Transcript Athens
The Power (and Politics) of Health Buildings
Barrie Dowdeswell Executive Director European Health Property Network
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
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
Performance gradation of case studies, potentially extreme lifecycle variations Performance Perspectives
•
Core business efficacy
• Financial
viability
• Adaptability • Lifecycle cost
profile
• Lifecycle
economic value
TR NIR JP
PFI
N 1 RIK SIT KAR
VAL COXA RK Weak Strong Sustainable ‘business’ effectiveness and efficiency
Five critical dimensions
Evidence-based investment decision-making
Flexible investment strategies – e.g. disinvest to reinvest – and refinancing
Technical knowledge and competency
Politics
Leadership
A new paradigm?
In a future era of economic uncertainty
Growth through redistribution will be critical to resolving and heading off future health inequalities
The dynamics of change – Capital Investment, rapidly increasing community focus Contraction Localised diagnosis & care growth ‘Hospital’ networks Hospitals reconfiguration integration Community facilities
Patients, € and staff are increasingly mobile
Markets and PPPs are often used by Governments to outsource ‘risky’ change
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
COXA
clinical and care / design synergy Capital investment as defining a change in systems and values before ward and diagnostic theatre ward after Theatre check in Recovery / rehab prog Diagnostic programming CPs Coxa Hospital and patient flow, 90+% compliance with care programmes Capital investment designed for whole systems networked integration
Performance Headlines
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
Rhoen Klinikum “
Quality through standardisation & service volumes & new integrated portals / information highways”
A wholly integrated multi-disciplinary model High intensity care Emergency Diagnosis Theatres Hot floor technologies High level care General care Rehab Patient treatment and discharge pathway
Quicker and better community support Community portal Polyclinic
Core principle - integrated, multi-disciplinary, systemised
care pathways & capital investment / design synergy
RK – capital investment value
Public Hospital RK Hospital Average cost per case € 3870 Capital investment element €270 Average cost per case € 2660 Capital investment element €720 Hospitals are ‘recycled’ every ten years – technology as per cost efficiency
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
Capital / Service Synergy vs Dislocation PFI The building, its environment and facility services The clinical, technologies, care and professional services Relationship governed by a contract structure and design set 5 to 7 years prior to commissioning - for 25 / 40 yrs A hospital is a combination of people, technologies, buildings and facilities working together for common benefit A principal aim of PFI has been macro government debt management
The problem is often (?usually) politics and evidence free ideology
Unrealistic populist manifestos
“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’
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 Greve Hopital Calmette LE HAVRE - Personnel en colère
The Key Issue, stating the obvious!
Investing for sustainable value
From - Cost saving and standardised guidelines
To - Lifecycle effectiveness, value and sustainability Integrated capital and revenue budgeting Money People Health impact Politics Clinical process systemisation Adaptable capital assets Redistribution of capital assets is difficult, controversial but critical
Thank You
euhpn.org
European Centre for Health Assets and Architecture, ECHAA