Category: Thought Leadership

Thought Leadership

A view from the front line: the Emergency Department is in need of critical care

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Dr Mark Harmon, A&E Clinician and Clinical Entrepreneur at eConsult, shares his experience at the NHS frontline, and discusses the technology that could help protect the NHS.

As an A&E clinician working in the emergency department during the ongoing strike action, my first priority is the care of our patients. Unfortunately, the sad reality is that even without the ambulance strikes, Accident and Emergency departments are no longer just cracking at the seams. We’re at breaking point.

When I signed up to work in the Emergency Department (ED) because I wanted to provide urgent care to patients in critical – and sometimes life-threatening – conditions, I did not anticipate working for a department in need of emergency care itself. Although I feel incredibly passionate about my job, the scale of the challenges we face need more recognition, and immediate action.

At the start of each shift, I worry about how already burnt-out staff and overstretched teams and services are going to cope with the volume of patients flooding through – and waiting outside – the front doors. NHS staff are working tirelessly to care for patients – so where is the system failing?

Resurrecting patient satisfaction with the NHS

At the end of last year, it was reported that public satisfaction with the NHS has fallen to its lowest levels since 1997, according to analysis of the 2021 British Social Attitudes survey (BSA). Concerns over long waiting times (65 per cent), NHS staff shortages (46 per cent) and inadequate government funding (40 per cent) were cited as key reasons for this drop in satisfaction.

With ongoing funding disputes and consequent staff shortages, it is unsurprising that the top three priorities to drive improvement in satisfaction included making it easier to get a GP appointment, improving wait times for planned operations and increasing the number of staff in the NHS.

To drive forward these changes, there needs to be innovation and digital transformation of how we deliver the healthcare service we currently offer.

As it stands, one of the biggest issues we’re tackling in the department at the moment is flow. When the ED pipeline gets blocked, flow is impeded, a backlog builds up and waiting times get significantly longer, all of which has a huge impact on the clinical care we’re able to provide, our patients’ safety and staff morale.

The sad reality is that around 30-50 per cent of patients we see in A&E could be treated more effectively elsewhere – for example, via their GP or pharmacist, or in an urgent care centre.

If we’re to make any headway, we desperately need support in slowing down the flow of people into A&E. We are not discouraging people from attending the ED. Those in need of critical care should absolutely come and see us. Instead, the ED needs support in implementing technology, combined with deep clinical expertise that will help us to automate digital triage upon patients’ arrival.

Reducing patient flow into the ED

In practice, my vision for a safe Emergency Department is one whereby patients can document their own symptoms on arrival at the ED via an iPad at the entrance and that way, we can prioritise the treatment of patients based on clinical need and reduce the flow of traffic into the waiting room. Technology now plays a vital role in rebuilding patient and emergency staff satisfaction, but most importantly ensuring people who need urgent care can get it quickly.

Gathering a patient’s history upfront, in their own time, not only means they can be automatically routed to the right resource, but the time-consuming task of taking the history from every patient, one question at a time, is done in advance. The case summary emergency staff receive through this process means they move from ‘history takers’ to ‘decision makers’, ultimately reducing waiting lists, and speeding up the patient journey.

To make this vision a reality, we need to introduce better safety measures for the long term.

Right now, working in the ED, I can see that there is a clear challenge with how patients are being triaged. To solve the problem, we desperately need clear and concise guidance that directs those in need of support to the right point of care.

Our ED waiting rooms need support in adopting this digital triage technology to correctly signpost patients to the right place, at the right time. Patients need to be guided as to when they need to attend the ED, or whether they can get help from a pharmacist, GP, or self-help tools.

Whatever we do, we need to eliminate queues at the front door, and identify those sick patients early, in order to maintain quality of care, which in turn will improve flow and working conditions for front line staff. This will help with restoring morale, and staff retention so that front line staff are not forced to strike to have their voices heard.

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Thought Leadership

Accessibility, interoperability, and personalisation: the three pillars for the future of digital primary care

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Mike Fuller explores why accessibility, interoperability and personalisation are the three pillars for the future of digital primary care.

The NHS defines digital systems as the foundation upon which it builds a modern, efficient, and responsive health service. With innovation within the healthcare space ongoing and everchanging, the role of digital technologies is going to be crucial for the very future of healthcare provision in this country.

More funding is being provided to healthcare to drive these innovations. The NHS England London Digital First Programme, for instance, has a funding opportunity to pilot automation solutions within primary care. It will be funding automation grants of up to £65k and is encouraging all pilots/projects across London’s Integrated Care Systems (ICSs) to apply.

