• We’re entering a new era in the NHS where there is “NO MORE MONEY“

@19min: describes “three big businesses in respiratory disease – asthma, COPD, apnoea”

• Value = Outcomes / Costs
• Outcome = Effectiveness (EBM+Quality) – Harm (Safety)
• Costs = Money + Time + Carbon

@22mins: moving from guideline care to personalised care

@26mins: Bureaucracy is important and necessary, but should stick to what it’s good at doing:

1. The fair and open employment and promotion of people
2. The un-corrupt management of money
3. !! Not the curing of disease or delivery of health care – populations defined by need, not jurisdiction

@32mins: law of diminishing returns – benefits plateau as invested resources rise

@33mins: Harmful effects of healthcare increase in direct proportion to the resources invested

@34mins: combine the 2 curves – get a j-shaped curve with a point of optimality – the point of investment after which, the health gain may start to decline

@35mins: as the rate of intervention in the population increases, the balance of benefit and harm also changes for the individual patient

@37mins: value spectrum

[HIGH VALUE]
– necessary
– appropriate
[LOW VALUE]
– inappropriate
– futile
[NEGATIVE VALUE]

@39mins: The Payers’ Archipelago

20th Century Care >> 21st Century Care
Doctor >> Patient
Bureaucracy >> Network
Institutions >> Systems

@42mins: clinicians responsible for whole populations, not just the patients in front of them

@45mins: How to start a revolution
– change the culture – destabilise and constrain; control language
– engage patients and citizens, and the future leaders of 2033
– structure doesn’t matter (5%)
– systems (40%)
– culture or mindset (50%)

@46mins: Culture – the shared tacit assumptions of a group that it has learned in coping with external threats and dealing with internal relationships” Schein (1999) The Corporate Culture Survival Guide

@47mins50s: data doesn’t change the world, emotion changes the world
– atlases written for OMG effect
– programme budgeting

destabilise then constrain then change the language

@49mins: MUDA means waste — resource consumption that doesn’t contribute to the outcome. motonai – the feeling of regret that resources are being wasted. ban old language.

@51mins: mandatory training in new thinking

The Third Healthcare Revolution is already underway
1. PHONE
2. CITIZENS
3. KNOWLEDGE

The third healthcare revolution will come out of the barrel of a smartphone

@56mins: Healthcare is too complex to be run by bureaucracies or markets. Work like an ant colony – neither markets nor bureaucracies can solve the challenges of complexity.

 

PDF: Sir-Muir-Gray-Masterclass-presentation-1-Oct-2013

ASQHC Presentation link: http://www.safetyandquality.gov.au/our-work/medical-practice-variation/presentations/