Introduction

INTRODUCTION

In recent years, increased emphasis has been placed on the study of healthcare systems to better understand the relation ship of how management and administrative systems best support clinical practice and promote quality improvement and patient safety . To some extent this has come about as a consequence of the increasing complexity of healthcare delivery , which, although credited with dramatically improving public health over the last 50 years, has led to the realisation that patient satisfaction and safety is frequently compromised. This issue is multifactorial but includes poor integration of care pathways, poor planning and utilisation of resources and errors in management and clinical care. A disa ff ected healthcare workforce challenged with excessive administrative and governance workloads compounds these issues and leads to ‘burnout’, which contributes to poor clinical outcomes and further compounds societal and patient dissatisfaction with patient care. Understanding healthcare systems, promoting ‘value’ for both healthcare providers and patients and supporting the healthcare workforce to deliver high-quality and safe care remains the biggest challenge for the healthcare industry in the current decade. This chapter addresses some of these import ant issues and provides a framework for surgeons to contribute to the design of safe and e ffi cient surgical pathways of care. Today’s healthcare systems face two big challenges: increas ing demand because of g reater volumes of patients who are older, who often have comorbidities and who often require multidisciplinary care; and an increasing volume of treatment options, often of greater complexity and cost. Despite the ability of medical science to manage and treat an increasing array of complex medical conditions, not all medical conditions are managed well. Implementing evidence-based care in complex health systems is challenging. Michael E Porter , b.1947, economist, Harvard Business School, Boston, MA, USA. Added to this, the financial cost of health care challenges both healthcare recipients and providers and questions how best to drive the ‘quality’ agenda in healthcare delivery . - According to the Institute of Medicine, patients do not always receive the most suitable care at the best time or in the best place. Its influential report, Crossing the Quality Chasm: A New Health System for the 21st Century, emphasises the need to redesign healthcare processes and systems in response to this quality gap. The concept of ‘value’ in health care has been developed to provide a focus for both healthcare recipient and provider . Professor Michael Porter, director of the Harvard Business School’s Institute for Strategy and Competitiveness, has advo - cated value-based health care as one of the most important topics in healthcare transformation. Porter proposed six prin - ciples that support a value-based approach to health care: 1 Organise care around medical conditions – care should be based upon the medical needs of a community . 2 Measure outcomes and costs for every patient. 3 Align reimbursement with value – to support better out - comes and more e ffi cient care. 4 Systems integration – organise treatment around matching patient, treatment and location. - 5 Geography of care – provide centres of excellence for complex care. 6 Information technology – provide integration of the - healthcare system. While value-based care has mainly gained traction within the USA and the private healthcare sector elsewhere, it is interest - ing to see its conceptual components being taken up by public health systems such as the National Health Service (NHS) in the UK, with an understanding of the need for a universal healthcare number and integrated healthcare infor mation technology (IT) platforms and healthcare initiatives such as

and near misses The importance of patient safety, strategies and • application in clinical practice Quality improvement as an overarching activity • The need for system thinking and leadership •

Wisely UK’, all of which are based on designing healthcare systems that are truly patient-centric and o ff er quality outcomes that matter to patients.