The long-term success of primary care across the NHS is more than simply dependent on investment, however. If it is to thrive in the future, primary care needs to reset and rethink its role within the wider healthcare ecosystem, and redesign what it means and does.

With this in mind, it has become clear that the future of digital primary care will be driven by three key pillars: accessibility, interoperability, and personalisation.

Making healthcare more accessible

Over the next two years, in particular, the key driver of digital primary care will be a concerted focus on making healthcare more accessible. It is anticipated that there will be a wider digital response to the consumerisation of health and care, with increased service accessibility and service user inclusion using telehealth for appointments, consultation, prescription refills, and mobile access of records.

The sheer range of apps on offer may be confusing to some patients, so to overcome this, it is expected that there will be some aggregation apps emerging in parallel to the general proliferation.

Accessibility will also be extended to more regionally-led packaged services for discrete patient cohorts, with more frequent use of virtual hospital ward and remote monitoring with wearable 5G connected devices for those who need or want it – and can afford it.

Funding this change will inevitably be a challenge, of course. The commercial and cultural hurdles are probably just as big for integrated care boards (ICBs). These boards will want to unlock more primary care data to better manage distributed patient risk and service provision for preventative and personalised care across the wider health economy, especially for public health use.

Healthcare institutions will need far more than just ease of data access, however. They will need the standards-based interoperability capabilities promised by a universal adoption of the latest editions of HL7 Fast Healthcare Interoperability Resources®, with widely fed repositories and standardised reporting.

The NHS will need to enforce the use of these standards, because today some industry stakeholders have only ticked the box of ‘compatibility’, and several have not understood or implemented adequate clinical safety compliance for the DCB0129 and DCB0160 clinical risk regulations.

Delivering proactive change

Scrolling forward five years into the future, ICBs will need to decide how they can help primary care fund change management and digital transformation, with a need for structural changes that fund both primary care provision and digital systems.

Unfortunately, the current batch of periodic data transfers and application interfaces are “too passive.” The information provided is scanned “paper behind glass”, amalgamated records that need human interpretation and action, or simplistic robotic automation processes that save people’s time but automate bad processes. Moving forward, what’s needed is end-to-end process interoperability to automate care proactively and intelligently. This will close the gaps in services and stop people falling through them.

Today, the overheads of separate point-solutions make purchasing decisions easier, with quick-wins and immediate gratification for their direct users. Yet the valuable data generated by these siloed interactions dissipates. Such disconnected systems create a whole iceberg of problems below the waterline that is in danger of being ignored.

To see more transparency, interoperability, and automation within digital primary care, the multiple regional stakeholders across ICBs must think in whole-system terms, with shared access and outcomes that span the patient, service users, and care professionals’ experiences. Every service is responsible for a patient’s care, especially those in their care circle, and so must be on par with acute and primary care funding and management.

This is starting to happen with the creation of the ICSs and has been recently evidenced by the redesignation of the P of integrated care partnerships (ICP) to now mean ‘place’, as in ‘place of care’.

There are also good examples of regional thinking such as regional waiting list triaging, and discussions for regional virtual wards for Ambulance Service patients in transit. Elsewhere, artificial intelligence (AI) is increasingly being used in numerous scenarios. From analysing patient-generated data from wearable and medical devices, and the early diagnosis of Alzheimer’s disease using image recognition, to facial analysis for ADHD, stress, and pain management. All these examples will provide better patient experiences and outcomes – and save money. And they exist now, albeit it small pockets.

To scale such innovation and sustain digital transformation in healthcare we need to connect the operational systems and use the ‘exhaust data’ generated by their workflows to teach machine learning and AI to ensure objective, informed, and timely decisions are made in the entire chain of care.

This must be accomplished with the transparency required to ensure human oversight and processes to avoid the all-too-prevalent, but overlooked, biases present in AI’s machine learning data, algorithms, and the robotic process automation it can enable.

This connectivity and governance will not be easy to achieve but there are grounds for optimism. There is every reason to believe that the larger, better funded, and visionary primary care regions will be able to achieve these advances in the next five years, provided they are willing to ‘flip the iceberg’ and fully integrate with the whole health economy in which they play a pivotal role.

Looking a decade ahead to a world of personalised healthcare

When it comes to ten years from now, recently published insights suggest that “personalised, precision medicine” could be on the horizon. While it may take more than a decade for wide adoption to occur, digital primary care can make a start with gender, age, and demographic aligned diagnosis and care pathways with measurable more effective medicines.

