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NAVIGATING THE SHIFT OF THE HEALTH CARE TECTONIC PLATES

NAVIGATING THE SHIFT OF THE HEALTH CARE TECTONIC PLATES. Kenneth W. Kizer, MD, MPH 4 th Annual Right Care Initiative Leadership Summit San Diego, CA October 3, 2011. About Navigation. The process of monitoring and controlling the movement from one place to another

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NAVIGATING THE SHIFT OF THE HEALTH CARE TECTONIC PLATES

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  1. NAVIGATING THE SHIFT OF THE HEALTH CARE TECTONIC PLATES Kenneth W. Kizer, MD, MPH 4th Annual Right Care Initiative Leadership Summit San Diego, CA October 3, 2011

  2. About Navigation • The process of monitoring and controlling the movement from one place to another • Requires knowing where you wish to go – i.e., your destination • Involves a combination of techniques and methods • All techniques require locating the navigator’s position compared to known locations • Information from the different methods must be integrated

  3. Health Care’s Destination Higher value

  4. Value = Quality/Cost

  5. Q ∑ TQ + SS + A + FS + CBQ = QualityTQ = Technical QualitySS = Service SatisfactionA = AccessFS = Functional StatusCB = Community Benefit

  6. What is the Challenge? • Harmonizing different perspectives about what is value • Understanding how best to drive value in health care, which operates as a complex adaptive system

  7. Complex Adaptive Systems • Component parts are nonlinear and dynamic; they do not inherently reach fixed equilibrium points • Composed of independent agents • whose needs and desires are heterogeneous, so their goals and behaviors often conflict • are intelligent and learn, so that system behavior adapts and changes over time and leads to self-organization • There is no single point of control; no one is truly “in charge”

  8. What is the Challenge? • Changing complex adaptive systems requires a different approach than in more linear or other traditional systems • Change cannot be specified and managed in fine detail • Finding the critical “change levers” – i.e., the things for which small changes produce large effects • Effective strategies for changing linear systems may be counter-productive in a complex adaptive system

  9. What Change Levers Are Most Likely to be Used • Increasing accountability • Alignment of payment with performance • Regulation and enforcement

  10. HEALTH IS ABOUT MUCH MORE THAN HEALTH CARE

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