Paul Batalden MD Professor Emeritus Dartmouth Institute for Health Policy and Clinical Practice Geisel Medical School University of Minnesota May 25 2016 Aim Today Tomorrow Learning ahead ID: 643012
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Slide1
Improving Healthcare Service
Paul Batalden, M.D.
Professor Emeritus
Dartmouth Institute for Health Policy and Clinical Practice
Geisel Medical
School
University of Minnesota
May 25, 2016Slide2
Aim
Today?
Tomorrow?
Learning ahead
?Slide3
Today?Slide4
The healthcare service
improvement challenge
:
1980’s
What might be required for “enterprise-wide” approaches to the improvement of quality in healthcare services?Slide5
Enterprise-wide Improvement Learning I
Generalizable
Knowledge
+
Particular
Context
Measurable
Improvement
Biology
Function
Cost
Satisfaction
Slide6
Enterprise-wide Improvement Learning
II
Patients, families could give us regular feedback (CHAPS)
Enterprise-wide quality could be
assessed at the
ceiling
as well as the
floor
(MBNQA)Scientific peer-reviewed literature could help advance/develop a science of improvement (SQUIRE)Slide7
Every system is perfectly designed to get the results it gets.Slide8
Tomorrow?Slide9Slide10
The healthcare service
improvement challenge
:
1980’s
What might be required for “enterprise-wide” approaches to the improvement of quality in healthcare services?
Going forward:
What might be required to improve the value of the contribution that healthcare services make to health?Slide11
So, two new invitations...
Service
Value
What might be required to improve the
value
of the contribution that healthcare
services
make to health?Slide12
Victor Fuchs
Making a service is fundamentally different from making goods, products. All service...at some level...is produced by professionals and those who receive the benefit.
1968Slide13
Harvey Garn, et al; Elinor & Victor Ostrom, others:
Elinor Ostrom 1933-2012
Nobel Laureate 2009
The co-production of public services is an economical way of providing service, solving community challenges. Slide14
The interdependent work of users and professionals to design, create, develop, deliver, assess and improve the relationships and actions that contribute to the health of individuals and populations.
The co-creation, co-production of
healthcare servicesSlide15
Relationship
......
(Knowledge,
Skill, Habit)
......
Activity
A healthcare service:Slide16
When I think of healthcare service as a “product” I am tempted to...
Limit my focus on the person needing services to “person-as-intervention-purchaser”
Focus on standards as if local situations were all the same
Judge, pay professionals by the co-created “outcomes” that actually “live” in the individual with the need
Use
information and digitization as agents of “
productification
” or “
machinification” of the relational work of healthcare serviceSlide17
Community and society
Co-execution
Co-planning
Civil discourse
Healthcare system
Co-produced high value
healthcare service
Good health for all
Patients
Professionals
M. Batalden, et alSlide18
Courtesy: Gautham SureshSlide19
Civil discourse
Co-planning
Co-execution
Patient/Client
Professional
Co-creating & Co-producing good
services
System(s)
What might professionals do, contribute, invite, offer?
What might patients/clients do, contribute, invite, offer?
What might systems do, contribute, invite, offer?
What might this mean?Slide20
Standard (ALARM/London)
New (ALARME)
Identification/decision
to investigate
Ask
pts
to tell their story—what went well/poorly. Select some for analysis
Select people
for investigation team
Include
patient/family where possible
Organization &
data gathering
Ask
pts
& family to tell their story,
reflect on contributory factors
Determine
accident chronology
Widen time frame to the whole
pt
journey
Ident
.
Care Delivery Problems
Ident
.
benefits & problems, incl. detection & problem recovery
Ident
. contributory factors
Ident
. contributory factors to
each problem...and to detection & recovery
Support for
pts
, families,
& staff not explicitly considered
Reflect,
comment on disclosure process & support for
pts
, families & staff
Recommendations,
develop an action plan
Select
from full portfolio of strategies and interventions
New form of incident analysis
Vincent, Amalberti: 2016Slide21
So, “coproduction”...
is not a new construct, nor limited to a single disciplinary
/knowledge-building
legacy
in healthcare services invites new attention to design, creation, production, measurement, assessment and improvement of those services...and the infrastructure that matters
in healthcare services invites new attention to the people and their roles
in healthcare services invites new energy, focus and resources
for discovery,
research & new knowledge development
in healthcare services invites new attention to the formation of professionals
in healthcare services invites new opportunities for thinking about social accountabilitySlide22
Opportunitie
s
Education
System design
Outside/edges
Measurement
Challenges
Diversity of people
Invitation vs. demand
Context & standardization
“Service” vs. “Product”
“Sturdy” professional culture(s)
Knowledge-building
If we’re serious about co-production,
co-
creation of healthcare service.
..Slide23
Questions for the path forward...
Difference
between a “product” and a “service” ?
If “co-produced” what might that mean for the dynamics in the relationships?
Implications for measuring goodness-of-result(s)?
Implications for the design of healthcare services?
What might we have to unlearn?Slide24
Learning ahead?Slide25
Neither health nor learning can be outsourced.Slide26
...and for those
engaged in learning to improve...
How should a professional learn to coproduce a service with a patient?
How could a professional discover the assets that patients, families and communities bring to the coproduction of healthcare service?
How should we learn to measure the outcomes of coproduced services?
How should we learn to
discover and build
knowledge of the
almost infinite number of combinations of “patient goal + good science?
”Slide27
Welcome to the
development, discovery
and the scholarship of improving healthcare service!