May 122015
 
Paul Gimson

Paul Gimson

It was a real privilege to be able to represent 1000 Lives Improvement and Public Health Wales at the 2015 Quality Forum this year.

I expected many things when I went along to but learning a new word was not one of them. The word was ‘Exnovate’ and it was used by Maureen Bisognano, the CEO of the Institute for Healthcare Improvement (IHI), to highlight the real need for healthcare systems across the word to do less of what isn’t important or needed. It chimed with those of us there from Wales because of its similarities with our own prudent healthcare principle of ‘Do Only What is Needed and Do no Harm.’ The issue of over diagnosis and overtreatment was a theme of many of the sessions within the conference and so it was nice to be able to feedback to Wales that the work we are doing here on prudency is not only ground breaking but it is of international significance.

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Dec 312014
 
Andrew Cooper

Andrew Cooper

Over the last year, members of the 1000 Lives Improvement team – along with guest bloggers – have been sharing their reflections and views on a wide range of subjects related to improving healthcare.

If you’ve joined us over the last twelve months, you’ll have read posts exploring how primary care is delivered in Alaska, found out about the impressive work celebrated at this year’s NHS Wales Awards and discovered that Mr Potato Head can teach you more about PDSA cycles than you thought possible.

As 2014 draws to a close, we thought we’d share with you the top five most read posts of the year – and give you the opportunity to catch up on any you may have missed!

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Nov 182014
 
Mike Spencer

Mike Spencer

Sarah Puntoni

Sarah Puntoni

Prudent healthcare challenges us to ‘remodel the relationship between user and provider on the basis of co-production’. However co-production is a concept that is often thought of in the context of service (re-)design, rather than in clinical consultations.

So how can co-production work in one to one interactions? Co-production is an approach to public services based on equal and reciprocal relationships between professionals, people using services, their families and their communities.  These are the same relationships that need to be in place to deliver person centred care through shared decision making and self management support. So, if we are able to support our service users to take a more active and confident role in managing their health and conditions, we will be nearer to achieving a prudent approach to healthcare.

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Nov 182014
 
Dr Alan Willson

Dr Alan Willson

I agree with the aims of prudent healthcare – I have yet to find anyone who doesn’t.

While the pre-election arms race between Westminster politicians is about promising extra money for the NHS, how much more useful to ask how we are spending what we have. When we ask that, like health systems all over the world, we find we could do much better AND that the result could be better care.

The more interesting question is “how?”. As Richard Bohmer says in his book Designing Care: “the work of care and the operating systems that support that work must be explicitly designed for that purpose and not just left to accrete by chance and happenstance”.

My recent experience of cardiac care at Morriston Hospital showed how a well defined pathway allows the many providers and individual receivers of care to play their part. Porters, cardiologists, A&E staff, nurses, technicians, GPs and physiotherapists were all confident and expert enough to support one another, take a pride in their contribution and to ensure that my experience was one of prudent healthcare.

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Oct 282014
 

Where do I start? Experiential learning seems a good place to begin, and being a part of theAngela Williams Improving Quality Together (IQT) Silver workshop sessions for educators in improvement organised by 1000 Lives Improvement earlier this year made me realise how good it is to undertake an improvement project myself. For all attendees choosing an ‘improvement’ project, it wasn’t as simple as first envisaged. A familiar situation for many students!

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Oct 102014
 

Peter Bradley

Professor Peter Bradley


Making prudent healthcare happen is a new website that was launched this week at the Welsh Public Health conference. It is an important online resource for everyone who works in NHS Wales, and everyone who relies on NHS Wales services, because it gets under the skin of ‘prudent healthcare’ and explores ways we can deliver better care and better outcomes.

Prudent healthcare has a central emphasis on outcomes – the results of what we do. We need to have a hard look at everything we offer as healthcare professionals and across all our support functions in NHS Wales. The question we need to ask is ‘Do we deliver high quality, good value services?’ And if we don’t know the answer, we must try and find out.

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Jul 012014
 

PeteStraw Image1A beautiful, sunny Llandudno greeted us on our arrival at the highly-anticipated 1000 Lives Improvement National Learning Event, a fantastic opportunity for healthcare practitioners and students to meet and discuss the notion of prudent healthcare and quality improvement within the NHS in Wales.

Welcome coffee and pastries lined the stomach for the launch session delivered by Professor Matthew Makin (Medical Director, BCUHB) and Dr Alan Wilson (Director, 1000 Lives Improvement), who introduced the concept of prudent healthcare – built on the three pillars of reducing avoidable harm, appropriately minimising intervention, and promoting co-production of health between service users and providers.

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Jun 092014
 
Marcus Longley

Marcus Longley

Prudent healthcare is a big idea, or it is nothing.

But big ideas are not always welcome in public policy – they tend to disrupt ‘business as usual’. While we are spending our precious, finite thinking time on what the big idea really means, we might just neglect all those other equally vital, but more pressing, objectives, like safer care and balancing the books… And anyway, big ideas come and go, don’t they?

