally and cost-effectively? Whomshouldweallow to eatmore? Why?

  7. Orcanwe just let the cake increaseovertime? Doeslargercake ensureimprovedwell-being?

  8. How couldhealthcareexpenditure of GDP increaseup to 20 % in UK duringnext 50 years? • GDP needs to betripled • Spending on non-health and social careneeds to bedecreasedfrom 80% -> 50 % Appleby 2013

  9. How to Choose the RightThings to Do and DoThemRight • Whohas the power to definewhat is ’right’?

  10. Physicians? Patients? Malcolm Willett • Citizenshavedifferentvalues as • Patients • Tax-payors • Voters in politics Malcolm Willett

  11. The power of money Money makes the theworldgoround Whopays and whogetspaid?

  12. Changes in valuesystems / ethics TraditionalAnalyticConsumeristic InvidualpatientsPopulationhealth Client service PaternalismSelf-determinationClients’ priorities and money Norms, rulesEthicalprinciples Business principles ProfessionWelfarestatePrivateenterprices Samuli Saarni

  13. Europeancountries • Access to high-qualityservices, efficiency, equity and affordability • EU ExpertPanel • Constitution of Finland • Adequate and equalhealthservices • Definition of Adequate? ’Goodenough’ is the new optimum.Dobelli 2013

  14. Western countries • spendmorein healthcare • producemoreservicesthaneverbefore Citizens • arehealthier • live longerthaneverbefore Demand and costsincreaseexponentially

  15. Poorpeoplewillstillgetpoorservices. Too Much Medicine  Overweight ’Slippy’ mascot  Malcolm Willett BMC Cartoonist

  16. ChoosingWisely – Aren’tWeAlreadyDoingit? • Digital servicesare • developedbyhealthy, highlyeducated and well-offpeople • to othersimilarpeople • Lasse Lehtonen, Erikoislääkärilehti 2/2018 • Affordable in developingcountries? Doestechnologypromote (global) equity? • WHO’sTedrosAdhanomGhebreyesus 5.12.2018 Slush Side Event

  17. We are both cause of the problem and the solution. Allimpacts (good and bad) - includingcosts in healthcarearisefromourdecisions.

  18. Big picture Details Seeing the forest and the trees

  19. Large variations Only 10–20 % of decisions based on high quality evidence Every-dayclinics Implementatation De-implementation Basic Translational Health Care Research Health Services Clinical Secondary

  20. EGS EducationContinuum 2016 2015 2007

  21. 1-5 evaluationscale

  22. 8-page evaluation of the curriculumthroughtout the continuum

  23. Mandatorypart of curriculum Gainexperience and beable to runindependently a clinic Knowledge on howto organize, run and continouslyimprove a successful and sustainable (cost-effective) careservice

  24. LeadershipCurriculum and Evaluation International 6 5 4 3 2 1 National Department Unit Team Oneself

  25. Everylevelcarriesresponsibility of decisionmaking Benefits, side effects and costs National Organizational Health careprofessionals

  26. Whatservices, to whom, howmuch? Resources? Evaluation

  27. The differences in well-beingtapered n % by 2030 with n € lowercosts • Defining ’adequate’ and ’equal’ services • Prioritisingactionson taperingdifferences • Promotingcost-effectiveness Collection of ’big data’ -> Simulationmodels to aid decisionmaking

  28. Eye on ACES – Automation in Care and Evaluation

  29. P5SE_RWDE_ICMT Model Strategy Measures ICMT Information, Communication and Medical Technology

  30. P5SE model • P rioritize • 1 S egment • 2 S tandardize • 3 S ustainability • 4 S haredcare • 5 S elf-care • E valuate in real-life

  31. Finland’s Eye on ACES

  32. Lumberjackmeasures output By the size of stack of wood - Not by comsumption of petrol in his chain saw.

  33. Costs of aflibercept per 65-year oldcitizen 2015 2016 2017 Allcannot be ’right’? Helsinki / Tays –ratio 2018 > 6 2015 2 Helsinki Kuopio Oulu Tays Turku Finnish Medical Agency

  34. International bench-marking Swedenusespredominantlyexpensive AMD drugs • About the samenumber of injections in 2017 (85 000) • In Finland for 5.5 million – population • In Sweden for 10 million - population • Who is ’right’?

  35. Details Big picture Seeing the forest and the trees

  36. Invitation: Together We Will See Further Citizens Patients Professionals Disruptive innovators Politicians Authorities Decisionmakers Media Choose the RightThings to Do – DoThemRight

  37. LeadershipCurriculum and Evaluation International 6 5 4 3 2 1 National Department Unit Team Oneself

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