It is all too easy to forget as you juggle the latest acronyms and policy concepts that everybody, the general public, patients, their carers, clinicians, management and even politicians should want higher quality healthcare at lower cost. Why they don’t get it often comes down to the organisational conceits of acronyms, policy and self-interest.
So it was very refreshing to attend the Institute for Healthcare Improvement‘s 22nd Annual National Forum on Quality Improvement in Health Care which was held between December 5-8, 2010 in Orlando, Florida. This was a gathering of mainly US clinicians and managers with a smattering of international attendees (including a reasonably sized UK group). They have a common interest in trying to improve the delivery of healthcare in their local areas. They come together to exchange notes and ideas. What was particularly refreshing was the emphasis on local initiatives; a willingness to learn and “borrow” ideas from others and a healthy scepticism of silver-bullet solution thinking. These people know that it takes hard work over a long time to change large and complex organisations and systems – but they are in it for the long term and the results so far are impressive.
The key theme of the conference was higher quality at lower cost. For me the main messages were:
- The USA is a natural laboratory because it contains examples of every healthcare system found in the world from the Indian Medical Service (i.e. UK) through Medicare (i.e. Canada), to employer insurance (i.e. Japan) and cash payment for services for those without healthcare insurance (i.e. most of third world).
- In the USA, regions with higher levels of healthcare activity and more capacity have poorer outcomes and higher costs (Dartmouth Atlas)
- Integrated healthcare providers (e.g. Kaiser Permanente; Geisinger; Medicare) are making the most progress in improving quality and cutting costs because they control the entire patient pathway and clinical incentives
- The focus on quality is moving strongly towards improving patient experience – a phrase from the keynote was “minimally disruptive healthcare” meaning investigation and treatment with minimal disruption to the the patient’s life.
- Increased patient participation as the internet and social networks empower patients; patient portals enable a shared approach to patient care; and the doctor – patient relationship shifts towards balance.
I’ll publish some detailed posts from the conference over the next few weeks on readmissions; addressing adverse events and increasing patient participation .share with: