Presentation on theme: "Creating Value and Joy in the Clinical Microsystem"— Presentation transcript:
1 Creating Value and Joy in the Clinical Microsystem Australian Institute of Health InnovationJulie K. Johnson, MSPH, PhDAssociate Professor and Deputy DirectorCentre for Clinical Governance ResearchAustralian Institute of Health InnovationUniversity of New South WalesSydney, Australia29 August 2013
2 Overview of Today’s Session How do we define value in healthcare?Value models and the implications for our workCreating value and joy in the clinical microsystem
3 Value in Healthcare“Achieving high value for patients must become the overarching goal of healthcare delivery”“Rigorous, disciplined measurement and improvement of value is the best way to drive system progress”Porter, M. N ENGL J MED 363: Dec 2010
4 What is value in healthcare? Hint: it’s not just about cutting costs and improving productivityValue is defined as the health outcomes achieved per dollar spentValue should always be defined around the patient’s needsPorter, M. N ENGL J MED 363: Dec 2010
5 How do we measure value?How do we assess whether value is improving over time?
6 A story about creating value and joy in healthcare Christian Farmandiagnosed with renal failure at age 25An athletic man in good shape“It was a big shock for me to get into dialysis.”Farman received a kidney transplant, but in 2005 he was back on dialysis in the Ryhov County Hospital hemodialysis clinic in Jönköping, SwedenHe researched self dialysis and became convinced that if he could manage his own treatment, the side effects would disappearHe spoke with Britt-Mari Banck, a nurse in the clinic. Farman said to her, “You have to help me treat myself – I need to have control in my life.” Source: IHI Annual Report 2012, ihi.org
7 A story about creating value and joy in healthcare Britt-Mari showed Farman how to use the dialysis machine, read and interpret lab results, and document his care in his chartWithin five weeks, Farman was managing his dialysis independently. The side effects decreased.Others wanted to learn to manage their own treatment . . .
8 A story about creating value and joy in healthcare Infection rates fell“We were a community, and we didn’t feel we were sick anymore, because the treatment was so good”Today, nearly 60 percent of the hospital’s dialysis patients are managing their own treatments. The hospital aims to increase that number to 75 percent.Banck says, “It’s a very joyful thing.”
9 Value Models Value Chain Value Shop Value Network Delineates a process Providing effective treatmentValue ShopCreates solutions to problemsMaking the diagnosisValue NetworkFacilitates connectionsLinking patients, healthcare professionals, processes, and the care giving environmentNelson, et al, Value by Design, 2011Stabell and Fjeldstad, Strategic Management Journal, 1998
10 Value Models Chain Shop Network Type of Firm Manufacturing Consultant TelecommunicationValue ElementsComponentsCompetenciesConnectorsDeliversProductSolutionConnectivity
11 Value is defined differently in each model Value chainsThe process works reliably every timeProfessionals prepared to adhere to the processProduce the service in a timely way (efficiency)Value (solution) shopIntensive application of customised knowledgeValue networkCreating and facilitating networksChristenson et al, The Innovator’s Prescription, 2009
12 How is value illustrated in Christian’s story? Christian’s story, and Rhyhov Hospital’s story, illustrates a “value network”What is important in this model?How would you measure value?What would you improve?
13 Value models applied to healthcare The delivery of healthcare is often organised as a “shop”Our current methods of improvement rely on redesigning the process or the “chain”Perhaps the most potential for improvement is to focus on the “network”
14 Lingering questions How do we design for value? How do we evaluate value?Is their a link between value and joy in work?
15 What brings us joy?Study of 41 primary care teams from 37 academic health centres participating in a chronic care improvement collaborativeCollaborative team members asked to describe experiences caring for people with chronic illness and the effect of the improvement collaborative on teams and teamwork1145 narrative entries submittedMembers of teams that achieved highest performance on Collaborative indicators demonstrated an enthusiasm resulting from the work, environment, and interactions which we termed “Joy in Work”Team members from teams that performed lower in collaborative measures, two key themes emerged that reflected the effect of providing care in difficult institutional environments—“lack of professional satisfaction” and awareness of “system failures”Johnson et al, Joys and Challenges in Improving Chronic Illness Care. Jgen Intern Med. Vol 25 (Suppl 4), 2010.
16 Joy in Work Our data suggest Improving specific clinical measures is meaningful for both the healthcare professional and the patientA patient that we have been calling weekly to titrate insulin came today with perfect sugars. She was happy and so were we. We called the nurses in to look at her logbook! It takes a village to take care of a patient. [Physician]
17 Joy in WorkImproved communication among team members and the recognition of non-physician team members contributing to the care of the patient also contribute to joy in workI am responsible for scheduling our diabetic patients for our Chronic Disease Management Visit Clinic... this is such an important task and a lot of our success hinges upon what I do. [Administrative Staff]
18 What next?There are certain experiences that increase professional satisfaction and bring joy in workThe stories our healthcare professionals tell provide a platform for thinking about design and redesign or careHow do we feed these stories back into the improvement process to further enhance professional satisfaction and continue to improve outcomes for our patients?
19 Link Between Value and Joy Improvement in value requiresmeasuring what is important to the patient,teamworkSharing accountability for performanceCooperation among providersAll hard to achieve when we work in departmental silos . . .
20 Clinical MicrosystemSmall group of clinicians and staff working together with a shared clinical purpose to provide care for a defined set of patientsThe clinical purpose defines the essential parts of the microsystemCore team of healthcare professionals and support staffDefined population of patients they care forInformation & information technologyCare processesEquipment, environmentProcesses, activities specific to accomplishing the aim
21 Systems within Systems . . . Self-care SystemIndividual caregiver & patient SystemClinical MicrosystemMacroOrganization SystemCommunity, Market, Social Policy System
22 Where Can You Find a Microsystem? Everywhere!A community based general practiceA cardiac surgery teamA dialysis clinic . . .
23 Microsystems are everywhere; however, some function better than others
24 What Are The Characteristics of High Performing Microsystems? LeadershipOrganizational SupportStaff FocusEducation and TrainingInterdependencePatient FocusCommunity and Market FocusPerformance ResultsProcess ImprovementInformation and Information Technology
25 Why is This Important?The overwhelming amount of the daily work of providing care within a microsystemThe organisational boundaries of the microsystem reflect the appropriate level for measuring and improving value
26 Intersection of Value and Joy in the Clinical Microsystem How do we design for, and evaluate, value and joy?Value should always be defined around the patient’s needsPatients, carers, and family members will have unique insights into the patient experience – we need to ask themWe need to elicit the stories, assumptions, and beliefs that people have about their illness, treatment of their illness, and living with their illnessWe can’t create value without first creating a partnership