Leadership: difficulties and challenges

Managers from National Health Service consortiums now seem an endangered species, according to the King's Fund. Politicians have demanded cuts and they have fought greatly so that their centres can maintain the required levels of care. The result: the leakage of first level managers disappearing from the public system.

The first reference documents, which has as its subtitle "No More Heroes" (the green one), describes the new leadership style beyond the mandatory compliance to the objectives imposed from above. It said that Managers who have an inside perspective are essential if we want to get the doctors, nurses and other health professionals to do their work with quality. The new leadership should not only correspond to the manager, the heroism no longer makes sense. Therefore, now we need to have leaders throughout the organization, leaders who are present in every corner of all processes and, above all, know how to involve professionals in the management of resources, but also know how to facilitate the participation of patients in the decisions that affect them.

Complex Chronic Patients: UK progress in funding

good article by Sam Everington on general practice http://t.co/Qk0iIs2ZZQ

— Chris Ham (@profchrisham) marzo 13, 2014

Director of King'sFund, Chris Ham’s tweet, takes us to Sam Everington’s article in The Guardian, about new experiences of financing (commissioning) towards community services deployed to address chronic complex patients in their own homes, even in episodes of clinical exacerbations, and thus avoiding likely unwise hospitalizations.

Chronic Models: the Wagnerian keys

Chris Ham, King's Fund Director, interviews Edward Wagner, Director Emeritus of MacColl Center for Healthcare Innovation Group Health Research Institute and promoter of the chronic patients care model (Chronic Care Model or CCM). As I think it is worth it, I decided to share a transcript summary of the conversation. It will not disappoint you.

Ham: How did you come up with the idea for CCM?

Wagner: From my own clinical practice. For me it was frustrating to see how well prepared and well-meaning physicians, when they had to deal with caring for chronic patients, failed to achieve good results, while we were starting to have evidence that by doing things differently, patients could better understand what was happening to them and could improve clinical outcomes. And for this reason I thought we had to share this evidence with the doctors.

Kaiser Permanente: the keys to success

Kaiser Permanente (KP) is an integrated managed care consortium, acting in California, and to a lesser extent on 8 other U.S. states. In the series of "Virtual Clinical Practice" I have already made ​​a brief presentation of the most relevant features of Kaiser Permanente to better understand the development of Health Connect, the electronic medical record of this insurer.

KP Results

What attracts us, European health managers, to KP are their excellent results, both in adjusted resource utilisation as well as in the quality of care which contrasts to the American environment where inequities in access, organisational and medical performance disorder prevails. To illustrate what I mean I have chosen this article:

Frail elderly patients: the case of Torbay

The health and social care for elderly people in Torbay (England) is fully integrated today (see the King's Fund document). In 2004 a pilot in one of the county’s districts was launched and soon spread to the entire area. Each of the 5 teams that were set up serves a population in a range from 25,000 to 40,000 inhabitants. In 2005 Torbay Care Trust was created.

The main objective of the service integration:

Maintaining the frail patients at home or in a community setting for as long as possible.

Key elements to achieve the objectives:

• Integration of health and social care professional teams
• Team budgets’ fusion
• Deployment (or purchase if appropriate) of a wide range of intermediate services that facilitates home support
• The enthusiastic support of family doctors (even though they have not been integrated)
• Institutional support, especially local support