Traffic Jam Learning

Traffic Jam Learning ; learn the key concepts and skills for 21st century healthcare while driving or just sitting

How many minutes do you spend in a car each day?

Even if you are lucky and don’t have a traffic jam there is a lot of down time. It’s not all bad of course, going in there is time to think, plan and prepare, even to rehearse a difficult consultation or conversation with a colleague (remember the SAS doctrine – Plan, Rehearse, Execute)
Going home it can be a chance to unwind and relax but the car is also a great place for learning by listening and reflecting, and completing the learning record at the end of the journey.
Of course if you can walk to work you can also do walking learning but DONT attempt cycling learning

Technical Value in Healthcare

Technical Value in Healthcare: determined by how well resources are used within services for each individual and the whole population .

Technical Value

…the proper objective is the value of health care delivery, or the patient health outcomes relative to the total cost (inputs) of attaining those outcomes. (1)

Productivity is measured by the relationship between outputs and cost, for example the number of peopletreated per bed per year . Efficiency is measured by the relationship between outcomes, not outputs, and costs, where the costs may be expressed not only as money but also as carbon or time, including the time of patients and carers. Technical value has to take into account not only efficiency but also the possibility of overuse and underuse

This is not only achieved by evidence-based decision-making, essential though that is.  The balance of good to harm changes as the amount of resources invested in an intervention or service increases as Avedis Donabedian showed in his classic diagram in 1980 which is reproduced below:

Value is replacing quality as the dominant paradigm for healthcare in the 21st century. Value is of course increased by quality improvement, by doing things better, cheaper, safer and greener; but doing things right is only half the story – it is also essential to do the right things by making the right decisions about identifying and discontinuing lower value activities.

Personal Value in Healthcare

Personal Value in Healthcare: the delivery of services informed by what matters to the individual.

Patient Centered Care

The term personalisation is used increasingly and, as a consequence, has developed an increasing number of meanings.

One of the earliest uses was in the definition of Evidence Based Medicine. Although accused of being cook book medicine, the origination of Evidence Based Medicine emphasised the need to relate the evidence to the unique clinical condition to the individual patient and his/her values:

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients’ predicaments, rights, and preferences in making clinical decisions about their care.

Source: Sackett, D. L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B., Richardson, W.S. Evidence based medicine: what it is and what it isn’t. BMJ 312 (p.71).

The model described is perhaps better illustrated as a diagram:

Patient Centered Care

This emphasises the need to take into account patients and their values to effectively deliver patient centered care. In some ways the term personalized medicine or personalized care is analogous to the concept of customisation in industry, made famous by Toyota and Dell Computers, and more recently, by the Mini factory in Oxford.

Customisation uses the benefits of large-scale construction when it makes sense but then customises the products to suit the needs of the individual. More recently the term personalisation has been associated with the use of genomic information as though it were a new term, but genomic information is not qualitatively different from biochemical information.  It is just information that needs to be tailored to the individual and should make the treatment specific to the unique clinical problems of that individual.

Other terms that have been used to describe how medicine will be practised when genomic information is available are the terms ‘precision medicine’ and ‘stratified medicine’ but the term personalised is probably now the most commonly used term.

It is important to remember that personalisation is just as important whether there is no genomic information available, as when there is genomic information available.

Transformation Shop

We have different resources for different needs, which can help drive improvements organisationally, individually or both.

Organisational Development 

Our aim is to help organisations transform their culture and develop integrated systems of care.  We will help single organisations that want to transform its culture/service or a group of organisations that want to work together to develop networks to deliver integrated systems of care to their populations.

We start with a transformation workshop which helps the key people in the organisation: 

  • Identify the main pressures they will face in the next decade
  • Agree on the principal features of a service transformed to flourish in the new environment

As a result of the Transformation Workshop, organisations can commit to one of our transformation programmes:

The Integrated Systems Development Programme

The Culture Foundations Programme

Individual Development

These programmes are designed for people who want to lead improvement of health and healthcare – either a whole professional group that knows it needs new skills and knowledge to flourish in the new paradigm or individuals who want to transform the care they provide but are too busy for an MBA.

Professional  Development Programme  helping very busy people create and adapt to the new paradigm

Individual & Organisational Development

Masters level modules – on the Five Giants we still have to conquer and the Enablers of transformation

The How To Handbooks – Knowledge Geared For Action
As well as enhancing the Transformation Programmes, the How To Handbooks can be read alone. They are available on paper, Kindle, and digital versions are available for Iphone, Smartphone, Mac, or PC. The first set of titles is:

  • How To Create the Right Healthcare Culture
  • How To Manage Knowledge in a Health Service (coming soon!)

    Healthcare Foundations is a BVHC podcast service. A subscription to this service entitles you to receive podcasts on current healthcare topics that are important to you – topics such as redistribution of resources, streamlining, reducing waste and increasing value will be illuminated by introducing you to distillates from the 1000 greatest books about or relevant to the health of populations and the delivery of high value healthcare. We also have podcasts from 1000 great articles on the science of health service management. 

    Master the language of healthcare -Language creates the social reality of the world in which we work.  Being clear about the meaning of terms is one of the key steps in shaping culture. Even if a word has more than one meaning, it is essential that everyone in a health service is aware of this and agrees which meaning should be used.  For this reason, BVHC has developed the Glossary of 21st Century Healthcare and a range of other resources to help clarify, and make more consistent, the language of healthcare. 

    The BetterValueHealthcare Bookstore – for really good coffee and 1000 really important book

 We also create bespoke solutions to meet your needs – find out more here.

Attitude

There is a negative, over pessimistic view of old age and older people. This derives partly from a failure to understand how many of the problems of old age are preventable and are not due to the ageing process. Poverty, for example, leads many people to withdraw from society but it is not a consequence of ageing. It is a consequence of social inequality and injustice. Some individuals can retain a positive attitude in the face of the these negative pressures but this requires resilience and a definitely decision to think positively about one’s position, capabilities and potential.

Worry Less

The Ageing Process is normal, biological and not pathological, and nothing can be done about it, for the present at least. But this does not mean that you should despair. On the contrary, you need to understand what is happening to you and how the three processes that cause much more trouble than ageing, at least before the age of ninety can be countered, how their impact can be reduced and how many of their effects can be reversed – the three processes are

  • loss of fitness, both physical and mental
  • preventable disease
  • a negative and pessimistic attitude

The Amazon Single titled An Antidote To Ageing summarises and explains the science and research that supports the proposal that instead of worrying about ageing you should take action to prevent, mitigate and reverse the three factors that cause many of the problems hitherto always ascribed to ‘ageing’.

There is increasingly strong evidence that many of the problems that  have been blamed on ageing are in fact caused by either social or environmental factors, with their influence felt from the earliest age. Furthermore it is now clear that much of the research that has been done on old age has had serious flaws which have over emphasised the effects of ageing. Simply comparing people who are eighty with people who are twenty is not a fair comparison. When a different research method is used which follows people from twenty to eighty, a method called the ‘life course method’, the reduction in muscle strength that occurs is much less than when the muscle strength of today’s twenty year olds and today’s eighty year olds are compared directly, and the same applies  to many other changes.  If you want to know more consult the excellent book A Life Course Approach to Healthy Ageing by Diana Kuh and colleagues.

A linked site on Good Health in Your Seventies gives practical advice to people aged seventy and older on the steps they can take to feel better and prevent and postpone many of the problems that are currently assumed to be due to the ageing process.