The future may even witness GPs using augmented reality visual tools supplemented by artificial intelligence and rich clinical decision support systems to diagnose patients faster and more accurately.

By extension, they could then automatically and easily publish that diagnosis with a personalised care plan based on the patient’s epigenetics, lifestyle, and agreed compliance to their approved care circle and patient support groups.

These kinds of fundamental digital changes are all very much in the offing over the next decade. However, to make them happen, it is crucial for the sector to reset and rethink the role of primary care in the NHS with its funding, and redesign what primary care means and does. That’s starting to happen today and so this positive vision is, all the time, beginning to look more like a viable future reality.

To find out more, please visit www.intersystems.com/uk/

Mike Fuller, Regional Director of Marketing, InterSystems
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Acute Care, Community Care, Thought Leadership

Non-emergency transport is crucial for winter resilience 

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ERS winter resilience

Seasonal pressures and existing backlogs look set to increase demand for non-emergency transport this winter. Writing for ICJ, ERS Medical’s Chief Executive Andrew Pooley, and Quality and Governance Director Simon Smith, outline why they are pushing hard for winter transport resilience.

The NHS was already experiencing significant pressures, even before this winter’s challenges. Although a smaller component of the NHS, non-emergency transport services (NEPTS), which provide transportation for patients with non-urgent conditions but who would struggle to travel independently, play a pivotal role in maintaining smooth patient flow.  

Last year, ERS Medical launched a campaign to raise awareness of non-emergency transport. The aim of this, in part, is to emphasise the importance of non-emergency transport and more importantly, to encourage the earlier booking of contingency winter patient transport shifts to support hospitals with patient discharge and alleviate some of the anticipated winter challenges.

Easing system pressure

Delays to patient discharge cause significant patient flow issues, and these are well documented. News headlines often focus on bottlenecks and delays via front door admissions, such as A&E, and the significant pressures being faced by emergency departments.  

However, if beds are not available in hospital wards where patients can be treated after assessment in A&E, there is less capacity for newer patients to be admitted. The traffic jam at the exit route now becomes a problem at the entry points for patients, as well as preventing ambulances from returning to the community, increasing already dangerously long ambulance response times.  

One of the main reasons for the patient flow crisis is the availability of social care. There is a direct correlation between the absence of an ongoing care package and higher rates of readmission. Further, discharging patients too early without any ongoing care and proper safeguards in place will often mean the patient is readmitted sooner or later. Poor discharge protocols can also lead to an increase in complaints and reputational damage for hospitals. It is no surprise then that discharge coordinators and healthcare staff have such a tough balancing act to manage, in addition to their workload challenges. 

The role of transport  

Transport can play a huge role in addressing the discharge backlog, and booking transport early is vital. This may sound simple enough, but transport is an often-overlooked aspect of the discharge process. When patients are ‘made ready’ for discharge, this is often the first point at which transport is considered. However, booking transport in advance, preferably the day or so before the patient will be ready to leave, is usually more efficient. While it is difficult to be a hundred per cent certain that a patient will be ready for discharge on a particular day, clinicians often have a good indication of when discharge might be feasible and appropriate.  

To this end, planning and communication are essential. Planning the transport in advance, booking it and then communicating with the provider if the plans change for any reason are crucial elements in the efficient discharge of patients. This ensures there are enough resources available in the system for trusts and integrated care systems to keep the patient flow running smoothly.  

One solution that is showing promise is to appoint specialist patient transport liaison officers (PTLOs) in hospitals. This “human” point of contact is a specially trained individual who can assess transport needs and then recommend the best approach on a case-by-case basis, often communicating with patients, hospital staff and families to keep everyone informed.  

Lessons from previous spikes in demand 

Contrary to conventional wisdom, one of the key insights from looking at our data (as illustrated below) is that spikes in winter demand often arise, not because of increased activity levels, but because of changes in booking behaviour, patient mobility, an increase in aborted journeys, and the subsequent need for more resources to accommodate these changes.  

 

Let’s take a hypothetical fleet of 10 vehicles servicing a local acute hospital. With the “normal” commissioned pre-planned booking behaviour and mobility mix, the activity matches resource and there are no service issues. Add in just one complex journey – for example, an obese patient that requires an additional crew to assess the property and support the journey – very quickly, that can reduce 10 per cent of available resource for more than half a day.  

