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Strategies for Enhancing Productivity in Healthcare Systems

Enhance healthcare productivity by focusing on efficiency, quality, and value-based decisions. Learn 5 key messages and how to implement strategies for better outcomes. Address variations in care and allocate resources effectively.

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Strategies for Enhancing Productivity in Healthcare Systems

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  1. Strategies for improving Productivity Mark Jennings 17th January 2011

  2. “The definition of insanity is doing the same thing over and over and expecting different results.” • “If you do what you've always done, you'll get what you've always gotten.”

  3. Outline • Improving productivity • 5 key messages • Who needs to do what? • Making it happen

  4. Thinking and acting differently: 5 key messages

  5. 1. The gap

  6. How we see the gap • Financial gap? – The same output with less money • Care gap? – More value with the same resource

  7. 2. The NHS paradigm “Quality costs”

  8. Quality Quality + + • NHS Plan • (2000 - 2011) • Built for Growth • ‘Quality costs’ • Productivity falls + + _ _ Efficiency _ _

  9. 0.2% pa Source: NAO Management of NHS productivity 2010

  10. 2% pa Source: NAO Management of NHS productivity 2010

  11. Quality Quality + + • Efficient care is quality care • (2011 on) • A new paradigm • Value focus • NHS Plan • (2000 - 2011) • Built for Growth • ‘Quality costs’ • Productivity falls + + _ _ Efficiency • Siege • (2011 on) • Fragmented system • Wrong decisions • Lower quality and efficiency • Cost Control • (1980s and 90s) • Slash and burn • ‘Efficient’ but lower quality _ _

  12. A new paradigm Health care can only considered to be high quality if it is also effective and efficient.

  13. 3. Focus • Providers – new • income focus • Commissioners • - growth money focus

  14. Focus

  15. 4. How and what we do… Technical efficiency is doing things right e.g. reducing unit costs by reducing lengths of stay or shifting care to more cost effective settings out of hospital Allocative efficiency is doing the right things e.g. allocating resources to achieve the most health gain for the population served and preventing future hospital admissions

  16. Technical efficiency Allocative efficiency

  17. 5. Variations in care “Variations in care are often idiosyncratic and unscientific with local medical opinion and local supply of resources appearing more important than science in determining how medical care is delivered” [J.Wennberg, BMJ, October 2002]

  18. Unjustified variations in health care cause….. Increased cost • Reduced quality

  19. Atlas indicator Variation 2-fold Cancer inpatient spending rate Major amputations among type 2 diabetes patients, by strategic health authority 2-fold Diabetes patients receiving nine key care processes (%) 5-fold Bariatric procedures rate 12-fold Elective admissions among epilepsy patients >4-fold High risk transient ischaemic attack cases treated within 24 hours (%) >10-fold Emergency admissions among asthma patients aged 18 and under >3-fold 2-fold Magnetic resonance imaging activity Caesarean section (without complications) spending 2-fold

  20. Who needs to do what?

  21. Focus on clinical services delivery….

  22. Acute Hospital Productivity

  23. Total Opportunity £4.38bn

  24. Jevons paradox • Increasing the efficiency with which a resource is used tends to increase the rate of consumption of that resource William Stanley Jevons Jevons (1866). The Coal Question (2nd ed.)..

  25. Quality Saves Money

  26. Value based decisions £500,000 Life years gained Decommission or reduce commissioning of the least cost effective interventions… 16,000 14,000 12,000 10,000 8,247 life years gained 8,000 6,000 … and increase commissioning of most costs effective intervention in line with the best practices standards 4,000 2,000 0 0 1,000 1,500 5,500 6,000 £k Adapted from: DH/Mckinsey

  27. Integrated Care Torbay Care Trust • Integrated health and social care teams serve localities of 25,000-40,000 – aligned with GP practices • Use of hospital beds has fallen from 750 in 1998/99 to 528 in 2008/09 • Unplanned hospital admissions and emergency bed day use for people aged 65+ lower than expected • Public assessment of the performance of the NHS is the most positive in the region Source: HSMC Birmingham 2010

  28. Mental Health and the productivity challenge: Improving quality and value for money

  29. Variation in Acute MH Bed days Opportunity £400m Source: Audit Commission (2010)

  30. Mental Health Priorities Action across the care pathway Assessment Acute beds Discharge processes Effective responses to complex needs Out of Area treatments Improve workforce productivity Shifts Sickness

  31. Making it happen

  32. Action at all levels of the system

  33. Clinical Microsystems Small, functional, front-line units that provide most health care to most people. They are the essential building blocks of larger organisations and of the health system. They are the place where patients and providers meet. The quality and value of care produced by a large health system can be no better than the services generated by the small systems of which it is composed’. Nelson,E., Batalden,P.B.et al. (2002) Learning from high-performing front-line clinical units. Journal on Quality Improvement

  34. Action at all levels of the system

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