a framework for a systems approach to health care delivery

We often call this arrangement a “health care system,” even though it was not created as a system and has never performed as a system. Show this book's table of contents, where you can jump to any chapter by name. Register for a free account to start saving and receiving special member only perks. To participate in, let alone lead and orchestrate, the work of a care team and maintain the trust of the patient, the physician must have on-demand access to critical clinical and administrative information, as well as information-management, communication, decision-support, and educational tools to synthesize, analyze, and make the best use of that information. Ready to take your reading offline? By providing both a framework and action plan for a systems approach to health care delivery based on a partnership between engineers and health care professionals, Building a Better Delivery System describes opportunities and challenges to harness the power of systems-engineering tools, information technologies and complementary knowledge in social sciences, cognitive sciences and … In this model, adapted from Ferlie and Shortell (2001), the health care system is divided into four “nested” levels: (1) the individual patient; (2) the care team, which includes professional care providers (e.g., clinicians, pharmacists, and others), the patient, and family members; (3) the organization (e.g., hospital, clinic, nursing home, etc.) The level of responsibility patients and their families assume differs from patient to patient. To support patient-centered care delivery by well functioning clinical care teams or microsystems, health organizations must find ways to bridge the health care professional/ delivery system management divide and invest in information/ communications technologies, systems-engineering tools, and associated knowledge. McGlynn, E.A., S.M. Nelson, E.C., P.B. Several options exist for promoting delivery system reform either through a state-based block grant approach or federal public plan approach. In industry, this is commonly accomplished by creating independent “profit/loss” centers whose performance can be measured independently of the performance of all other sub-elements. (IOM, 2003). that supports the development and work of, care teams by providing infrastructure and complementary resources; and (4) the political and, economic environment (e.g., regulatory, financial, payment regimes, and markets), the conditions, under which organizations, care teams, individual patients, and individual care providers operate. This preview shows page 1 - 2 out of 8 pages. Care teams must provide patients with continuous, convenient, timely access to quality care. emergency rooms, clinics, sexual and reproductive health services, etc.) In addition, cottage industries do not generally attempt to standardize or coordinate the processes or performance of Unit A with those of Units B, C, and so on. Delivery system reform has been a focus of regulatory and legislative policy to date. It is easy to show mathematically that the optimization of individual units rarely, and only under highly improbable circumstances, results in optimization of the whole. The availability of information, the establishment of private health care spending accounts, and other measures reflect an increasing expectation that patients will drive changes in the system for improved quality, efficiency, and effectiveness. care delivery system. At the present time, precious few care teams or clinical microsystems are the primary agents of patient-centered clinical care. Like individual care providers, the care team must become more responsive to the needs and preferences of patients and involve them and their families (to the extent they desire) in the design and implementation of care. Even in this simple example, however, and certainly in practice, such independence does not exist. Even in many hospitals, individual departments operate more or less autonomously, creating so-called “silos.” Many physicians practice independently or in small groups, and ambulatory clinics, pharmacies, laboratories, rehabilitation clinics, and other organizations—although part of the delivery system—often act as independent entities. Recent changes in health care policy, reflect an emphasis on “consumer-driven” health care. FIGURE 2-1 Conceptual drawing of a four-level health care system. Do you want to take a quick tour of the OpenBook's features? Harvard Business Review 71(4): 78–91. In any large system that has many subsystems, achieving high operating performance for each subsystem while taking into account the mutual influence of subsystems on each other and on the system as a whole can be a daunting task. One member of the care team must be responsible for ensuring effective communication and coordination between the patient and other members of the care team. The case studies provide practical information on key aspects of the primary care sys… Many industries have attempted to use information/ communications systems in place of manual operations, such as record keeping. Intelligent Enterprise: A Knowledge and Service Based Paradigm for Industry. effective, efficient care encompasses the patient’s medical record, including real-time physiological data; the most up-to-date medical evidence base; and orders in process concerning the patient’s care. Although the federal government, the single largest purchaser of health care services, principal regulator, and major research patron, is, in many ways, best positioned to drive changes in the health care delivery system, some private-sector payer organizations and state governments are better positioned to experiment with new mechanisms and incentives for improving the quality of care and making health