Add in multiple issues – for example, bookings made at the last minute, or with incorrect mobility requirements, or patients’ drugs not being ready at the pickup time – and it is possible to see how demand outstrips built-in spare capacity and pressures build in the system. Integrated care boards (ICBs) should act with caution when being presented with supposedly easy fixes. The Uber model does not work with a regulated service that relies on trained staff and specialist equipment, and simply drawing on resources from outside the contract often fails because other services will also be under pressure, as they rarely hold spare capacity. The simple answer is to plan well in advance – it takes time to mobilise a fully compliant NEPTS ambulance crew, communicate with all stakeholders and educate healthcare staff about the correct use and limitations of the NEPTS service.  

Providers should also re-examine the point at which mobility assessments are carried out. When hospitals carry out patient mobility assessments, this is often done at a fixed, predetermined point. If a patient is independently mobile, but has been sitting and waiting for a doctor’s assessment, the patient’s mobility levels could deteriorate. When crews arrive to pick up a patient that has been booked on a seated vehicle to accommodate four patients, the crews undertake what is called a dynamic mobility assessment of the patient. They then establish whether or not the patient can walk independently, and whether they might now require a wheelchair or stretcher. This means that the vehicle originally booked to transport the patient is no longer suitable, and more, or different, resources are required.  

The reality is often different to the perceived activity levels  within NEPTS, where the ideal scenario is multiple patients in the same mobility category travelling in one vehicle. If transport is planned at the last minute for patients with the lowest mobility (patients who need stretchers), this blocks out a significant number of vehicles in one go, thereby increasing delays and placing a greater strain on existing resources.  

Of course, effectively balancing these factors comes down to proper planning, communication and funding contracts on actual resources needed, not just activity levels. This does not mean simply communicating with transport providers, but also between hospital departments.  

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Thought Leadership

Britain’s bed backlog: are ‘at home’ sensors the solution?

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Jayne Rooke, Health and Care Sector Lead at WM5G, writes for Integrated Care Journal (ICJ).

The NHS is currently at crisis point with significant funding gaps, staff shortages, record waiting times for patients and extraordinary pressures on ambulance services that are unable to handover patients due to a lack of available beds.

One of the causes of this ‘bed backlog’ is a severe shortage of social care provision, resulting in medically well patients becoming ‘stuck’ in hospital because it is deemed unsafe for them to return home alone. In fact, according to NHS data analysed by The Telegraph, six in 10 patients assessed in October were well enough to be discharged.

In a bid to address this problem, innovative technology is being used to improve healthcare provision for the growing elderly population. ‘Virtual wards’ that make use of a combination of connected technologies and face-to-face care have been introduced by NHS England to provide treatment and rehabilitation in the patient’s own homes.

The aim is not only to prevent unnecessary hospital admissions among vulnerable patients who are most susceptible to infections, but also to allow quicker discharge; increasing productivity, improving patient experience and reducing costs.

Some providers are choosing a combination of technological solutions and adopting a flexible ‘step-up, step-down’ approach that adapts to support patient’s needs.

For example, a virtual ward can be offered to those who are medically stable enough to go home but who require wrap around care until they are well enough to progress to a self-monitoring solution. In the same way, for those who are self-monitoring but show signs of deteriorating or further illness, progress from self-monitoring to the more intensive virtual ward support, can prevent them going back into hospital.

However, relying on self-reporting can lead to problems if there is a lack of patient engagement. It also doesn’t provide a real-time assessment of the patient’s health, with physical visits from healthcare providers still required to ensure the safety of patients.

As specialists in connectivity and digital innovation, WM5G has partnered with IoT Solutions Group to develop ‘At home’ or ‘care’ sensors that can assist the virtual ward model by monitoring patients within their home 24/7, alerting care providers of any change in patient behaviour.

Could sensors in the home provide the solution to the bed backlog?

Placed in the kitchen of vulnerable or elderly person’s homes, at-home sensors use humidity in the room – such as that generated from boiling a kettle, using a toaster or oven – to build an accurate picture of the resident’s daily life, creating a behaviour template or ‘digital twin’. That data is then used to notify healthcare providers in real time if there are changes in behaviour, lack of activity or unusual readings within the home.

These ‘at home’ sensors have been trialled across several council assisted-living residencies in the UK, including Sutton and Wolverhampton, with extremely encouraging results. In fact, Sutton Council believes at least four lives have already been saved by the sensors when alerts triggered visits by carers who found vulnerable residents unable to move following a fall or illness. These included residents already using ‘wearable alarms’ who were unable to activate them and meant that help could be provided immediately, rather than the residents waiting for the next scheduled visit.

