Competitive environment: What is it and how to thrive … Agath_ Competitive... · 21 March 2013 RCPsych+St Andrew's Healthcare 1 Psychiatric Leadership in Action: Delivering High

21 March 2013 RCPsych+St Andrew's Healthcare 1

Psychiatric Leadership in Action: Delivering High Quality Care for All

Competitive environment: What is it and how to thrive in it

Dr Kostas Agath, EMBA, FRCPsych

Consultant Psychiatrist, NWDAS, CNWL NHS FT

Medical Director, Addaction


Overview

1. Competition: Drivers and Features

2. Role of Psychiatrist

3. New Leadership Paradigm


Why is Competition out there?

• Wanless Report:

Unless communities are fully engaged and empowered, health services will be unaffordable in 20 years.

[DH 2002. Securing Our Future Health: Taking a Long-Term View.

The Wanless Report. DH, 1 January 2002]


Introducing “Competition” & its “Market”


What is Competing With What?

• 5 minutes with your neighbour.

• Report back to the floor


Introducing the Social Determinants of Health


Rainbow Model of Determinants of Health (Dahigren 1995)

Age, Sex &

Constitutional

FactorsAgriculture

& food

production

Education

Work

E

nvi

ronm

ent

Living & working conditionsUnem

ployment

Water &

Sanitation

Health

care

services

Housing


The Health Inequalities….

• Hot off the Press..

UCL Institute of

Health Equities:

“Working for Health

Equity: The Role of

Health Professionals”

(March 2013)


Health Secretary views…

Jeremy Hunt has backed a

report calling on health

professionals to tackle the

social and economic

causes of ill health - not

just the medical.

…NHS has a legal duty to

reduce health inequality…

(BBC, 18 March 2013)


Inequalities decision making in practice

• 5 minutes with your neighbour:

– There is a proposal to close an A&E to save money towards building accommodation for young people sleeping in the streets. What do you do?

– A old age psychiatric firm is to disbanded to save money for an initiative for underprivileged children. What do you do?


Marmot Review: 6 policy drives

1. Give every child the best start in life

2. Enable all children, young people and adults to

maximise their capabilities and have control over their

lives

3. Create fair employment and good work for all

4. Ensure healthy standard of living for all

5. Create and develop healthy and sustainable places

and communities

6. Strengthen the role and impact of ill health prevention



Minimum Pricing


Minimum Pricing….

• 5 min with your neighbour:

– Are you surprised that the government is

backtracking on pursuing minimum pricing on

alcohol?

– What were the chances of a different

government to pursue with the

implementation?


Research Vs Policy

• Research evidence plays a minor role in National

Policy making (Muscat 2008)

• Crisis Intervention Teams: ? effectiveness

(Johnson, 2011)

• Service lines: Introduction in FTs years before the

Tariffs



What is Quality?

• 5min with you neighbour

• Bonus points if you said that it is:

– ARBITRARY measure

– COMPOSITE measure

– Articulated only within a FRAMEWORK.


What is Quality in Health Care?• ‘Structure, process, outcome’ model Donabedian (1980)

• Quality Elements Maxwell(1984)– Acceptability

– Accessibility

– Appropriateness

– Effective

– Efficiency

– Equity

• Clinical Governance Pillars DH (1998-2009)

• Standards of Care Quality Commission (CQC, 2010)

• NHS Quality Strategy (+HEAT) (Health and Social Care, Scotland, 2010)

• Features of Quality Care: Darzi Review (DH 2007)– Fair – Personalised –Effective - Safe

• QIPP Agenda [Quality – Improvement – Productivity – Prevention] (DH 2008)

• Quality Accounts [board responsibility-safety-effectiveness-patient feedback] DH ‘10



Leadership Vs Management

• 5 min with your neighbour:

• How can we differentiate the one from the other?

• Examples?


Leadership Vs Management

• Both responsible for decision-making when problem-solving, but:

• Leadership: what is the appropriate question?

• Management: what is the appropriate process?

[Grint & Holt, King’s Fund, 2011]



Thank you!

[email protected]

[email protected]

Documents

Competitive environment: What is it and how to thrive … Agath_ Competitive... · 21 March 2013 RCPsych+St Andrew's Healthcare 1 Psychiatric Leadership in Action: Delivering High