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 messages
Who needs to do what?
Making it happen
Thinking and acting
differently:
5 key messages
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
©The King’s Fund 2010
2. The NHS paradigm
“Quality costs”
+
Quality
NHS Plan
(2000 - 2011)
•Built for Growth
•‘Quality costs’
•Productivity falls
+
_
Efficiency
_
©The King’s Fund 2010
0.2% pa
Source: NAO Management of NHS
productivity 2010
2% pa
Source: NAO Management of NHS
productivity 2010
+
Quality
Efficient care is
quality care
NHS Plan
(2000 - 2011)
(2011 on)
•Built for Growth
•A new paradigm
•‘Quality costs’
•Value focus
•Productivity falls
+
_
Efficiency
Siege
(2011 on)
Cost Control
•Fragmented system
(1980s and 90s)
•Wrong decisions
•Slash and burn
•Lower quality and
efficiency
•‘Efficient’ but lower
quality
_
©The King’s Fund 2010
A new paradigm
Health care can only considered to
be high quality if it is also effective
and efficient.
3. Focus
Providers – new
income focus
Commissioners
- growth money focus
©The King’s Fund 2010
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
Technical
efficiency
Allocative
efficiency
©The King’s Fund 2010
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
Atlas indicator
Variation
Cancer inpatient spending rate
2-fold
Major amputations among type 2 diabetes
patients, by strategic health authority
2-fold
Diabetes patients receiving nine key care
processes (%)
5-fold
Bariatric procedures rate
12-fold
Elective admissions among epilepsy patients
>4-fold
High risk transient ischaemic attack cases
treated within 24 hours (%)
>10-fold
Emergency admissions among asthma patients
aged 18 and under
>3-fold
Magnetic resonance imaging activity
2-fold
Caesarean section (without complications)
spending
2-fold
Who needs to do what?
|
Focus on clinical services
delivery….
Acute Hospital Productivity
Total
Opportunity
£4.38bn
Jevons paradox
Increasing the
efficiency with
which a resource
is used tends to
increase the rate
of consumption
of that resource
William Stanley Jevons
Jevons (1866). The Coal Question (2nd ed.)..
Quality Saves Money
Value based decisions
£500,000
Life years gained
Decommission or reduce
commissioning of the least
cost effective interventions…
16,000
14,000
12,000
10,000
8,247 life
years
gained
8,000
6,000
… and increase commissioning of most
costs effective intervention in line with the
best practices standards
4,000
2,000
0
0
1,000
1,500
5,500
6,000 £k
Adapted from: DH/Mckinsey
|
|
Integrated Care
Torbay Care Trust
Integrated health and social care
teams serve localities of 25,00040,000 – aligned with GP practices
Use of hospital beds has fallen
from 750 in 1998/99 to 528 in
2008/09
Unplanned hospital admissions
and emergency bed day use for
people aged 65+ lower than
expected
Public assessment of the
performance of the NHS is the
most positive in the region
Source: HSMC Birmingham 2010
Mental Health and the
productivity challenge:
Improving quality and
value for money
Variation in Acute MH Bed days
Opportunity
£400m
Source: Audit Commission (2010)
Mental Health Priorities
Action 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