While at-home sensors are predicted to play a pivotal role in supporting virtual wards, they could also provide additional benefits, such as monitor temperature with homes to identify those at risk of fuel poverty, as well as playing a role in preventative approaches, managing people’s behaviour and promoting healthier lifestyles.

The sensors are just one of a vast array of technologies that promise to revolutionise how we deliver care and bridge the gap between home and hospital settings. Its progression relies on hospitals engaging with innovation and remaining open to new ways of working the could improve services for patients while freeing up resources for other front-line services. It also needs connectivity to be factored into service and facility design, ensuring patients, carers and clinicians have access to the reliable networks they need to support this more ‘arms-length’ approach. It doesn’t have to be complicated, as demonstrated by the sensor-based pilots referenced above – the sensors used here require no digital skills to set up and convey data using low-powered, wide area networks – but it does need to be thought through and planned in from the earliest stages.

With hospitals constantly being asked to deliver more for less, an ageing population and social care services being stretched to breaking point, can we afford not to investigate how technology could hold the key to unlocking the beds backlog and supporting people safely back into their homes?

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Thought Leadership

Automation solutions essential for reducing administration errors

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Ed Platt, Automation and Analytics Director at Omnicell International, describes a step-by-step process for implementing automation technologies across NHS.

There are enough tried and tested technology solutions today to all but eradicate prescription and administration errors from across the healthcare system. It is therefore all the more concerning that 6,000 people were harmed and 29 died last year in England following prescription errors.

Data from NHS England, via the National Reporting and Learning System (NRLS), reveals that almost one in six Trusts in England do not even have a funded plan in place to reduce these errors via electronic prescribing systems – an issue raised in the media recently by Peter Walsh, Chief Executive of Action against Medical Accidents.

It seems baffling that not all Trusts have a suitable plan for adoption of electronic prescribing – why is the adoption of digital technology and more specifically, automation solutions, not front of mind? The UK’s Prime Minister, Rishi Sunak, echoed this message at the recent Confederation of British Industry (CBI) conference in Birmingham, when he called for more investment in automation and technological innovation as part of NHS reforms.

For any Trust at the moment, there is a lot of ‘fire-fighting’ taking place in terms of resources. In the aftermath of Covid, Trusts have had to be focused on a ‘recovery’ strategy, with the added burden of staff retention and recruitment issues. These are, understandably, posing extreme funding challenges and the job of leadership teams is not to be envied.

With a need to justify investment at such a testing time in the sector, many are finding it hard to put a number on the cost of such errors. According to studies, one in ten doses are not given to patients. However, many errors are also under-reported, so hypothesising a number to make a clear-cut case for investment in automation is almost impossible. It is simply not possible to monetise the impact of medication errors to show the economic effect. It is no wonder, therefore, that many Trusts are finding it hard to commit to a plan, despite having an intuitive feeling that they should invest in this area.

I know from personal experience the challenges nursing and pharmacy staff within hospitals are faced with when it comes to medication management; one hospital I visited recently required nurses to locate patient medication from 17 different locations across the ward with the patient and his/her needs at the very core of their service. This is simply not sustainable and makes the risk of mistakes undoubtedly higher. But broad-based challenges such as this, which are difficult to measure, are always going to be secondary for Trusts when compared with the most pressing and immediate concerns.

The ‘gold standard’ for any hospital should be electronic prescribing with automation. These two go hand-in-hand to ensure: improved patient safety; fewer medication errors; fewer missed doses; fewer drugs wasted; fewer instances of out-of-stock medicines, and reduced clinical staff time spent preparing and dispensing medication.

The impact of automation can swiftly be felt across an organisation, especially when key issues such as staff morale are considered. Automation takes the headache out of mundane and repetitive tasks, meaning clinical staff can concentrate on patient care, with a reduced workload and can do what they joined the NHS to do. The process should place patients at the heart of the service, to understand their medicine requirements and feel empowered. importantly, it will also facilitate the faster discharge of patients, either back home or into a community-based care setting, whilst eliminating avoidable waste in the system.

For successful investment and implementation of automation in any NHS Trust, I would recommend the following 7-step process to ensure success:

Ø Assess and understand your organisation’s current challenges – consider the hospital’s geography, ward layout, supply chain from central pharmacy to wards, discharge processes, workflows, date quality and current and future digital systems.

Ø Integration with existing digital systems – can it integrate seamlessly with existing solutions – both electronic prescribing systems and electronic patient record systems? The ability to integrate will help optimise both workflow and data visibility.

