Efficient Delivery of Healthcare Services to Patients -Jack Nagel, Alpha Healthcare

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Jack Nagle looks at Supporting Quality & Efficient Delivery of Healthcare Services to Patients in Ireland and the UK.

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  • Each primary care team is planned to be part of a wider network known as the Health & social care networks
  • Introduce why talking about quality and TQM – enabler for efficiency ; bring in by private sector; examples wrt to UK
  • Introduce why talking about quality and TQM – enabler for efficiency ; bring in by private sector; examples wrt to UK
  • Introduce why talking about quality and TQM – enabler for efficiency ; bring in by private sector; examples wrt to UK
  • Seven people will be appointed as directors to the new directorates, one of which will be appointed as the Director General. Purpose twofold – they will run the health services as they exist and prepare for the transformation required in the move to UHIThe Implementation Group formed in Feb/12 by the Minister is to oversee the development of detailed proposals and implementation processes of UHI designed to fit the Irish Health system and to obtain the bets outcomes for patients
  • Efficient Delivery of Healthcare Services to Patients -Jack Nagel, Alpha Healthcare

    1. 1. Supporting Quality & Efficient Delivery ofHealthcare Services to PatientsJack NagleCEO,Alpha Healthcare
    2. 2. Outline• Irish Healthcare System,• Quality• Benchmarking,• Efficiency Improvements,• The key role of IT• Patient Care
    3. 3. Irish Healthcare System• Undergoing major change on road to a Universal Health Insurance model(to be introduced by 2016),• HSE board resigned & replaced with interim – HSE & DOH officialsSeven pillars of care to be set up under individual directorships:– Hospital Care,– Primary Care,– Mental Health,– Children and Family Services,– Social Care, Public Health and– Corporate/Shared Services.• Seven key Directors, one of the seven will be appointed as the DirectorGeneral.
    4. 4. Primary Care• Appointment of Ministerial position for Primary Care,• Dedicated budget,• The Minister has established a project team to work on primary careinitiatives,• Questions remain over the approach and pace of primary care developmentin Ireland:– Promoted as pillar of future healthcare delivery system,– Slow pace of delivery in primary care centres,– Slow pace in delivery of services,– Roll out of CDM?– PCT’s?• Primary Care Teams mapping – 530 ( Target for end 2012 -485)• Sought funding for the development of primary care centres,
    5. 5. Primary Care Team StructureNetwork ServicesSource : HSE f
    6. 6. Chronic Disease Management– Over 25% of Irish population suffer from chronic diseases – thesechronic diseases account for 80% of all healthcare costs,– 18 Chronic diseases account for 80% of hospital based expenditure –10% for diabetes alone,– CD accounts for 80% of GP consultations, 60% of hospital bed days& 2/3rds of emergency medical admissions to hospitals– Best practice for management of chronic diseases involvesintervening with the patient when they are unwell the 1st time –this isknown as CDM or chronic disease management– CDM is the foundation of the most effective healthcare systems inthe world - Canada, Australia and New ZealandConfidential
    7. 7.
    8. 8. NHS Health System …Vision - Key priorities for the “new” NHS are– A patient led NHS,– Better health outcomes,– More autonomy and accountability– improved efficiency• NHS White Paper – “Equity & Excellence : Liberating the NHS”,• CCG’s – GPs in the driving seat re commissioning of services,• QIPP – Quality, Innovation, Productivity & Prevention - need£20bn in savings by 2014/2015
    9. 9. Patient Choice -• Choice of “any willing provider”• Choice of consultant-led team• Extended maternity choice• Choice of mental health service• Choice of treatment, care in long term conditions and end-of-life care• Choice of any GP practice – not limited by where a patient lives or practiceboundary
    10. 10. Quality & TQM ?• Quality – is it going to really impact on general practice?• A philosophy!– Focus on the patient,– Focus on preventing problems rather than having to fix them,– Relentlessly eliminating waste and inefficiencies,– Involving all staff,– Benchmarking and sharing best practice,– Monitoring and reviewing performance,
    11. 11. HIQA
    12. 12. HIQA - Standards
    13. 13. CQC Registration & Compliance• CQC – independent regulator of all health and social careservices in England,• GPs & Primary Medical Service – register by April 2013• Focus on outcomes;• Looking at evidence;• Practices will self declare;• If not compliant in an area – show plan and timescale tobecome compliant;• Premises - if problems show how practice will overcome,
    14. 14. CQC – 16 Essential StandardsCQCs Essential Quality & Safety StandardsPractices must meet these standards:•OUTCOME1: Regulation15: Respecting& Involvingpeople whouse the services•OUTCOME2: Consentto care & treatmentInvolvement & Information•OUTCOME4: Care & welfare of people use use the services•OUTCOME5: Meetingnutritional needs•OUTCOME6: Cooperating with otherprovidersPersonalised Care Treatment& Support•OUTCOME7: Safeguardingpeople whouse servicesfrom abuse•OUTCOME 8: Cleanliness& InfectionControl•OUTCOME9: Managementofmedicines•OUTCOME10: Safety& Suitabilityof premises•OUTCOME11: Safety,availabilityand suitabilityof equipmentSafeguarding & Safety•OUTCOME12: Requirementsrelatingto workers•OUTCOME13: Staffing•OUTCOME14: SupportingworkersSuitability of staffing &Suitability of Management•OUTCOME16: Assessing& monitoringthe qualityof service provision•OUTCOME17: Complaints•OUTCOME21: RecordsQuality & Management
