"The Nuka system of care: Lessons for healthcare redesign in Wales" - Dr Stephen Tierney

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Health & Medicine

Published on February 20, 2014

Author: 1000Livesi

Source: slideshare.net

Description

1000 Lives Improvement hosted Dr Stephen Tierney of Southcentral Foundation, to discuss how they transformed a system of care in Anchorage, Alaska, and how their lessons could help in transforming healthcare in NHS Wales.

Primary Care needs changing  Medical care is too big and too complex with way too many services, agencies, and offerings to be left uncoordinated and without a strong navigator/coordinator role  Doctor-centric Medical Model primary care has failed – need to rethink everything  Poor ‘primary care’ = ineffective system  Current model actually does HARM Copyright © 2011 Southcentral Foundation. All Rights Reserved.

Previous Healthcare Fixes - USA  Limited capability if fundamental platform is not rethought • Think like a business, managed care, safety • Case Management 2002-2007 • Then – Six Sigma, TPS, flow, reliability, spread, bundling, P4P, E.H.R • Now - PCMH, ACO, Affordable care, single payer Copyright © 2011 Southcentral Foundation. All Rights Reserved.

The result of previous fixes  Medical Model – not questioned  Each piece of healthcare optimizing their financial position – very sophisticated financially and bankrupting society  Better, faster, safer version of what we have – no fundamental change Copyright © 2011 Southcentral Foundation. All Rights Reserved.

Who really makes the decisions? 100% Custome r-Owner /Family “Control” 0 1. 2. 3. 4. em” The “Syst Low Acuity High Control – who makes the final decision influencing outcome? Influences – family, friends, co-workers, religion, values, money Real opportunity to influence health costs/outcomes – influence on the choices made – behavioral change Current model – tests, diagnosis, treatment (meds or procedures) Copyright © 2011 Southcentral Foundation. All Rights Reserved.

Risk of Reductionism  Attempting to isolate a single intervention as the approach to change within a complex dynamics system assumes all other processes, events and participating remain static over time.

Disease Approach to Improvement  Severe dental caries  ADHD  Anxiety Disorder  Domestic Violence  Severe dental caries  Hypertension

Approaching the Philosophic Thought Process of Redesign Outcome not income Person not disease Population not process Service not practice

Reality  Health is a longitudinal journey • Across decades • In a social, religious, family context • Highly influenced by values, beliefs, habits, and many ‘outside’ voices.  Office visits are brief, reactive stop-gaps  Hospitalizations are brief, intense interruptions  MUST fix basic, underlying primary care platform first or nothing else will work well Copyright © 2011 Southcentral Foundation. All Rights Reserved.

Purpose of Primary Care  We are a Service Industry – NOT a product industry – coaching, teaching, partnering are central – pills and procedures supportive  Changes what we think we do, who we hire, how we train, how we structure, how we reward, and how entire system is constructed as a system.  We must optimize relationship – personal, trusting, accountable – minimize barriers Copyright © 2011 Southcentral Foundation. All Rights Reserved.

Challenges  Unquestioning belief in the medical model and professionalism  Firm basis in science, technology, industrial manufacturing models, body as physical  Many people making a whole lot of money in current system – as independent pieces  Current system allows/supports/rewards independence and entrepreneurial thinking – no common purpose, framework, principles  Very weak workforce and management theory, knowledge, skill in healthcare Copyright © 2011 Southcentral Foundation. All Rights Reserved.

Data and Measurement Key Improvements  Multiple levels  Mission, Vision, Key Points  Data experts  Data and sharing story  Data Mall Copyright © 2011 Southcentral Foundation. All Rights Reserved.

Information to Knowledge 50% % SCF Central Pharmacy customer-owners requesting other medications at dispensing 40% Change Tested Better Change Implemented 30% 20% Percent Average 10% 0% 8/5/10 8/12/10 8/19/10 8/26/10 9/2/10 9/9/10 9/16/10 9/23/10 9/30/10 Source: Cent ral Pharmacy-Pharmacy tic-sheet 9.27.10 Copyright © 2011 Southcentral Foundation. All Rights Reserved.

Health care provider changes  No longer a hero but a partner • • • • • Control does not equal compliance Replace blaming with understanding Give customer options, not orders Provide customer with resources Make it simple Copyright © 2011 Southcentral Foundation. All Rights Reserved.

Operations Focus Key Improvements  Microsystem Optimization -teams • • • Primary Care: Physician, RN, Certified Medical Assistant, CM Support, Behaviorist, Dietician, Pharmacist, office redesign Behavioral Health teams: Physician, Master Level Therapist, Case Manager Human Resources teams: HR Generalist and Assistants – Same day service, etc.  Home Health, Nutaqsiivik, Waiver Care Coordination, Home Visiting Physician Copyright © 2011 Southcentral Foundation. All Rights Reserved.

Workforce Focus Key Improvements  Interview /Hiring  Onboarding (ASTP, etc)  Leadership development  Development Center  Career Ladders  Job Progressions  Mentoring  Employee Wellness Copyright © 2011 Southcentral Foundation. All Rights Reserved.

Would You Like to Live in Alaska? Copyright © 2011 Southcentral Foundation. All Rights Reserved.

Are You Sure? Copyright © 2011 Southcentral Foundation. All Rights Reserved.

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