Presentation is loading. Please wait.

Presentation is loading. Please wait.

The Power (and Politics) of Health Buildings Barrie Dowdeswell Executive Director European Health Property Network.

Similar presentations

Presentation on theme: "The Power (and Politics) of Health Buildings Barrie Dowdeswell Executive Director European Health Property Network."— Presentation transcript:

1 The Power (and Politics) of Health Buildings Barrie Dowdeswell Executive Director European Health Property Network

2 OECD OECD societies are healthier than ever, spend more on health care - but health inequalities and variances persist The question is simple: is the rise in costs affordable and are health care systems becoming more efficient and delivering more value for money? Key priorities, are:  Overcoming health inequalities  Managing demographic & epidemiological transitions  Delivering sustainable value

3 The need for a better ‘Capital Asset’ evidence base to plan for the future A Pan-European Evaluation of Capital Investment Strategies:  The European “Fit for Purpose Capital Study”  EuHPN / European Observatory as partners  14 case studies  Thematic analysis across 12 dimensions of process and effectiveness  First results now - publication early 2009 Capital - as a catalyst for change Capital - as responding to change Capital - as a defining value in healthcare

4 Performance gradation of case studies, potentially extreme lifecycle variations PFI TR NIR COXA RK VAL N 1 SIT JP Sustainable ‘business’ effectiveness and efficiency ‘Design excellence’ RIK Performance Perspectives Core business efficacy Financial viability Adaptability Lifecycle cost profile Lifecycle economic value Weak Strong KAR

5 Five critical dimensions  Evidence-based investment decision-making  Flexible investment strategies – e.g. disinvest to reinvest – and refinancing  Technical knowledge and competency  Politics  Leadership

6 A new paradigm?  In a future era of economic uncertainty  Growth through redistribution will be critical to resolving and heading off future health inequalities

7 The dynamics of change – Capital Investment, rapidly increasing community focus Localised diagnosis & care Community facilities Hospitals Patients, € and staff are increasingly mobile Contraction growth ‘Hospital’ networks reconfiguration integration Technical dimensions Societal and efficacy dimensions Markets and PPPs are often used by Governments to outsource ‘risky’ change

8 Facilitating health reform, whole systems efficacy: towards a new investment balance Institutional technical efficiency Trajectory of reform A political, professional & cultural barrier to change Systems efficiency Disease pathway frameworks Allocative efficiency Evidence-based resource reallocation Disease / Service Model efficacy We are now squeezing the balloon We are now squeezing the balloon

9 COXA clinical and care / design synergy Capital investment as defining a change in systems and values CPs Theatre check in Diagnostic programming Recovery / rehab prog before after theatre ward and diagnosticward Coxa Hospital and patient flow, 90+% compliance with care programmes Capital investment designed for whole systems networked integration

10  Activity – from 1,500 to 3,500  Systems – 70% patients discharged to PC  Structures – wholly integrated regional model  Quality - complication (infection) rates <.1%  Cost – 10% price reduction for 2008 Performance Headlines

11 Rhoen Klinikum “Quality through standardisation & service volumes & new integrated portals / information highways” Emergency Diagnosis Theatres Hot floor technologies High intensity care High level care General care Rehab Patient treatment and discharge pathway Community portal Polyclinic Quicker and better community support A wholly integrated multi-disciplinary model Core principle - integrated, multi-disciplinary, systemised care pathways & capital investment / design synergy

12 RK – capital investment value Public Hospital Average cost per case € 3870 Capital investment element €270 RK Hospital Average cost per case € 2660 Capital investment element €720 Hospitals are ‘recycled’ every ten years – technology as per cost efficiency

13 The capital investment and planning conflict in Europe  Service outcome evidence Benefits of integrated care pathway models of care  Capital investment outcome evidence Benefits of technically competent - care pathway shaped - planning, design, financing and procurement  Ideological trends Towards market led episode delivery strategies The flight to PPPs, but ----- rarely evidence based

14 Capital / Service Synergy vs Dislocation The building, its environment and facility services The clinical, technologies, care and professional services PFI A hospital is a combination of people, technologies, buildings and facilities working together for common benefit Relationship governed by a contract structure and design set 5 to 7 years prior to commissioning - for 25 / 40 yrs A principal aim of PFI has been macro government debt management

15 The problem is often (?usually) politics and evidence free ideology  Unrealistic populist manifestos “More beds / more hospitals” “More beds / more hospitals”  Emphasis on mid-term ‘apparent’ success / progress An obsession with targets Gestures – was the NHS ‘deep clean’ really relevant  Service / capital change dissonance - re time scales  The hidden hand of Treasuries Economic rationalism Aversion to planning beyond parliamentary cycles Politics can ‘block the view’

16 Candelit vigil as hospital protest grows Farce as junior health minister joins protest against NHS closures Protests over Irish hospital closure plan Tuesday 18th December Cabinet member joining hospital protest 'just doing my job as MP' Blears accused of hypocrisy after joining protest over hospital closure Protest over closure of cancer services at hospital Doctors threaten to quit Government ignoring public on polyclinics – Lib Dems Million protest as surgeries make way for the polyclinics Health Warning - Fixed Assets are classically used as a defence mechanism against change Greve Hopital Calmette LE HAVRE - Personnel en colère

17 The Key Issue, stating the obvious! Investing for sustainable value  From - Cost saving and standardised guidelines  To - Lifecycle effectiveness, value and sustainability Health impact Clinical process systemisation Adaptable capital assets Integrated capital and revenue budgeting Money PeoplePolitics Redistribution of capital assets is difficult, controversial but critical

18 Thank You    European Centre for Health Assets and Architecture, ECHAA

Download ppt "The Power (and Politics) of Health Buildings Barrie Dowdeswell Executive Director European Health Property Network."

Similar presentations

Ads by Google