Ø Change management – The successful adoption of technology includes the need to have a solid change management plan in place. Immediate employee engagement is key for bringing about change in the workplace – employees have to be part of the planning as much as the execution. Ensure pharmacy, nursing teams and digital leaders work together to put a holistic solution in place.

Ø Training – Ensure there is a clear training plan, clear SOPs, roles and responsibilities, and an ongoing training strategy to maintain standards.

Ø Adoption – It is essential to work with the right partners. Technology solution providers need to spend time on site understanding different workflows in various departments and provide expert guidance on how technology can best be used to make significant time and cost savings very quickly. This should be scalable from a ward, to a hospital, Trust and ICS so that consistent standards and workflows can be adopted.

Ø Execution – A go-live with the correct resource, clear clarity of the future state, at the shoulder support and swift resolution to any challenges.

Ø Life-support and follow-up – Experts should be on-hand to provide guidance and communication materials, and tailor, where possible, the technology to suit the specific case required by the hospital. Clear metrics and measurements to determine the expected outcomes ought to be in place.

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Thought Leadership

Improving health outcomes through value-based care 

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As value-base care gains currency, Tim Morris, VP Go-To-Market at Elsevier Clinical Solutions writes for ICJ about how this approach can improve clinical outcomes and boost cost-efficiency.

The value-based care model has gained traction across healthcare systems globally since it was first introduced by Michael Porter and Elizabeth Olmstead Teisberg in 2006.1 It rewards healthcare providers with incentives based on the quality of care they provide to patients and has been shown to improve healthcare outcomes and cost efficiencies.

Discussions focusing on the need to advance value-based care have been ongoing in the NHS for many years. Back in 2009, NHS RightCare was established and rolled out. This was a national programme from NHS England committed to reducing unwarranted variation and promoting the shift to value-based care.2

Most recently, the disruption caused by Covid-19 has accelerated the focus on costs, equity of access to care and reducing variability in healthcare outcomes. This has prompted healthcare leaders and policymakers to rethink how care is delivered to improve patient outcomes in the most cost-effective way.

Defining ‘value’ in health systems

The interpretation of ‘value-based’ care differs globally, mostly around how value is defined per region. According to an expert panel facilitated by the European Commission, there are four broad definitions when it comes to understanding what ‘value’ means.3

  • Personal value – appropriate care to achieve patients’ personal goals
  • Technical value – achievement of best possible outcomes with available resources
  • Allocative value – equitable resource distribution across all patient groups
  • Societal value – contribution of healthcare to social participation and connectedness

Applying value-based healthcare models to the increasingly fragmented healthcare landscape helps improve clinician well-being and recommends strategies to overcome key environmental and organisational barriers to optimal care. Value-based health care connects clinicians to their purpose as healers, supports their professionalism, and can be a powerful mechanism to counter clinician burnout.4

Implementation barriers

Committing to reducing unwarranted variation can improve health outcomes and help to deliver a financially sustainable health system. However, there are common barriers that providers must overcome to establish new organisational structures:

  • Lack of integration – healthcare organisations using isolated technology platforms is one of the most significant challenges of value-based care
  • Limited resources – overburdened staff, insufficient technology that lacks automation capabilities, and continual administrative tasks can slow the adoption of value-based care
  • Fragmented care delivery – poorly managed patient care transitions can result in higher costs and adverse health events
  • Lack of measurement – if effective clinical data capture is not in place, reporting patient information and accurate care coordination becomes challenging

Adopting a multidisciplinary approach to value-based care

To improve outcomes, healthcare providers must adopt a multi-disciplinary approach, ensuring that clinicians from different disciplines are working collaboratively as a team, alongside the patient. Unless they are looking at the impact across all elements of healthcare delivery, healthcare organisations won’t have a full understanding of the total cost of care.

There is also a need to effectively engage patients in their own care. If the patient doesn’t follow post-care advice, outcomes may not improve. The provider should connect with the patient throughout the whole process of care, maintenance and recovery.

It is important to acknowledge that there is a lack of health literacy among patients and therefore a need to support an improved understanding of the care they are receiving. As described in Elsevier Health’s Clinician of the Future report, which gathered insights from close to 3,000 clinicians from 111 countries, patient empowerment has been identified as a key area that could potentially reduce complexity for clinicians.

Putting in place appropriate measurements which focus on the outcomes that matter is vital. The three main outcomes that hospitals can start to measure in terms of the patient experience are:

  • Capability – the ability of patients to do the things that define them as individuals, and enable them to be themselves
  • Comfort – the relief from physical and emotional suffering
  • Calm – the ability to live normally while receiving care

Improving value for patients

Value-based care models in health systems provide the opportunity to lower costs, increase patient satisfaction, reduce medical errors, and improve patient engagement.

