The Wizards of Oz!

Over the years I’ve met a number of Australian health informatics specialists while working in the UK and I’ve always been impressed by their apparent ability to cope with any challenge! But I’ve never had first hand exposure to the Australian health system and the state of informatics – I had the opportunity to change this last October when we visited eastern seaboard to meet up with some companies and individuals.

Happily I also registered for the Health Data Analytics conference in Brisbane. My hope was that it would give me insight into the Australian health informatics scene and current projects. It did that and more!

As I’d hoped a broad range of analytics projects were presented but in addition I noted some really excellent sessions – highlights for me were:

  • the sessions on Precision Medicine with an excellent key note by Eric Dishman, Director of the Precision Medicine Initiative Cohort Program (USA), on the US initiative and, elsewhere on the program, a fascinating talk on moving the IT underpinning genomics services into the “cloud”;
  • a masterclass and sessions on FHIR which moved my understanding on in leaps – I’d come across it as a new technology for interoperability but not had the opportunity to understand it in detail. It was great to have Grahame Grieve, the inventor of FHIR, in the audience to contribute;
  • an inspiring masterclass and sessions from the team at Princess Alexandra Hospital, Brisbane, on their Cerner deployment and approach to using data to support quality healthcare and research. Their enthusiasm and determination to achieve their vision was inspiring.

Although the australian health system is smaller than the UK’s, spending slightly more as a %age GDP (9.4 vs 9.1%, WHO 2014) on a GDP that is about 60% the size, there is a lot of innovative thought and good science being done. I look forward to tracking progress over the next couple of years and I can strongly recommend the conference and our australian colleagues in the HISA.


The myth that will not die?

I’ve seen Don Berwick speak many times, at the Kings Fund and IHI conferences, and it is always a pleasure to hear his well constructed, intelligent presentations delivered with that uniquely american “folksy” charm he shares with other great communicators from across the Atlantic.

His keynote address (link here) questioned why people (particularly politicians) still believe that it is possible to deliver high quality through “inspection” performed by regulators. It is the stock reaction to every failure in the public sector or any sector that has an impact on the public; how often have you heard “this must never happen again – the regulator has failed and we must” either i) “do a ‘root and branch’ review” or ii) “abolish it and setup a better one”?

Don Berwick argues against reliance regulators on the grounds that they generate fear, control of information and a lack of transparency amongst the regulated. Worse, the over reliance on external control stunts the internal development of quality improvement and innovation.

I would add another reason – because external quality control doesn’t work because of weaknesses intrinsic to every regulator and the organisations they regulate. In “The Challenger Launch Decision” by Diane Vaughan, the author describes the failure of safety regulation which was one of the causes of the Challenger launch decision and subsequent tragedy. The culture within NASA and its subcontractors was open, professional and not one of fear. She suggests that the regulatory system still failed for two reasons :

  • autonomy of the regulator, while giving objectivity, meant that the regulator had limited access to information and often lacked the specialist skills to interpret it.
  • this reinforces interdependence of the regulator and regulated organisations, where there are shared goals and sharing of specialist resources. This led to the regulators becoming a part of the regulated organisations culture resulting in negotiation and management of safety issues rather than discovery and sanctions.

When we look at recent NHS “never again” healthcare disasters (for example Mid-Staffordshire NHS Foundation Trust) we see the same issues in play.

So we must ask, if the definition of insanity is doing the same thing over and over again and expecting different results, why the knee jerk reaction to poor quality of service, or worse, is to setup “better” regulators? It doesn’t work, never has and never will!


Choosing Wisely – in whose interest?

In a recent article in the NEJM, by Nancy Morden and  others, titled  “Choosing Wisely — The Politics and Economics of Labeling Low-Value Services” the authors have reviewed the outputs of the Choosing Wisely campaign. The campaign engages professional medical societies (nine) in listing tests and treatments that should be discussed with patients because they are of “low value” – there may be better treatment choices, with lower risks and lower costs.Continue reading

Reducing readmissions – lessons for England from Kaiser Permanante

In June 2010 Andrew Lansley announced in a major speech “..we’re going to ensure that hospitals are responsible for patients not just during their treatment but also for the 30 days after they’ve been discharged.” The NHS Operating Framework for 2011/12 states that hospitals will not be reimbursed for emergency readmissions within 30 days of discharge following an elective admission, and all other readmissions within 30 days of discharge will be subject to locally agreed thresholds, set to deliver a 25% reduction, where possible.

At the IHI conference in December 2010 Kaiser Permanente reported on their research into the causes of readmissions of all types within 30 days of an admission. They put in place an improvement programme that reduced readmissions across the board from 16% to 9% in 6 months.

What lessons can the NHS in England learn from this experience?Continue reading

IHI logo

The Institute for Healthcare Improvement annual conference 2010

IHI logoIt 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. Continue reading