UK - USA - Global health (physical care, mental health care, social care)

individual
INTERPERSONAL : SCIENCES

humanistic ------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

group

Affordable?	Affordable?
Affordable?	Accountable?

Prompt:
5 Megatrends With The Potential To Transform U.S. Health Care

From: Slow is beautiful (Bloomstein, net, July 2014)

The quotes below are from a one page article in the July issue of net magazine. The message is that while efficiency in online experiences is critical especially in ecommerce and business there is still a place for 'slow' and content that asks questions (I hope so):

"Second thoughts undermine efficient ecommerce experiences. But if we only value efficiency, we ignore opportunities for learning and validation that characterise effective, less transactional experiences.

... (How several brands - "Foster Good Decisions")

DESIGN FOR QUESTIONS

These content types and design patterns aren't necessarily the fastest way for users to complete transactions. Instead, they help users engage with purchases with greater confidence, satisfaction and certainty. When content pushes us to weigh options and wrestle with difficult concepts, it pushes us to ask questions - and place greater weight on their answers."

It does not take a giant leap of imagination to consider this in health and social care contexts?

Margot Bloomstein, .net, July 2014, Issue 255, p. 42.

Informatics in Primary Care - journal

Informatics in Primary Care Journal

On Wednesday I visited HC2014. Having the week off and with the event literally on the doorstep (London in 2015) it was very convenient.

I'd received an email the evening before on the new informatics federation and heard the official announcement in the opening session. My last HC event was 2005, my first 1986 also in Manchester if I remember correctly.

I posted the federation news this morning. On the BCS stand I picked up a copy of the INFORMATICS IN PRIMARY CARE.

This journal is open access. Despite the title and perhaps illustrative of the dependencies within and need to integrate health (and social care) the journal's coverage is broad and inclusive:

We are interested in how computerised medical records can better record the clinical status of patients and can be used to measure the quality, safety and efficiency of health care professionals and organisations – including primary care, hospital, mental health, and social and community care.  The scope of the journal also includes integrated care and how genetic data might be used to enhance health care.

I will reflect a little more on HC2014 soon.

Calling all healthcare radicals!

A call to action: Helen Bevan’s blog (BMJ)

Rocking the boat and staying in it: how to succeed as a radical in healthcare

 

 

Corporate Rebels United is a global movement of “corporate rebels” across multiple industries and sectors. Many healthcare rebels/radicals are part of this. This is the manifesto of Corporate Rebels United which perfectly captures the mission of organisational radicals in healthcare to deliver the new truth of healthcare transformation.

Through Hodges' model I am an advocate for 'radical history', nursing care lessons from the past can (must!) inform future health and social care.
 

The Case for Information: Investment in patient information improves outcomes and reduces costs

A new Patient Information Forum (PiF) research report highlights how providing information to patients and their carers improves outcomes, reduces costs and gives people a better experience of care.

PiF commissioned research to identify the benefits of investing in health information. The project, which looked at over 300 studies, found that there are good business reasons to justify the investment of more time, money and training in health information provision and support. These include positive impacts on service use and costs, substantial capacity savings, and significant returns on investment by increasing shared decision-making, self-care and the self-management of long-term conditions.

To access the report please see:
http://www.pifonline.org.uk/the-case-for-information-investment-in-patient-information-improves-outcomes-and-reduces-costs/

My source: Irina Johnston, CHAIN Administrative Assistant

Interprofessional Collaborative Care Will Be Key to Meeting Tomorrow’s Health Care Needs

Maryjoan Ladden, Ph.D., R.N., F.A.A.N., Robert Wood Johnson Foundation Senior Program Officer

A little over a year ago, the Institute of Medicine’s landmark Future of Nursing: Leading Change, Advancing Health report put forward a series of recommendations for transforming the nation’s health care system. Among them was a call for a system in which “interprofessional collaboration and coordination are the norm.” That’s no simple assignment in a system that often operates in silos, from schooling through practice. But a number of innovators around the nation are already making headway.

Their work is the subject of a new policy brief from the Robert Wood Johnson Foundation, part of its Charting Nursing’s Future (CNF) series. The brief delves into what the IOM recommendation means for health care systems, offers case studies of several collaborative care models already in place, and examines the implications of the recommendation for how we train nurses and other health care professionals.

According to the brief, Implementing the IOM Future of Nursing Report–Part II: The Potential of Interprofessional Collaborative Care to Improve Safety and Quality, the “silo” approach must soon give way if we are to meet coming health care challenges. For example, chronic conditions are increasingly common—not surprising given an aging population. But the health care system is poorly structured to provide the sort of coordinated care and preventive services needed to give these patients quality care while reducing costs. Some health care institutions are gearing up for the challenge.

• In Boston, where Harvard Vanguard Medical Associates developed its Complex Chronic Care (CCC) program, primary care has become interprofessional, collaborative and noticeably more efficient. Each CCC patient is assigned a nurse practitioner (NP), a registered nurse with advanced education and clinical training. The NP consults with all the patient’s subspecialists and incorporates their guidance in a single plan of care. The NP then manages and coordinates that care, connecting patients to nutritionists, social workers, and other professionals as needed. The model is dynamic, allowing patients to meet more or less frequently with the NPs and their primary care physicians, who remain responsible for the patients’ overall care.
  

