Transforming our health system requires continuity and coherence

Nacho Vallejo
Atenció integral 

Photo of Alexas. Photos in Pexels

“Transforming health care requires continuity and consistency.” This is the title of a Harvard Business Review article written by Mark Britnell. Dr. Britnell is an executive of KPMG International and a global health systems expert. He dedicated his professional life to this field and has worked in more than 80 countries, a circumstance that has allowed him to gain first-hand unique experience of healthcare models. In 2000 he was appointed chief executive of University Hospitals Birmingham NHS Foundation Trust where he was responsible for the design of the largest NHS hospital. He is also the author of the book In Search of the Perfect Health System.

After several years of searching for the best health system, the author reflects and draws attention to the fact that we all want to provide safe, coordinated, and financially sustainable health care, but few have been able to achieve this goal.

Our healthcare systems share similar ambitions: value-based care with improved outcomes, lower costs, and increased patient satisfaction; converting hospitals into centres that provide health; focusing on preventive actions rather than treating the disease; implementing technology to make the care more efficient; empowering patients... However, despite these goals, we only see a few examples of systems that are achieving truly transformative changes.

He also reports that he has been able to identify cases of excellent health care, although all too often the people who inspire these role models have been hindered rather than helped. It remains a serious drawback to innovation and progress that the different actors in health systems do not have a shared purpose. Changes occur, albeit slowly, fragmented and difficult.

Problems that hinder sustainable change

Three problems impede, according to Britnell, a large-scale sustainable change:

Firstly, the myopia of our organizations, which tend to think that they are good. Often, their leaders see the need for change in the rest of the system and do not reflect on the importance of transforming their own "house".

Secondly, the usual tendency to make transactional changes (do things better) over transformational changes (do better things). It is often easier and less threatening to make small, seemingly important changes than it is to make a transformational change that will produce better care and add value.

Thirdly, large-scale changes are seldom understood. A compelling vision of a better future must generate energy, motivation and communicate well. Professionals and patients are generally not involved. Empowering them is a necessary element that is often absent, which prevents them from being able to shape changes and challenge the status quo.

Reference: Why Innovation in Health Care is So Hard

Solutions

Dr. Britnell cites the Crossing the Quality Chasm report, published in 2001 by The National Academy of Medicine, which identifies and recommends improvements in different dimensions of health care, in this case in the United States. This document recommends four ingredients for a high-quality health care system, which can be extrapolated to any institution:

• A correct outlook
• The design of clinical processes from the perspective of the patient
• The integration of organizations
• The modification of the legal framework and the financing of the institutions

Translating these inputs into successful management of change is challenging. But, as we have previously mentioned in this blog, clinical management must be a lever and engine of change. Rigorous application of best practices, approaching complex processes with trial-and-error mechanisms, making decisions as a team, and learning how to change things, also daily, can improve the effectiveness and optimization of our resources.

This roadmap should not miss a look at what health care has to learn from the business world. It seems key to the future of care to reorganize around the needs of patients in the same way that businesses reorganize around the needs of customers.

It also seems interesting to reflect on the reasons for not changing. In this sense, an entry on this matter written by the psychiatrist J. Camilo Vázquez on his blog Anabasis is highly recommended.

A couple of further reads. We have already talked about Corporate Rebels in this blog. Well, the Dutch friends have released their book in a Spanish edition. There are no longer any excuses for not reading them and finding pioneering organizations that decided to radically change their way of working and take advantage of what we can incorporate into our institutions. Lastly, Transforming Management in Health Institutions (Esencial. Transformando la Gestión en las Instituciones Sanitarias), a book published in 2020 whose main author is Vicenç Martínez Ibáñez. The text analyses the problems of our health system proposes alternatives and suggests an operational methodology to be able to implement change.

Change requires skill, will, time, and doing so through a rigorous process. This is the paradox of change: it requires continuity and coherence. But as long as our leaders don't spend enough time on change and don't trust professionals and patients in their ability to develop and implement sustainable solutions to problems, we will continue to settle for only one reward: survival. We need to make more use of our energy. Not just to do better, but to do better things.