When implementing such models, we must look at how we work across primary and secondary care to work with patients and empower them to manage their care effectively.

1 Michael Porter and Elizabeth Olmstead Teisberg https://archive.org/details/redefininghealth00port (sourced April 2022)

2 NHS. (2017). RightCare and the shift to value-based healthcare. NHS. https://www.england.nhs.uk/wp-content/uploads/2017/02/board-papers-090217-item-6-nhs-rightcare.pdf

3 European Commission. (2019) Defining Value in Value-based Healthcare. Available at: https://health.ec.europa.eu/system/files/2019-11/024_defining-value-vbhc_en_0.pdf (Accessed: November 10, 2022)

4 Teisberg, E., Wallace, S. and O’Hara, S. (2019) “Defining and implementing value-based health care,” Academic Medicine, 95(5), pp. 682–685. Available at: https://doi.org/10.1097/acm.0000000000003122 (Accessed: November 10, 2022)

Tim Morris, VP, Go-To-Market, Elsevier Clinical Solutions
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Thought Leadership

What Steve Barclay must do for the NHS to survive the winter

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England’s Integrated Care Systems are still finding their feet as another winter sets in. What must the new Health Secretary do if the NHS is to survive the winter?

Three areas in which Steve Barclay, the new Secretary of State for Health and Social Care, could help are backlogs, health inequalities and digital. In each case, the lag between where we are and where we need to be is big enough for the right creative leap to put us ahead of the curve (and everyone else).

Backlogs

The NHS’s waiting list is about 7 million (although under revision). This number exceeds a tenth of the population, so if you are not waiting you probably know someone who is – but how big is this problem?

The NHS costs options in terms of QALYs – the quality adjusted life year. If a person were dying from a road traffic accident, for instance, and A&E enabled them to walk out in perfect heath, they would have received roughly one QALY of benefit by the anniversary of their discharge.

However, most of us benefit in increments. For instance, a knee implant may support an extra 10-15 years of active life – perhaps a benefit of just over 0.2 QALYs per year for 15 years, or nearly 3 QALYs overall. A few years ago, Lomas et al calculated that it cost the NHS around £13,000 for every QALY delivered. Now, we need to know how many QALYs are needed by the average person who is waiting.

Nobody knows the case mix, but we can set limits on the cost of addressing their needs. It’s hard to see how the average can be less than 0.15 QALYs per person (which means a £14 billion problem) or how the average could exceed a whole QALY per person (a £90 billion pound problem). England’s entire health and social care budget in 2021/22 was £190 billion, so these are colossal numbers, even as limits.

This problem is huge and unaffordable if set about in the traditional way. The Secretary of State could use this crisis to leverage innovation at unprecedented scale. As an example of a small success that would scale, I have been working with Badger, a social enterprise that pioneered drive through clinics during lockdown (see articles below). Badger’s approach to smart service design, information management and new pathways could be scaled up to shrink national waiting lists quickly.

Health inequalities

A potentially bigger problem is health inequality (which we can identify but are only just learning to scope). Very simply, the needy die earlier than that the affluent and enjoy poorer health, as do ethnic minorities and other groups recognisable through mental health or long-term conditions. In the UK, there are communities whose healthy life expectancy is 10-20 years shorter than others in the same city. Still more worrying, there are regions where around half the population now suffers from unequal access to health care or unequal outcomes when they do gain access.

Signposting, or creating positions to direct those suffering poor health outcomes towards the services they need, or adding staff to tailor ineffective services is very expensive, while more GP slots cannot improve a system that consistently inconveniences those who need it most. We know that most aspects of service, from appointments to diagnosis and treatment, are difficult even for the majority so it is hardly surprising that anyone with even a small extra challenge in life will be disproportionately affected.

An alternative is to redesign key aspects of ICS delivery so that they work easily for everyone. Better still, use the poor outcomes from health inequalities as a barometer. By focusing on their needs, the care system would be critically reformed at system level, benefitting us all as a by-product.

Digital

Finally, there is a widespread belief that digital can solve many of our care delivery problems – and it’s true, in principle. Digital access and services will certainly work for the affluent, IT literate and whoever uses the most popular services. In doing so, they will also worsen health inequalities, unless designed and rolled out with exceptional skill and ingenuity to narrow the digital divide.

