Using the power of variation to transform care
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The document discusses the challenges of unwarranted variation in healthcare within the NHS, emphasizing the need for a coordinated approach to reduce this variation and improve patient care. It highlights various reports and frameworks calling for action to enhance value and focus on population health rather than traditional service models. Ultimately, the document advocates for transforming care delivery by prioritizing patient needs and optimizing resource allocation to foster better health outcomes.
Using the power of variation to transform care
- 1. Using the Power of Variation to Transform Care Michelle Mello Deputy National Director NHS RightCare Phil DaSilva Co Founder NHS RightCare
- 2. A postcard from Anytown CCG Dear All As nurses we know there is no new money – yet we try hard to find some, thinking that is the answer to our financial problems and fragmented care- we often think more is better. We believe that all the service s we provide are of high quality and all are needed, but we also being told they are no longer affordable and we constantly reorganise the services around our teams and organisations, not always the need of our population..…. ….WISH YOU WERE HERE ?? Patients and Visitors Some Town Population Anytown Trust England
- 3. Variation – ‘It’s just a buzzword’ Variation is not a new phenomenon – it has been highlighted as an issue since the beginning of the NHS in 1948… indeed it has been around since Glover’s seminal paper in 1938… … but it continues to puzzle policy makers, politicians, professionals and our patients and has been highlighted, yet again, in 4 key documents with a call for the NHS to take action to identify and reduce unwarranted variation.
- 4. Variation in Healthcare The prevalence of variation is well documented. Not all variation is bad. Some variation is inevitable, as well as random, and perhaps an outcome of innovation and improvement, which are essential pillars of a modern health care system. However much of the observed variation is unwarranted. Variation in the differences in care (costs, activity or outcomes) which cannot be explained by public health needs or patient needs and is often a result of clinicians, managers or whole organisations simply doing things differently, often based on historical patterns of care and local preferences.
- 5. The Context Health systems across the world are rising to the challenge, many backed up through the development of a centre, or alliance, between state partners to drive this agenda. In England, beyond the NHS England “RightCare” programme, there is little coordination, creation of knowledge, training or sharing of good practice between organisations and no clear systematic approach to addressing unwarranted variation. There is opportunity, and need, to go further, including in co-ordinating and understanding where the best impact can be gained through the application of national, technical, political and regulatory drivers to enable the system to reduce unwarranted variation. The solution requires a focal point where knowledge and wisdom can be harnessed and shared.
- 6. Addressing Variation – more calls for action The NHS E document ‘the 5 year Forward View’ www.england.nhs.uk/ourwork/futurenhs/ The PHE strategy document ‘From Evidence to Practice’ www.gov.uk/government/publications/from-evidence-into-action-opportunities- to-protect-and-improve-the-nations-health The Carter review – declaring that NHS Providers take decisive action to reduce unwarranted variation www.gov.uk/government/news/review-shows-how-nhs-hospitals-can-save- money-and-improve-care Leading Change, Adding Value a framework for nurses, midwives and care staff * www.england.nhs.uk/wp-content/uploads/2016/05/nursing-framework.pdf
- 7. Looking for unwarranted variation Population Focus Referred Patients Most in need Most seen
- 8. Exploring variation When faced with variation data, don’t ask: How can I justify or explain away this variation ? Instead ask: “Does this variation present an opportunity to improve ?”
- 9. Awareness is the first step If the existence of clinical and financial variation is unknown, the debate about whether it is unwarranted cannot take place.
- 10. 10 First Atlas 2010 34 maps of variation 11 disease areas Series now covers 7 themed Atlases & 3 Compendium (2015)
- 11. 11 Some useful Tools to Help Awareness is the first important step in addressing unwarranted variation; if the existence of variation is unknown, the debate about whether it is unwarranted cannot take place Shared Decision Making: 36 PDAs 27 pieces of surgical commissioning Guidance with FSSA and RCS 211 CfV packs & Pathways on a Page
- 12. Stroke Care Stroke is the third biggest cause of death and single biggest cause of adult disability in England As with all NHS services, there are significant variations in the quality of stroke care across the country
- 13. Some Questions to Consider • How much do we spend on stroke care? • Do we know if the care is better in Northampton, Nottingham or Newcastle – is it equitable? • How much do we allocate to preventative Care? • How many admissions for stroke did we have last year? • How much waste and duplication is there in the system? • How can we release funds and direct them to better value health care? Why don’t we know?...
- 14. LOWER VALUE = BUREAUCRACY BASED CARE HIGHER VALUE = PERSONALISED AND POPULATION BASED CARE Design and Deliver Care through Systems – not organisations Develop clinical focus on populations – including unidentified patient need Search for unwarranted variation – eliminate waste and duplication Personalised care planning- shared decision making Culture Change – Transformati on Programme
- 15. How do you use your CfV pack
- 16. Principles of NHS RightCare approach Ingredients Indicative data Atlas of variation Cf Value Packs Evidential data Locally sensitive data to build a Case for Change BPE Clinical leadership & Engagement Nursing is perfectly positioned to design and lead transformation
- 17. Understand the data • CfV packs • Opportunity areas • Analytical team/support • Managing data deniers • Demographic peers
- 18. Getting the full picture Population Focus Referred Patients Most in need Most seen
- 19. • Delivery Partner • Local Clinical Leads • Commissioners/Providers/LA • 3rd sector • STP • Buddy up Connectionsand Networks
- 20. Leadership • Focus on quality and outcomes as well as finance • Creating the right culture and relationship building • STP system transformation • Linking initiatives so the focus is on value and outcomes • Making RightCare business as usual • Professional networks
- 21. RightCare & the Nursing Profession Adopt and enhance the Right Care approach, to help health systems in maximising value as part of their transformation programmes Generate a cadre of experienced people to support improvement Take a lead role in working with national organisations and Arm’s Length Bodies to understand and enhance the co-ordination and the application of national technical, political and regulatory drivers to reduce unwarranted variation AND Enhance the prestige and kudos for the Profession as it develops national and international collaboration and becomes a focal point on this important policy issue
- 22. Increasing value Value to the Individual Value to the Population Value to the Professions • Engage • Organise & • Transform RightCare Designing And Delivering Optimal Value
- 23. A postcard from Anytown CCG Patients and Visitors Some Town Population Anytown Trust England Dear All We now know that we have to use the resources differently, we do have to ‘stop starting and start stopping’ those things that don’t add value. So, we will focus on population health care, thinking about the whole system, not just organisations and traditional ways of working. To do that we will look at how and where we allocate our resources and how we share our knowledge to re-design better ways of providing care. That feels right so …. we really do WISH YOU WERE HERE!!
- 24. i NHS RightCare is a programme of NHS England For more information and support about how to use the NHS RightCare approach to get best value for your population, go to www.england.nhs.uk/rightcare/ or email us at rightcare@nhs.net