Quality and Value-based Healthcare India Presentation

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Quality and Value-based Healthcare India Presentation

  1. 1. HCQI Health Care Quality Improvement QUALITY AND VALUE-BASED HEALTH CARE  Joseph Britto MD, MRCPCH (UK) www.hcqi.org
  2. 2. HCQI Health Care Quality ImprovementTwo stories related to my own health care journey !Improving outcomes of critically ill children by mobile pediatric intensive careImproving the quality of point-of-care clinical decision making by decreasing decision error with data driven decision making and intelligent information processing www.hcqi.org
  3. 3. HCQI Health Care Quality Improvement ELEMENTS OF QUALITY OF HEALTHCARE www.hcqi.org
  4. 4. HCQI Health Care Quality Improvement ELEMENTS OF QUALITY OF HEALTHCARE SAFETY EFFECTIVENESS EFFICIENCY TIMELINESS PATIENT CENTREDNESS www.hcqi.org
  5. 5. HCQI Health Care Quality Improvement ELEMENTS OF QUALITY OF HEALTHCARE SAFETY EFFECTIVENESS EFFICIENCY TIMELINESS PATIENT CENTREDNESS OUTCOMES COST www.hcqi.org
  6. 6. HCQI Health Care Quality Improvement Quality and value-based healthcare Six short cases MM: medical device burns during angioplastyPS : severe respiratory failure waiting for an hour for a consultant before being put on a ventilatorSM: Global myocardial ischemia, 60 mins in ER not seen by consultant – charged Rs. 4,00,000 www.hcqi.org
  7. 7. HCQI Health Care Quality Improvement Quality and value-based healthcare Six short cases JJ – 10 hours waiting on oxygen in MICU for 550ml pleural fluid to be tapped by radiologistNo oxygen in physiotherapy departmentTW – fresh myocardial infarction in pulmonary edema transferred from HDU to MICU via lift without oxygen www.hcqi.org
  8. 8. HCQI Health Care Quality Improvement QUALITY VALUE-BASED SAFETY EFFECTIVENESS EFFICIENCY TIMELINESS PATIENT CENTREDNESS OUTCOMES OUTCOMES COST COST www.hcqi.org
  9. 9. HCQI Health Care Quality Improvement QUALITY & VALUE IN HEALTH CARE PROVIDER PAYE PURCHASER R PATIENT POLICY PHARMA www.hcqi.org
  10. 10. HCQI Health Care Quality Improvement A New Redesigned Healthcare are System – Why ? Little regulation of inputs No regulation of outputs Undefined standards and standardization No product specifications No outcomes data Little effective patient participation Non-alignment of incentives Competition on price not value Little effective watchdog, remediation, litigation www.hcqi.org
  11. 11. HCQI Health Care Quality Improvement A New Redesigned Healthcare System – How ?How do we improve quality of care and lower costs ?How do we manage chronic disease and achieve better outcomes ?How do we standardize excellent care and control costs ?How do we leverage buying power of purchasers to improvequality, reduce waste and drive down costs ? Source: Bisognano & Kenney – “Pursuing the Triple Aim” 2012 Wiley & IHI. www.hcqi.org
  12. 12. HCQI Health Care Quality Improvement A New Redesigned Healthcare System – How ? How do we pay for care under an innovative contract that compensates quality rather than quantity ? How do we build capacity to innovate, spread innovations and ideas for improvement throughout an organization and to sustain those improvements ? How do we develop leaders – men and women with vision, leaders with an obsession for improvement, fearless in their pursuit of better healthcare ? Source: Bisognano & Kenney – “Pursuing the Triple Aim” 2012 Wiley & IHI. www.hcqi.org
  13. 13. HCQI Health Care Quality Improvement A New Redesigned Healthcare System – What ? Current Approach New WayProfessional autonomy drives variability. Care is customized according to patient needs and values.Professionals control care. The patient is the source of control.Decision making is based on training and Decision making is evidence based.experience.Preference is given to professional roles Cooperation among clinicians is aover the system. priority.Do no harm is an individual responsibility. Safety is a system property.Source: To Err is Human - Institute of Medicine report - Kohn, Corrigan, & Donaldson, 2000,Table 3-1. www.hcqi.org
  14. 14. HCQI Health Care Quality Improvement A New Redesigned Healthcare System – What ? Current Approach New WaySecrecy is necessary. Transparency is necessary.The system reacts to needs. Needs are anticipated.Cost reduction is sought. Waste is continuously decreased.Information is a record. Knowledge is shared and information flows freely. Care is based on continuous healingCare is based primarily on visits. relationships.Source: To Err is Human - Institute of Medicine report - Kohn, Corrigan, & Donaldson, 2000,Table 3-1. www.hcqi.org
  15. 15. HCQI Health Care Quality Improvement FROM NON-SYSTEM TO SYSTEM Any time the majority of the people behave a particular way the majority of the time, the people are not the problem. The problem is inherent in the system. W. Edwards Deming - the father of the quality movement www.hcqi.org
  16. 16. HCQI Health Care Quality Improvement EFFORT TO OUTCOME O CULTURE U BEHAVIOUR T C SYSTEMS O PROCESSES M E DECISIONS S www.hcqi.org
  17. 17. HCQI Health Care Quality Improvement QUALITY AND VALUE-BASED HEALTH CARE“The journey of a thousand miles begins with one step.” Lao Tzu, Chinese philosopher and father of Taoism www.hcqi.org

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