    15. 15. TQM• Quality – is it going to really impact on general practice?• A philosophy!– Focus on the patient,– Focus on preventing problems rather than having to fix them,– Relentlessly eliminating waste and inefficiencies,– Involving all staff,– Benchmarking and sharing best practice,– Monitoring and reviewing performance,• TQM tools to enable practice improvements by improvingquality of service delivery & efficiencies.
    16. 16. Case Study :Reducing A&E and Emergency AdmissionsObjectives:– GatNet ( serving population ~ 250,000 patients NEEngland),– Improve continuity of care focused on best quality & bestvalue health care,– Reduce increase in A&E activityChallenges:– Patient Access– More efficient use of primary care resources
    17. 17. ICase Study :Reducing A&E and Emergency AdmissionsApproach:Commissioning Level:- GatNet data gathering,- GatNet guidance on “LIS” – local incentive scheme,- Guidance generated for practices/health centres,Provider Level:- Review of practice /centre patient admission rates- Identified avoidable admission episodes- Identified patient access issues- Practices signed up to incentivised LIS
    18. 18. Case Study :Reducing A&E and Emergency AdmissionsApproach ( Medical Centre, NE England – 15 GP Centre):Access:• Patient survey – find what patients want & problems with access– Continuity of care important,– Difficult to see preferred GP,– Patients double booking,– Complex system to see same day /urgent appointments• Completed comprehensive clinical capacity analysis– Re-defined appointments system– Better matching of “urgent” to routine appointment slots to needs – timing!– More streamlined for patients,– Eliminated need for patient call backs,– Introduced “dynamic” appointment system that responds to peak (urgent) day need
    19. 19. Case Study :Reducing A&E and Emergency AdmissionsApproach ( Medical Centre, NE England – 15 GP Centre):Patients in Care Homes:• Identified as one of the main areas for avoidable admissions,• Optimise CDM of these patients• Increase medication review rates to optimise treatment control• Medication Review Protocol revised:Diabetic Patient Care:• Complex patient pathway for diabetic care;• Access problems for patients,• Backlogs of waiting patients
    20. 20. fCase Study - DiabetesPathway:• Identified access issues• Reviewed patient pathway• Set out review criteriaPodiatristNurseDieticianGPPatient
    21. 21. ISO 9001 2008Case Study - DiabetesResult:• New patient pathway defined• Improved Diabetic Clinical review• Increased Diabetic review capacity by 100% in 3 months,• Eliminated patient backlogLeading to:• Improved patient care,• Clinically improved patient pathway• Patients seen in community environment• Better access
    22. 22. Benchmarking• Key part of measuring a practice performance• Positions practice,• Focus for service delivery improvement,• Improvement in practice efficiency,
    23. 23. Role of IT• Good practice management software is critical to the efficientand successful running of a practice,• Essential records system for GPs & healthcare professionals,• Carries the essential patient record and practice keyinformation,• Database & records management system,• Socrates very good package, easy to use, reliable and has asuite of tools /reporting available,• Good quality data is essential,
    24. 24. Clinical Audits• Part of professional competence assurance• Use of IT systems– GP Practice Software• CDM– Patient data analysis– EOL Care management• Medication Reviews
    25. 25. Quality Outcomes Framework• The Quality and Outcomes Framework (QOF) is a voluntary annual reward andincentive programme for all GP surgeries in England, detailing practiceachievement results.• Clinical Domain, Organisational Domain, Patient Experience Domain andAdditional Services Domain.– clinical care: the domain consists of 86 indicators across 20 clinical areas (e.g.coronary heart disease, heart failure, hypertension) .– organisational: the domain consists of 36 indicators across five organisationalareas – records and information; information for patients; education andtraining; practice management and medicines management.– patient experience: the domain consists of three indicators that relate to lengthof consultations and to patient experience of access to GPs.– additional services: the domain consists of nine indicators across four serviceareas – cervical screening, child health surveillance, maternity service andcontraceptive services.• Aim of QOF is to improve standards of care by assessing and benchmarking thequality of care patients receive.
    26. 26. Recap• The importance of Quality - Total Quality Management,• Benchmarking & Efficiency Improvements,• IT & Practice Management Software critical• Patient Care & Improved Service Delivery
    27. 27. THANK YOUQ&AFor more info:www.alphaprimarycare.comwww.alphaprimarycare.co.ukwww.primarycare.ie

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