Public services know how to deal with latest Ministerial big ideas. The time-honoured approach is to thank the Minister profusely for providing vital new direction and insight, talk about it a lot in conferences organised for that purpose, include the new catch-phrases in every possible document… then re-badge all the things you were doing already using the new label, and get back to the day job.

But before health boards and trusts kill off prudent healthcare in this way, let’s just recognise that its three key planks cannot just be swallowed up into business as usual.

First, a prudent healthcare system will really empower people to maximise their own wellbeing, often recognising that that there are no clinical fixes. Chronic conditions are often, by definition, incurable, and good healthcare is about helping people to minimise their impact on what matters most to them in their lives. So people with chronic conditions – most of our patients – should routinely be offered a wide menu of support, from information and skills training, to individual and peer group support, often provided by the third sector, so that they can find things which work for them. Choice and diversity here are vital – one size will not fit all.

Second, when it comes to clinical intervention, prudent healthcare depends on patients really choosing what’s best for them. That means finding new ways of supporting patients really to think through what would be best for them, and creating the expectation that they will often say “No”.  And if they say “No”, we have to have alternatives to offer them (see above).

Third, it means re-defining what good care means. Under prudent healthcare, the key issue is what patients think about their care, not as they leave the hospital, but months down the line. A perfect operation which the patient wishes they hadn’t had two years later, is a huge waste of time and effort, on so many counts.

So … All we need, then, is a whole new swathe of non-clinical service provision, supported but not provided by the NHS; a re-thinking of the clinical encounter, with new systems to support that; and a new way of measuring our performance, with patient-defined and reported outcome measures routinely collected and compared on thousands of clinical interventions.

That’s not ‘business as usual’.

We need to hear the managerial squealing of brakes across NHS Wales, as our leaders realise that this is big change, fit for a big idea, requiring a new direction.

For further information, read Achieving prudent healthcare in NHS Wales or visit the prudent healthcare section of the 1000 Lives Improvement  website.

Marcus Longley is Director of the Welsh Institute for Health and Social Care and Professor of Applied Health Policy

Jun 092014
 

 

Professor Peter Bradley

Professor Peter Bradley

Achieving prudent healthcare in NHS Wales is a new paper published by Public Health Wales which outlines the findings of four workshops set up to test ‘prudent healthcare’ in the real world. 

What is prudent healthcare? The Minister has defined it as, “Healthcare that fits the needs and circumstances of patients and actively avoids wasteful care that is not to the patient’s benefit.” In practice this looks like safe, effective care delivered without delays. I think we’d all agree we would like to be guaranteed healthcare like that.

In the paper, we have summarised the principles of prudent healthcare as:

  • Minimise avoidable harm.
  • Carry out the minimum appropriate intervention.
  • Promote equity between the people who provide and use services.

The workshops raised several points of interest, but there was general agreement form the staff and service users present that the current system’s faults and occasional failings could be fixed by applying these principles.

The third one is key to successfully applying these principles. We know that when people are involved in their healthcare, and are given complete information and genuine choice, they often choose the less risky options, which usually are the least expensive. For example, if we advise people about pharmaceutical side-effects, they are more likely to want to try changing their lifestyle rather than being prescribed medicines.

The workshops also looked at some specific questions:

  1. What happens now that does harm or little good?
  2. What happens now in an expensive way, which could be done in a more cost effective way?
  3. What would the pathway look like if organised around the minimum intervention principle?

There are huge gains to be made in quality, improved patient outcomes and cost-effectiveness from reducing delays in the system. We sometimes automatically put people through the system because we are set up to deliver certain treatments or interventions rather than offering people a lower level of intervention that would be of equal benefit to them, and possibly more!

The perspective of the people who use our services is vital. They can alert us to delays and wastage in the system and have an equal role to play in ensuring they receive the treatment that is right for them. We have to learn to listen and involve them more. The future of our health service depends on it.

For further information, read Achieving prudent healthcare in NHS Wales or visit the prudent healthcare section of the 1000 Lives Improvement website.

Dr Peter Bradley is the director of Public Health Development in Public Health Wales. Follow Peter on Twitter @pbradley1965

May 022014
 
Mike Davidge

Mike Davidge

When Don Berwick features the Dalai Lama in a keynote presentation, you know something is going on.  When he compounds that by linking health to an 18th century British clockmaker and talks about being kind to one another and the benefits of charity giving, you might be forgiven for thinking he’d sort of lost the plot.

Well maybe except for two things.  Firstly, it was his delivery.  The keynote was delivered in his very understated style.  Those reassuring East Coast tones lend gravitas and are so reminiscent of Alastair Cooke – not the England cricket captain but the BBC’s long time US correspondent – and his Letters from America.  We trust this man not to lead us astray. Continue reading »