Transcript Marginal analysis: a worked example from the mental
Online Learning Series Right Care for Populations How do you innovate when the NHS budget is no longer growing?
Sir Muir Gray Joint National Director, Right Care August 2013 Copyright 2011 Right Care
2
Five major problems
..
..all health services, world wide, still face 5 major problems • • • • • failure to prevent preventable disease inequity patient harm, even when quality is high waste of resources unwarranted variation in: - activity - quality, safety - outcome & cost = value
3 A Paradigm shift is needed…
The third healthcare revolution… 4 Citizens Knowledge Technology …clinicians as “stewards”
5 Triple Value Programme
Individual & Personalised Allocative
resources distributed
Technical
, best effect
6 A New Culture Focus on value Population Based Systems Patient Centred Clinicians as Stewards
Programme Budgeting, & the use of Marginal Analysis for reallocation is a commissioner responsibility, with public involvement 7 Allocating resources - Commisioners Mental Health Cancer Respiratory Gastro intestinal
Complexity and Complications Mental Health Cancers Respiratory Gastro intestinal Many people have more than one problem ; GP’s are skilled in managing complexity 8
Allocating resources - Clinicians Cancers Asthma COPD (Chronic Obstructive Pulmonary Disease) Apnoea 9 Respiratory Within Programme, Gastro instestinal Between System Marginal analysis is a clinician responsibility Triple Drug Smoking Therapy cessation O 2 Rehabilitation
The STAR Tool 10
http://www.health.org.uk/areas-of-work/star/
11 Innovation Cancers Respiratory Gastro instestinal Asthma COPD (Chronic Obstructive Pulmonary Disease) Apnoea Triple Drug Therapy O 2 Smoking cessation Rehabilitation
12 Technical efficiency
Value = Outcomes / Costs Outcome = Good – Bad
Outcome = Effectiveness (EBM + Quality) – Harm (Safety)
Costs = Money + time + Carbon
13 The future • Need and demand will always increase faster than resources • More of the same is not the answer – we need innovations# • Programme Budgeting • Within Programmes – Marginal Analysis • Clinicians and patients as “stewards” of the resource • Innovation, not only in technology, but in the way we think
14
Online Learning Series Right Care for Populations Find the full series at:
www.rightcare.nhs.uk/resourcecentre • • •
Follow Right Care online
Subscribe to get a weekly digest of our blog alerts in your inbox, Receive occasional eBulletins Follow us on Twitter @qipprightcare