care more affordable (see papers by De Parle and Milstein in this volume). This, in turn, requires a model, that is, an abstract representation of how the system operates (a mathematical form that can be used to analyze the system) that includes parameters that determine the performance of each sub-element of the system, as well as descriptions of interactions. These investments must be accompanied by an organizational culture that encourages the development of care teams working with semiautonomous agents/ physicians (see paper by Bohmer in this volume). Also, you can type in a page number and press Enter to go directly to that page in the book. 2003. Because the health care system involves a myriad of interacting elements, it is difficult, or even impossible, for any individual to have a complete picture of the system without using special tools to perform a systems analysis. We encourage transformation teams to test out the framework… The model is a tool for simulating the performance of the actual system. Unfortunately, this procedure rarely, if ever, results in optimization of the entire system. physicians’ contracts) in health care outcomes. But clinical elements are not the only important elements in an analysis. A handful of health care organizations have embraced the systems view (e.g., the Veterans Administration and Kaiser-Permanente Health Care). The availability of information, the, establishment of private health care spending accounts, and other measures reflect an increasing, expectation that patients will drive changes in the system for improved quality, efficiency, and, effectiveness. Each unit must not only achieve high performance but must also recognize the imperative of joining with other units to optimize the performance of the system as a whole. Social determinants of health (SDoH) are the conditions in which people live and work that shape access to essential social and economic resources. However, a deeper understanding invariably involves creating a mathematical description of subsystems, their performance, and their interactions. Understanding and following this framework will enable healthcare organizations to reduce variation in clinical and operational processes to drive sustainable, enterprise-wide cost and quality gains. For example, continuous, real-time communication of a patient’s physiological data to care providers could accelerate the pace of diagnosis and treatment, thereby reducing complications and injuries that might result from delays. Through a holistic understanding of a health system’s building blocks,1 systems thinking identifies where the system succeeds, where it breaks down, and what kinds of integrated approaches will strengthen the overall system and thus assist countries in reaching … With incredible advances in computational speed and capacity and parallel advances in computer software, clinical information and communications systems can provide immediate access to information, including patient-based information (e.g., past laboratory values and current diagnoses and medications), institution-based information (e.g., drug-resistance patterns of various bacteria to different antibiotics), profession-based information (e.g., clinical-practice guidelines, including summaries of recommended best practices in various situations), real-time decision support (e.g., alerts about potential drug interactions or dosing patterns in a patient with a compromised drug-metabolism mechanism), practice-surveillance support (e.g., reminders about upcoming screening tests recommended for a patient), and population health data (e.g., for epidemiological research, disease and biohazard surveillance, notification of post-introduction adverse drug events). Building a learning organization. The experiences of several organizations with impressive outcomes from application of systems approaches can be illustrative on the potential applications of systems tools to 1. design health care operations to assure consistently high performance, such as using safeguards and redundancies, standard and resilient work processes, and elements that account for human factors; 2. develop frameworks for understanding health care structures, processes, and outcomes, along with their relatio… In addition to the care team, a clinical microsystem includes a defined patient population; an information environment that supports the work of professional and family caregivers and patients; and support staff, equipment, and facilities (Nelson et al., 1998). Plume. By providing both a framework and action plan for a systems approach to health care delivery based on a partnership between engineers and health care professionals, Building a Better Delivery System describes opportunities and challenges to harness the power of systems-engineering tools, information technologies and complementary knowledge in social sciences, cognitive sciences and … Health care organizations face many challenges. Moreover, to deliver patient-centered care (i.e., care based on the patient’s needs and preferences), the physician must be equipped and educated to serve as trusted advisor, educator, and counselor, as well as medical expert, and must know how to encourage the patient’s participation in the design and delivery of care. The patient and/or his or her clinician/counselor or family member must also have access to educational, decision-support, information-management, and communication tools that can help them integrate critical information from different sources. A model might also reveal if a different communication system might reduce the required inventory or the best way to assign a nursing staff when 10 percent of the nurses are not available. that supports the development and work of care teams by providing infrastructure and complementary resources; and (4) the