Quality and Value-based Healthcare India Presentation
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QUALITY AND VALUE-BASED HEALTH CARE www.hcqi.o rg Joseph Britto MD, MRCPCH (UK) Health Care Quality Improvement HCQI HCQI
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Transcript of Quality and Value-based Healthcare India Presentation
QUALITY AND
VALUE-BASED HEALTH CARE
www.hcqi.org
Joseph Britto MD, MRCPCH (UK)
Health Care Quality Improvement
HCQHCQII
Two stories related to my own health care journey !
Improving outcomes of critically ill children by mobile pediatric intensive care
Improving the quality of point-of-care clinical decision making by decreasing decision error with data driven decision making and intelligent information processing
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ELEMENTS OF
QUALITY OF HEALTHCARE
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ELEMENTS OF
QUALITY OF HEALTHCARE
SAFETY
EFFECTIVENESS
EFFICIENCY
TIMELINESS
PATIENT CENTREDNESS
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Health Care Quality Improvement
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ELEMENTS OF
QUALITY OF HEALTHCARE
SAFETY
EFFECTIVENESS
EFFICIENCY
TIMELINESS
PATIENT CENTREDNESS
OUTCOMES
COST www.hcqi.org
Health Care Quality Improvement
Quality and value-based healthcare Six short cases
MM: medical device burns during angioplasty
PS : severe respiratory failure waiting for an hour for a consultant before being put on a ventilator
SM: Global myocardial ischemia, 60 mins in ER not seen by consultant – charged Rs. 4,00,000
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JJ – 10 hours waiting on oxygen in MICU for 550ml pleural fluid to be tapped by radiologist
No oxygen in physiotherapy department
TW – fresh myocardial infarction in pulmonary edema transferred from HDU to MICU via lift without oxygen
Quality and value-based healthcare Six short cases
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QUALITY VALUE-BASED
SAFETY
EFFECTIVENESS
EFFICIENCY
TIMELINESS
PATIENT CENTREDNESS
OUTCOMES OUTCOMES
COST COST
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PROVIDER
PURCHASER
PHARMAPOLICY
PAYER
PATIENT
QUALITY & VALUE IN HEALTH CARE
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Little regulation of inputs No regulation of outputs Undefined standards and
standardization No product specifications No outcomes data Little effective patient participation Non-alignment of incentives Competition on price not value Little effective watchdog,
remediation, litigation
A New Redesigned Healthcare are System – Why ?
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A New Redesigned Healthcare System – How ?
How do we improve quality of care and lower costs ?
How do we manage chronic disease and achieve better outcomes ?
How do we standardize excellent care and control costs ?
How do we leverage buying power of purchasers to improve quality, reduce waste and drive down costs ?
Source: Bisognano & Kenney – “Pursuing the Triple Aim” 2012 Wiley & IHI.
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How do we pay for care under an innovative contract that compensates quality rather than quantity ?
How do we build capacity to innovate, spread innovations and ideas for improvement throughout an organization and to sustain those improvements ?
How do we develop leaders – men and women with vision, leaders with an obsession for improvement, fearless in their pursuit of better healthcare ?
Source: Bisognano & Kenney – “Pursuing the Triple Aim” 2012 Wiley & IHI.
A New Redesigned Healthcare System – How ?
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Current Approach New Way
Professional autonomy drives variability.
Care is customized according to patient needs and values.
Professionals control care. The patient is the source of control.
Decision making is based on training and experience.
Decision making is evidence based.
Preference is given to professional roles over the system.
Cooperation among clinicians is a priority.
Do no harm is an individual responsibility.
Safety is a system property.
Source: To Err is Human - Institute of Medicine report - Kohn, Corrigan, & Donaldson, 2000, Table 3-1.
A New Redesigned Healthcare System – What ?
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Current Approach New Way
Secrecy is necessary. Transparency is necessary.
The system reacts to needs. Needs are anticipated.
Cost reduction is sought.Waste is continuously decreased.
Information is a record. Knowledge is shared and information flows freely.
Care is based primarily on visits.
Care is based on continuous healing relationships.
Source: To Err is Human - Institute of Medicine report - Kohn, Corrigan, & Donaldson, 2000, Table 3-1.
A New Redesigned Healthcare System – What ?
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FROM NON-SYSTEM
TO SYSTEM
Any time the majority of the people behave a particular way the majority of the time, the people are not the problem. The problem is inherent in the system.
W. Edwards Deming - the father of the quality movement
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EFFORT TO
OUTCOME
CULTURE
BEHAVIOUR
SYSTEMS
PROCESSES
DECISIONS
OUTCOMES
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QUALITY AND
VALUE-BASED HEALTH CARE
“The journey of a thousand miles begins with one step.” Lao Tzu, Chinese philosopher and father of Taoism
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