The clinical advances of the last fifty years have led to dramatic increases in life expectancy and years of life free from disability. However even after two decades of evidence based decision making, guideline production and explicit focus on quality and safety every country on earth still faces still five outstanding problems:
The first is massive unknown and unwarranted variation, with unwarranted variation being defined by Jack Wennberg as “variation in utilization of health care services that cannot be explained by variation in patient illness or patient preferences” . These variations reveal four other problems that can be observed:
patient harm, from over diagnosis and over treatment, even when the quality of care is high
inequity, from underuse of high value health services by certain social groups
waste, that is anything that does not add value to the outcome for patients or uses resources that could give greater value if used for another group of patients
failure to prevent the diseases that healthcare can prevent stroke in atrial fibrillation for example.
In addition every health service faces the new challenges of rising need and demand, which in most countries will increase faster than the resources available. They will therefore not be able to be solved by the injection of more money, in part because there is no more money, inpart because they have developed and persisted in an era of growth in investment that will never be repeated. Money is not the solution. Neither will they be solved by technology. Some new technology will mitigate them but other technology will aggravate them and the will certainly not be solved by structural reorganization they need a new paradigm. Bureaucracies are necessary but not sufficient, to cope with the challenge of complexity we need a non linear, not a linear response.
The aim is triple VALUE and achiving the aim requires four new types of intervention.
The bureaucratic approach is necessary but insuffient to meet the challenge of complexity. New measures are needed to achieve high value population and personalised care.
Better Value Healthcare is a registered company limited by guarantee in England & Wales No. 06533986. Registered office at 18-32 Summertown Pavilion, Middle Way, Oxford OX2 7LG.