political and economic environment (e.g., regulatory, financial, payment regimes, and markets), the conditions under which organizations, care teams, individual patients, and individual care providers operate (see Figure 2-1). As Alan Pritsker, the author of many treatises on large-scale system modeling and simulation, writes, “The system approach is a methodology that seeks to ensure that changes in any part of the system will result in significant improvements in total system performance” (Pritsker, 1990). The framework introduces the notion of care delivery value chains that apply a systems-level analysis to the complex processes and interventions that must occur, across a health-care system and over time, to deliver high-value care for patients with HIV/AIDS and cooccurring conditions, from tuberculosis to … The quality of health care delivered to adults in the United States. From the patient’s perspective, improving the timeliness, convenience, effectiveness, and efficiency of care will require that the patient be interconnected to the health care system. Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. The exponential increase in medical knowledge, the proliferation of medical specialties, and the rising burden of providing chronic care have radically undercut the autonomy of individual physicians and required that they learn to work as part of care teams, either in a single institution/organization or across institutional settings. All processes must be quantitatively described to be included in the model. Integrated, patient-centered, team-based care requires material, managerial, logistical, and technical support that can cross organizational/institutional boundaries—support that is very difficult to provide in a highly fragmented, distributed-care delivery system. The care team, the second level of the health care system, consists of the individual physician and a group of care providers, including health professionals, patients’ family. The goal of this report is to identify existing tools that can be used to address problems and to suggest areas for further exploration. As per general system theory, inputs (patient, nurse and system characteristics) to the Patient Care Delivery Model interact with throughputs (nursing interventions, work environments and environmental complexity) to produce intermediate (staffing levels) and distal outputs (patient, nurse and system … Overall, the role of the patient has changed from a passive recipient of care to a more active participant in care delivery. Pritsker. 1993. Keywords: Urgent and emergency care, Whole systems working, Leadership, Workforce development, Multiple case This report was co-produced with engineers, clinicians, and healthcare leaders, to explore how an engineering approach could be applied in health and social care to develop systems that meet the needs of patients, carers and NHS staff. ), the management of most hospitals faces the challenge of “managing” clinicians, the majority of whom function as “independent agents.”. Most health and medical services today, however, are not delivered by groups or teams. Remote (e.g., in-the-home, on-the-go) monitoring, diagnosis, and treatment would make care much more convenient for patients, save them time, and conceivably improve compliance with care regimes (see paper by Budinger in this volume). Get step-by-step explanations, verified by experts. The fourth and final level of the health care system is the political, economic (or market) environment, which includes regulatory, financial, and payment regimes and entities that influence the structure and performance of health care organizations directly and, through them, all other levels of the system. ), and health care payment/reimbursement regimes that provide little, if any, incentives for health care organizations to invest in non-revenue-generating assets, such as information/ communications technologies and process-management tools. Communication technologies also have the potential to change the nature of the relationship between patient and provider, making it easier for patients to develop and maintain trusting relationships with their clinicians. At the same time, the fragmented delivery system, combined with the growing burden of chronic disease and the need for continuous care, have all but forced many patients to assume an active role in the design, coordination, “production,” and implementation of their care, whether they want to or not. Not a MyNAP member yet? The remainder of this chapter provides a “systems view” of health care and a brief description of the potential role of information/ communications systems. NCBI Bookshelf. Each unit has considerable freedom to set standards of performance and measure itself against metrics of its own choosing. 1. The slow adaptation of individual clinicians to team-based health care has been influenced by several factors, including a lack of formal training in teamwork techniques, a persistent culture of professional autonomy in medicine, and the absence of tools, infrastructure, and incentives to facilitate the change. The fourth step in developing a health system strategy is to outline what health care delivery organizations might look like, again drawing from innovative examples worldwide. State governments, which play a major role in the administration of Medicaid, also influence care systems. framework and to develop standards for an integrated approach to workplace facilitation to grow the capacity of facilitators that can use the workplace as a resource for learning is needed. London adopted one simple maxim in developing delivery models: “decentralize where … Other industries, health care organizations, were initially trained in Medicine or public health also the... 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