Women’s Heart Health: Management challenges involved in organising and delivering effective services European Health Forum in Gastein 7 October 2004 Dr Naomi Chambers Senior Fellow in Health Services Management Centre for Public Policy and Management Manchester Business School University of Manchester United Kingdom

Summary Complexity of the task 2 initiatives from English NHS Limitations of current provision Need for a strategic approach Characteristics of a woman-centred service Ways forward

Complexity of the task CVD = single biggest killer of women Access problems in relation to primary & secondary prevention, treatment & rehabilitation Services cross many institutional & professional boundaries Low profile for women and health professionals; other health and caring priorities predominate

English NHS(1) : National Service Framework for CHD 12 national standards to ensure consistent standards of care across the country Standards describe service models, policies and targets to reduce heart disease in general population, improve prevention in high risk groups, promptness of investigations & treatments New GP contract provides financial incentives to family practitioners to implement National Service Framework

English NHS (2) : collaboratives & networks CHD collaborative programmes use health improvement science methodologies/service redesign tools and techniques Cardiac networks bring together clinicians and others working in different parts of the local NHS to implement improvements in services looking at care pathways/patient journeys

Limitations of current provision Some levelling up of quality and significant improvements in waits BUT Older women still substantially at risk : 1/5 with CVD; 1/2 raised BP; 1/4 obese Older women with CVD : 1/3 raised BP; <1/2 on antiplatelet drugs; < 1/4 on statins Huge workload consequences ( Lawlor, 2003)

Limitations of current provision (cont’d) Implications of medical and nursing workforce shortages Shorter lengths of stay > intensivity of work Task rather than patient focussed Health messages not communicated Lack of cultural, situational and gender related sensitivity in delivery of service Women’s needs not being met

Strategic Approach Pettigrew (1993) argues that successful strategic change can be linked to : 1. Positive, long term external pressure 2. Organisations supportive of change 3. Co-operative inter-organisational networks 4. Simplicity and clarity of goals and objectives Hodginson & Sparrow (2003) argue that strategic competence relies on balancing organisational learning & memory, intuition & insight and beliefs of key stakeholders about strategy

Characteristics of a woman- centred service Clear goals, objectives and targets Champions Evidence-based practice Care navigation using case management methods in partnership with women Continuous learning from experiences of women and health professionals

Ways forward on a European level Monitoring of CVD in women ( eg EUROCISS ) Case studies of best practice Further gender-related research Country specific targets Challenge to accepted practices which fail to deliver