DEVELOP INTEGRATED SYSTEMS, NETWORKS AND PATHWAYS
The 20th century was the century of the hospital and the hierarchy; the 21st century is the century of the system and the network.
I can't remember when I first heard about systems but my copy of General System Theory by Ludwig von Bertalanffy ( two f’s in bertalanffy please) is inscribed ‘bought with a book token give for a talk to Oxfordshire community dietitians – 1977'. What the talk was about I cannot remember, and neither could they I am sure, but the book has been a lasting influence. In 1983 in the midst of our last lean times I published an article in the Lancet called ‘Four Box healthcare; development in a time of zero growth’ (1) which proposed that all services should be planned on the basis of health problems such as ‘diabetes, osteoarthritis, Parkinson’s disease, menstrual disorders…asthma and the process of dying’. Thirty-five years on the time for systems has arrived.
The horizontal arrangement of healthcare into primary, secondary and tertiary care is no longer useful or fiscally prudent. It creates an environment where it is all too easy to focus on bureaucracy and empire building at the cost of recognising the patient and clinician as decision-makers capable of assessing the most relevant quality of care for their needs. We must move from a service in which institutions are the dominant type of organisation to one in which systems dominate, a system being a set of activities:
- with a common set of objectives
- to measure progress towards each objectives
- with outcomes of relevance to patients and
- with a set of standards against which the service can measure progress
A systems approach to healthcare recognises the vital importance of self-care and informal care. It provides a vehicle to better address the misdistribution of patients throughout the primary, secondary and tertiary systems. It can answer the currently unanswerable question of “How much money do we spend on our core business?” where the core business of healthcare consists of presentations such as chest pain and conditions such as depression and asthma. Some now call such designs Accountable Care Organisations
Systems are delivered by networks. The 20th century was the century of the hospital and the bureaucracy: the 21st century is the century of the system and the network, and the pathway is the route that patients usually follow through the pathway.
Systems and programmes with budgets to maximise value
Our programme, handbook and other interventions that help professionals
and patients develop systems also include the need to focus not only on quality and safety, but also on value. We emphasise the need to look for unwarranted variation, and when working for the Department of Health, played a key role in the production of the first NHS Atlas of Variation - based on the great work of Jack Wennberg and his team at Dartmouth. We also introduce the need for budgets that relate to systems, such as systems for asthma and Chronic Obstructive Pulmonary Disease, and programmes, such as the Lung Disease programme - a programme being a set of systems with a common knowledge base and a common budget. This method of finance management relates the outcomes to the costs.
The Systems Programme
This is an online development programme that equips you with the knowledge and skills to build and strengthen systems of care. The programme has a series of practical activities that allow you to practice the steps necessary in creating systems of care. Action Learning sets ensure you get the most from the content and support you in your efforts to:
- Set standards and decide on
objectives
- Choose valid, feasible criteria
- Create sustainable clinical networks to deliver
your systems of care
- Convince clinicians that using
systems will improve rather than diminish their status
Support is tailored to match your unique needs to make sure you get the maximum impact from the programme.
Try our eLearning demo at http://www.ocht-systems.net.
How to Build Healthcare Systems
This handbook, which will be available on paper and on Kindle, is one of our set of How To Handbooks.
Complementing Bureaucratic Authority with Sapiential Authority
Systems and networks are knowledg-based organisations. There may be some contractual relationships but it is knowledge that gives those who have to lead and change systems their authority, a type of authority called sapiential authority. The effective management of knowledge is a solution that allows systems to flourish.
