Sir Muir Gray Director of the NHS Knowledge Service Chief Knowledge Officer of the NHS

1. The future is not something like Mount Everest; it is more like the Auckland Harbour Bridge

4. 1. Focus on value 2. Engage patients & public as co-producers 3. Focus on the whole population 4. Design & build system & networks 5. Manage knowledge as carefully as money 6.Exploit the internet and smartphone 7. Create the right culture 8. Master the language of healthcare 9. Absorb the wisdom of others 10. Become obsessed about sustainability

5. Solution 1. Focus on value

6. 1980’s Effectiveness 1990’s Cost-effectiveness 2000’s Quality and Safety 2010 and for the rest of the century VALUE

7. Value = Outcomes / Costs Outcome = Good – Bad (Outcome= Effectiveness – Harm) Costs = Money Costs = Carbon + Opportunity Lost

8. 1. Focus on value 2. Engage patients & public as co-producers

10. 1. Focus on value 2. Engage patients & public as co-producers 3. Focus on the whole population

11. Hospital Community

12. Self care Informal care Generalist care Specialist care

13. People with Fracture of The Tibia

14. People with the Condition

15. People Who Receive The Service People with the Condition

16. People Who would Gain most From the Service People with the Condition

17. Dr Jones is a respiratory physician in the Brighton Hospital Trust and last year she saw 346 people with COPD and to provide evidence based, patient centred care, and to improve effectiveness, productivity and safety

18. Dr Jones estimated that there are 1000 people with COPD in East Sussex and a population based audit showed that there were 100 people who were not referred who would benefit ; she needs to practise population medicine

19. Dr Jones, the co-ordinator of the East Sussex COPD Network and Service has responsibility, authority and resources ( i day a week and support ) for Network development Localisation of the Map of Medicine Quality of patient information Professional development of generalists, and pharmacists Production of the Annual Report of the service She is keen to improve her performance from being 27 th out of the 106 COPD services, and of greater importance, 6 th out of the 23 services in the prosperous counties

20. 1. Focus on value 2. Engage patients & public as co-producers 3. Focus on the whole population 4. Design & build system & networks

21. A SYSTEM is a set of activities with a common set of objectives ( also known as a service) A NETWORK is a set of individuals and organisations that deliver the system’s objectives ( a team is a set of individuals or departments within one organisation) A PATHWAY is the route patients usually follow through the network

22. This is an example of a national service set up as a system

23. HIERARCHY NETWORK

25. 1. Focus on value 2. Engage patients & public as co-producers 3. Focus on the whole population 4. Design & build system & networks 5. Manage knowledge as carefully as money

30. CHIEF KNOWLEDGE OFFICER

32. 1. Focus on value 2. Engage patients & public as co-producers 3. Focus on the whole population 4. Design & build system & networks 5. Manage knowledge as carefully as money 6.Exploit the internet and smartphone

33. 1. Focus on value 2. Engage patients & public as co-producers 3. Focus on the whole population 4. Design & build system & networks 5. Manage knowledge as carefully as money 6.Exploit the internet and smartphone 7. Create the right culture

34. “ Culture is the shared tacit assumptions of a group that is has learned in coping with external tasks and dealing with internal relationships.” Source: Schein, E.H. (1999) The Corporate Culture Survival Guide. www.ocht-glossary.net

35. Leadership and a company’s culture are inextricably intertwined.” Source: Morgan, J.M. and Liker, J.K. (2006) The Toyota Product Development System. Integrating people, process, and technology. Productivity Press, New York, pp. 217, 218.

36. Cancers Ophthalmology Gastro- instestinal Glaucoma ARMD Cataract Low vision services Lucentis Within System marginal analysis Retinopathy

38. 1. Focus on value 2. Engage patients & public as co-producers 3. Focus on the whole population 4. Design & build system & networks 5. Manage knowledge as carefully as money 6.Exploit the internet and smartphone 7. Create the right culture 8. Master the language of healthcare

39. If you asked all the key decision makers in India to define 1. what they understood by the word quality and value, or 2. the difference between productivity and efficiency what would they write ?

40. 1. Focus on value 2. Engage patients & public as co-producers 3. Focus on the whole population 4. Design & build system & networks 5. Manage knowledge as carefully as money 6.Exploit the internet and smartphone 7. Create the right culture 8. Master the language of healthcare 9. Absorb the wisdom of others

42. 1. Focus on value 2. Engage patients & public as co-producers 3. Focus on the whole population 4. Design & build system & networks 5. Manage knowledge as carefully as money 6.Exploit the internet and smartphone 7. Create the right culture 8. Master the language of healthcare 9. Absorb the wisdom of others 10. Become obsessed about sustainability

43. CARBON FOOTPRINT NHS ENGLAND

44. Neither markets nor bureaucracies can solve the challenges of complexity

45. www.bvhc.co.uk

46. www.ocht.net