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Strategies for improving Productivity Mark Jennings 17 th January 2011. “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.”. Outline. Improving productivity - PowerPoint PPT Presentation
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Strategies for improving Productivity
Mark Jennings
17th January 2011
“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.”
Outline
Improving productivity – 5 key messagesWho needs to do what?Making it happen
Thinking and acting differently: 5 key messages
©The King’s Fund 2010
1. The gap
©The King’s Fund 2010
How we see the gap
Financial gap? – The same output with less money
Care gap? – More value with the same resource
2. The NHS paradigm
“Quality costs”
©The King’s Fund 2010
Quality
Efficiency_
_
+
+
NHS Plan
(2000 - 2011)
•Built for Growth
•‘Quality costs’
•Productivity falls
_
_
Quality+
+
Source: NAO Management of NHS productivity 2010
0.2% pa
Source: NAO Management of NHS productivity 2010
2% pa
©The King’s Fund 2010
Quality
Efficiency_
_
+
+
NHS Plan
(2000 - 2011)
•Built for Growth
•‘Quality costs’
•Productivity falls
Cost Control
(1980s and 90s)
•Slash and burn
•‘Efficient’ but lower quality
_
_
Siege
(2011 on)
•Fragmented system
•Wrong decisions
•Lower quality and efficiency
Quality+
+
Efficient care is quality care
(2011 on)
•A new paradigm
•Value focus
A new paradigm
Health care can only considered to be high quality if it is also effective and efficient.
©The King’s Fund 2010
3. Focus
Providers – new income focus
Commissioners - growth money focus
Focus
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
©The King’s Fund 2010
Technical efficiency
Allocative efficiency
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]
Unjustified variations in health care cause…..
Increased cost
Reduced quality
2-foldMagnetic resonance imaging activity
2-foldCaesarean section (without complications) spending
>3-foldEmergency admissions among asthma patients aged 18 and under
>10-foldHigh risk transient ischaemic attack cases treated within 24 hours (%)
>4-foldElective admissions among epilepsy patients12-foldBariatric procedures rate
5-foldDiabetes patients receiving nine key care processes (%)
2-foldMajor amputations among type 2 diabetes patients, by strategic health authority
2-foldCancer inpatient spending rate
Variation Atlas indicator
|
Who needs to do what?
Focus on clinical services delivery….
Acute Hospital Productivity
Total Opportunity
£4.38bn
William Stanley Jevons
Jevons paradox
Jevons (1866). The Coal Question (2nd ed.)..
Increasing the efficiency with which a resource is used tends to increase the rate of consumption of that resource
Quality Saves Money
|
1,0000
6,000
8,000
Life years gained
£k
2,000
16,000
14,000
12,000
4,000
06,0005,5001,500
10,000
£500,000
8,247 life years gained
Decommission or reduce commissioning of the least
cost effective interventions…
… and increase commissioning of most costs effective intervention in line with the
best practices standards
Adapted from: DH/Mckinsey
Value based decisions
|
Integrated Care
Integrated health and social care teams serve localities of 25,000-40,000 – aligned with GP practicesUse of hospital beds has fallen from 750 in 1998/99 to 528 in 2008/09Unplanned hospital admissions and emergency bed day use for people aged 65+ lower than expectedPublic assessment of the performance of the NHS is the most positive in the region
Source: HSMC Birmingham 2010
Torbay Care Trust
Mental Health and the productivity challenge:Improving quality and value for money
Variation in Acute MH Bed days
Source: Audit Commission (2010)
Opportunity £400m
Mental Health PrioritiesAction across the care pathway– Assessment – Acute beds– Discharge processes
Effective responses to complex needs– Out of Area treatments
Improve workforce productivity– Shifts– Sickness
Making it happen
Action at all levels of the system
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
Action at all levels of the system
