Across member countries of Organisation for Economic Co-operation and Development (OECD) a significant share of healthcare system spending and activities are wasteful at best, and harmful to our ...health at worst.1 By way of example OECD cites, 11.7% of visits to emergency departments (EDs) in England and 31.3% in Portugal are identified as ‘inappropriate’—resulting in the misappropriation of scarce healthcare resources and the inappropriate use of patient time (many of whom could have been more appropriately treated in primary care, without the need for a visit to an ED). ...the continuation of provision of some imaging, therapeutic and surgical procedures on an inpatient as opposed to outpatient basis further contributes to the ‘wasteful’ utilisation of expensive resources and inappropriate patient admissions, when such interventions could be carried out in other settings. The Leadership Alliance estimate that US$6.2b alone could be ‘paid back’ associated with preventable hospital-acquired infections.3 4 Step 3: creating a strategic framework for removing non-value-added waste The Leadership Alliance frame their aim of ‘Systematically and proactively identifying and eliminating 50% of non-value added waste in the US health care system by 2025’. The results demonstrated evidence of the suboptimal use of medicines as a contributory factor to avoidable hospital admissions—with pharmacy team input reducing patient length of stay by 2 days and readmission within 30 days by 10%; avoiding a £825 cost per patient.6 A second example was illustrated by the scaling up evidence-based practice with regard to an end of life (EoL) care model, which showed that patients who experienced the model had 50% fewer inpatient admissions, a 2.2-day reduced length of stay, a 20% lower presentation rate at the ED.
Pursuing the Triple Aim Bisognano, Maureen; Kenney, Charles
2012, 2012/01/01, 2012-03-15
eBook
Written by the President and CEO of the Institute for Healthcare Improvement (IHI) and a leading health care journalist, this groundbreaking book examines how leading organizations in the United ...States are pursuing the Triple Aim—improving the individual experience of care, improving the health of populations, and reducing the per capita cost of care.Even with major steps forward – including the Affordable Care Act and the creation of the Center for Medicare and Medicaid Innovation -- the national health care debate is too often poisoned by negativity. A quieter, more thoughtful, and vastly more constructive conversation continues among health care leaders and professionals throughout the country. Innovative solutions are being designed and implemented at the local level, and countless health care organizations are demonstrating breakthrough remedies to some of the toughest and most expensive challenges in health care.Pursuing the Triple Aimshares compelling stories that are emerging in locations ranging from Pittsburgh to Seattle, from Boston to Oakland, focused on topics including improving quality and lowering costs in primary care; setting challenging goals to control chronic disease with notable outcomes; leveraging employer buying power to improve quality, reduce waste, and drive down cost; paying for care under an innovative contract that compensates for quality rather than quantity; and much more. The authors describe these innovations in detail, and show the way toward a health care system for the nation that improves the experience and quality of care while at the same time controlling costs.As the Triple Aim moves from being largely an aspirational framework to something that communities all across the US can implement and learn from, its potential to become a touchstone for the work ahead has never been greater. Pursuing the Triple Aimlays out the vision, the interventions, and promising examples of success.
A major issue for the US health care system will be accommodating the needs of the estimated thirty-two million Americans who will gain insurance coverage under the Affordable Care Act by 2019. For ...hospitals, a traditional response to this increased demand might be to add resources, such as more staff and beds. We argue that such actions would be unaffordable and unnecessary. Research has demonstrated that large gains in efficiency can be made through streamlining patient flow and redesigning care processes. We argue that once managed efficiently, US hospitals, on average, could achieve at least an 80-90 percent bed occupancy rate--at least 15 percent higher than the current level--without adding beds at capital costs of approximately $1 million per bed. This article outlines a plan for hospitals to accommodate more patients without increasing beds or staff, and for policy makers to require hospitals to make these changes or provide incentives for them to do so.
Understanding how small unexpected acts or gestures by healthcare professionals, known as Mangomoments, are translated into practice, what their preconditions are and what their impact is on patients ...and families, healthcare professionals and organisations.
A multi-method design was used based on four phases: (1) A (media)campaign to collect Mangomoment stories (n=1045), of which 94% (n=983) were defined as Mangomoments; (2) Semi-structured interviews (n=120); (3) Focus group interviews (n=3); and (4) A consensus meeting.
Respondents from a hospital and primary care setting.
Patients, family, healthcare professionals, managers, researchers and a policymaker participated.
Mangomoments are mainly classified in the dimensions 'Respect for values, preferences and needs' and 'Emotional support'. Differences in importance of the dimensions were found between healthcare professionals, oncological patients and family and non-oncological patients and family. The results of the interviews, focus groups and consensus meeting were visualised by the Mangomoment model. It identifies several preconditions on the level of patients, healthcare professionals and leadership. For each of these preconditions a catalyst was identified to increase the prevalence of Mangomoments. In general, Mangomoments improved the patient and family experience and facilitated adherence to therapy and led to a positive perception on the healing process. Positive effects for professionals include personal accomplishment and anti-burnout, joy in work and a positive team atmosphere. This led to positive resonance by a relationship of trust between the patient and the healthcare professionals, feelings of tolerance during negative experiences and open communication and a safe climate. Overall, patients and healthcare workers concluded that Mangomoments led to loyalty to the healthcare organisation.
Mangomoments do not only have a positive impact on patient and family but also on the healthcare professional. Leadership should shape several preconditions and catalysts which can lead to positive resonance and loyalty of patients and professionals.
Healthcare is in an unprecedented time of change. Our aging population experiences more chronic disease. The rapid expansion of technology and AI learning in diagnostics and care offer opportunities ...to think and care in new ways. We are learning from an unprecedented amount and speed of research production. Spreading new models of care quickly and reliably is on the agenda for all senior leaders. We have more diversity in the workforce, with five distinct generations for the first time in history. And increasingly, patients will be co-designers in the health and care. Our work today clearly needs innovations and new ways to think about health and care.
Leading the nursing profession today is a challenging and rewarding opportunity. We see great challenges in the pace and breadth of change; today, change happens at a breathtaking pace, with new ...technology and data systems, new procedures and equipment, new research and guidelines, and changing patient and staff expectations. But the work is incredibly rewarding. Nurses are leading in new ways, at new sites of care, and in ways I never contemplated when I began my career as a nursing leader many years ago.
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