• In New Jersey, the Camden Coalition of Health Care Providers is “revolutionizing health care delivery for Camden’s costliest patients,” according to the brief. These individuals, sometimes called super utilizers, typically rely on hospital emergency rooms for care. Not surprisingly, such patients account for an outsized share of local hospital costs, often with diagnoses that would have been more properly handled in a primary care setting. The Coalition developed its Care Management Project to reduce these unnecessary emergency room visits by treating patients where they reside, even when that means treating them on the street. A social worker, NP and bilingual medical assistant work as a team to help patients apply for government assistance, find temporary shelter, enroll in medical day programs and coordinate their primary and specialty care.
  

Training the Next Generation to Collaborate

Of course, the silo effect usually begins in school. In May 2011, six national education associations representing various health care professions formed the Interprofessional Education Collaborative (IPEC) and released a set of core competencies to help professional schools in crafting curricula that will prepare future clinicians to provide more collaborative, team-based care. Such efforts are already under way at a number of institutions.

• Maine’s University of New England has developed a common undergraduate curriculum for its health professions programs in nursing, dental hygiene, athletic training, applied exercise and science, and health, wellness and occupational studies. The curriculum includes shared learning in basic science prerequisites and four new courses aimed specifically at teaching interprofessional competencies.
  

• In Nashville, Vanderbilt University is also pursuing an interprofessional education initiative that unites students from the medical and nursing schools with graduate students pursuing degrees in pharmacy and social work at nearby institutions. Students are assigned to interprofessional working-learning teams at ambulatory care facilities in the area.
  

• The Veterans Health Administration (VHA) is piloting an interprofessional initiative, as well, focused on preparing medical residents and nursing graduate students for collaborative practice. As part of the initiative, five VHA facilities have been designated Centers of Excellence and received five-year grants from the U.S. Department of Veterans Affairs. Each VHA Center of Excellence is developing its own approach to preparing health professionals for patient-centered, team-based primary care.
  

• In Aurora, Colorado, the University of Colorado built its new Anschutz Medical Campus with the explicit objective of creating an environment that promotes collaboration among its medical, nursing, pharmacy, dentistry and public health students. It features shared auditorium and simulation labs, as well as student lounges and other dedicated spaces in which students from different professions can pursue common interests such as geriatrics in a collaborative fashion.
  

Such initiatives are clearly the wave of the future, if only because the pressures of caring for a larger, older and sicker population of patients in the years to come will drive efforts to identify efficiencies. In the words of Mary Wakefield, PhD, RN, head of the Health Resources and Services Administration, “As the health care community is looking for new strategies and new ways of organizing to optimize our efforts—teamwork is fundamental to the conversation.”

Sign up to receive future Charting Nursing’s Future policy briefs by email at
www.rwjf.org/goto/cnf.

My source: Matt Freeman (PRS)

Wooly vests, Engines and Health care: One stroke or two?

The cover of Nursing Times this week declares helpfully and positively that nursing is not broken. Stressed on several fronts clearly, but not broken. The feature explores the contribution that skill mix makes to nursing practice, quality and outcomes.

With the past day of industrial action and the economic climate you hear repeated commentators extolling the need for and benefits of investment in services be that: health and social care, house and road building, high speed rail, green energy, ...

The economy is often described as an engine. The knowledge and skills of the workforce (and students) help fuel prosperity through creativity, innovation and ultimately productivity.

As the looming winter settles in - I start to think about vests. The wooliest I can find.^* You wonder to what extent the in-vest-ment in skill mix on the wards and other clinical encounters are oriented  towards tasks, activity and how much that skill mix has the necessary redundancy in place to afford high-quality patient education and person-centered care? You see we need to revest patients and the public at large with the knowledge and self-efficacy to keep well and stay well.

Economies that rely on two cylinder engines are usually considered as a bit behind the times. Noise. Pollution. Waste. How many cylinders do our health care systems run on?

Well, it looks and sounds like one.

One poorly machined cylinder with CURE at one end and PREVENTION at the other. So, the irony. We need a two-cylinder engine not just in health and social care, but people's lives. What a dream machine that would be. Is there a conceptual prototype out there...? You hope that Local Authority changes can refactor the engine, because looking at re-admissions (Milne and Clarke, 1990; Dowler, 2011) a radical redesign is greatly needed.

The truth is that as things stand (and the masses sit) this isn't enough.

(Interesting to note that apparently some 'one-cylinder' designs actually depend on two operations that overlap.)

Milne, R., Clarke, A. (1990) Can readmission rates be used as an outcome indicator? BMJ, 301, 17 NOV. 1139-4.

Dowler, C., (2011) Penalties fail to cut readmission rate, HSJ, 24, 11, 11, 4-5.

*Only kidding.