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1000 Lives Improvement hosted Dr Stephen Tierney of Southcentral Foundation, to discuss how they transformed a system of care in Anchorage, Alaska, and how their lessons could help in transforming healthcare in NHS Wales.
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Medical care is too big and too complex with way too many services, agencies, and offerings to be left uncoordinated and without a strong navigator/coordinator role
Doctor-centric Medical Model primary care has failed – need to rethink everything
Poor ‘primary care’ = ineffective systemCurrent model actually does HARM
Primary Care needs changing
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Limited capability if fundamental platform is not rethought• Think like a business, managed care, safety• Case Management 2002-2007• Then – Six Sigma, TPS, flow, reliability, spread, bundling, P4P, E.H.R
• Now - PCMH, ACO, Affordable care, single payer
Previous Healthcare Fixes - USA
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Medical Model – not questionedEach piece of healthcare optimizing their financial position – very sophisticated financially and bankrupting society
Better, faster, safer version of what we have – no fundamental change
The result of previous fixes
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Who really makes the decisions?
Acuity
“Control”
The “System”
Customer-Owner/Family
0Low
High
100%
1. Control – who makes the final decision influencing outcome?2. Influences – family, friends, co-workers, religion, values, money3. Real opportunity to influence health costs/outcomes – influence on the
choices made – behavioral change4. Current model – tests, diagnosis, treatment (meds or procedures)
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Risk of Reductionism
Attempting to isolate a single intervention as the approach to change within a complex dynamics system assumes all other processes, events and participating remain static over time.
Severe dental caries ADHD Anxiety Disorder Domestic Violence
Severe dental cariesHypertension
Disease Approach to Improvement
Outcome not income Person not diseasePopulation not process Service not practice
Approaching the Philosophic Thought Process of Redesign
Health is a longitudinal journey• Across decades• In a social, religious, family context• Highly influenced by values, beliefs, habits, and many ‘outside’ voices.
Office visits are brief, reactive stop-gaps Hospitalizations are brief, intense interruptions MUST fix basic, underlying primary care platform first or nothing else will work well
Reality
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
We are a Service Industry – NOT a product industry – coaching, teaching, partnering are central – pills and procedures supportive
Changes what we think we do, who we hire, how we train, how we structure, how we reward, and how entire system is constructed as a system.
We must optimize relationship – personal, trusting, accountable – minimize barriers
Purpose of Primary Care
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Unquestioning belief in the medical model and professionalism
Firm basis in science, technology, industrial manufacturing models, body as physical
Many people making a whole lot of money in current system – as independent pieces
Current system allows/supports/rewards independence and entrepreneurial thinking – no common purpose, framework, principles
Very weak workforce and management theory, knowledge, skill in healthcare
Challenges
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Data and Measurement Key Improvements
Multiple levels Mission, Vision, Key Points Data experts Data and sharing story Data Mall
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Information to Knowledge% SCF Central Pharmacy customer-owners requesting other
medications at dispensing
0%
10%
20%
30%
40%
50%
8/5/10 8/12/10 8/19/10 8/26/10 9/2/10 9/9/10 9/16/10 9/23/10 9/30/10
Percent
Average
Better
Source: Central Pharmacy-Pharmacy tic-sheet 9.27.10
Change Tested
Change Implemented
% Employees with Current Annual Disaster Tng
53
74
94 98 100
0
50
100
2005 2006 2007 2008 2009
%
SCF Industry Best (100%)
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
No longer a hero but a partner• Control does not equal compliance• Replace blaming with understanding• Give customer options, not orders• Provide customer with resources• Make it simple
Health care provider changes
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Microsystem Optimization -teams• Primary Care: Physician, RN, Certified Medical
Assistant, CM Support, Behaviorist, Dietician, Pharmacist, office redesign
• Behavioral Health teams: Physician, Master Level Therapist, Case Manager
• Human Resources teams: HR Generalist and Assistants – Same day service, etc.
Home Health, Nutaqsiivik, Waiver Care Coordination, Home Visiting Physician
Operations Focus Key Improvements
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Interview /Hiring Onboarding (ASTP, etc) Leadership
development Development Center Career Ladders Job Progressions Mentoring Employee Wellness
Workforce FocusKey Improvements
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Would You Like to Live in Alaska?
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Are You Sure?
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
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