The examples below showcase how smart information systems are critical to innovation. It’s not just about apps – the health system’s entire information infrastructure needs attention. The new Secretary of State can nudge the NHS from simply collecting information to deploying real-time data to identify and serve those who are suffering most.

Every ICS needs advanced information, analytics and simulation, capabilities to continuously improve existing services, deploy new services and track the near-invisible populations who are missing out.

If the new Secretary of State can ease ICSs in this direction, he will long be remembered and for all the right reasons.

For further reading on a small-scale demonstration of smart systems in care deliver:

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News, Thought Leadership

Integrated care and service transformation – the role of experience

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Emil Peters, Group CEO at Tunstall Healthcare, discusses the role of experience for all stakeholders within the health and social care systems, and how ICSs will enable improvements to care provision and delivery for all.

When it comes to the transformation of health and care services, there have been numerous iterations of reforms. The current implementation of Integrated Care Systems (ICSs) and Integrated Care Boards (ICBs) in my view, presents an opportunity to truly transform our services and become a global leader within the health and care landscape.

However, it is important to remember that there are still key issues that need to be addressed at the heart of the health and social care landscape if we’re going to innovate and improve the care that health systems are able to provide the population. Addressing the concerns of all stakeholders, from users and residents to professionals and leaders in health and social care, and where technology sits within this, will give us a good chance of working with ICSs to create a landscape that is able to effectively serve everyone.

Experience is key

Experience matters, but not only in the traditional sense. While there are many key facets involved in the development and transformation of services, the experiences of patients, the workforce, and the entire community are crucial. If we align with these stakeholders and their lived experiences, we can begin to change the health and social care landscape.

Identifying the needs of each individual, and understanding that every population is made up of a set of people, will make it easier to deliver better services. If the entire ecosystem works in harmony, citizens will receive better care and their outcomes will be improved. It’ll also mean that health systems are better equipped to meet the expectations of the population when it comes to care delivery.

It will also be essential to keep the experiences of the workforce, from challenges to working practices, at the forefront. If we can meet the various needs of professionals, it will be easier to engage with them, and they will be more open to trying and deploying new solutions and services, such as technology. Ultimately, if professionals are cared for first, the care of citizens is likely to be improved in a consistent and sustainable way. While professionals keep in mind the compensated workforce, must also include the voluntary sector as a vital cog in our ability to deliver the lived experience we all want.

By working together, the health system will be better equipped to navigate care provision for residents and the community when it is required. We’ll know what the care is going to look like, how we’re going to deliver it, and communicate to service users what they can expect. This in turn will give them the information they need to become empowered and able to make the best decisions for themselves. As people become more empowered and involved in their own health, wellbeing and care provision, their outcomes are much more likely to improve.

Experience and technology

Technology has a key part to play in enabling the UK to become a global leader in the health and social care space, but a holistic view which looks beyond technology on its own is vital. While digital solutions have the ability to become sustainable if done right, focusing on how users interact with technology will also be crucial.

Regardless of the huge range of technology that is available and the incredible features that it can provide, it’s the people involved who will enable the true potential of digital solutions to be reached. If the experience of users and caregivers with technology is subpar, it’ll be difficult to deliver digital solutions that are sustainable and impactful.

When it comes to the public’s perceptions of the nation’s health services, many people consider the different levels and organisations of health and care in the UK to be effectively joined up, rather than the reality where many are working in silo. Investing in technology will enable an environment where the workforce can share vital information, communicate effectively and provide better care for residents. This in turn will create better outcomes for everyone involved and will promote care that is tailored to every individual within the care system, whether it be a nurse, a patient, or a family member.

The more that professionals are able to engage with digital solutions, the more that their time will be freed up to listen to the people that they care for. Patients and service users are very aware of the care that they are receiving, particularly when it comes to the small things, and technology can help to change their perception in a positive way.

Integrated care systems and their role

It’s important that stakeholders look beyond the monetary gains that can be achieved through the successful implementation and integration of ICSs and ICBs. If service transformation is viewed solely through the lens of finance, it’s easy to forget about the people and stakeholders who actually make the transformation possible and how they can be engaged.

ICSs can help us to involve all people from the top down, and provide the tools that to support everyone and deliver proactive and preventative care. Both the health and social care services are ultimately caring industries, with the majority of professionals working within them to support the health and wellbeing of communities through effective care provision.

ICSs are also giving us the opportunity to work with groups beyond the immediate health and social care sectors that are still able to have a significant impact on the health and wellbeing of residents. For many, good health begins in the community, and so if ICSs can engage with organisations and places such as public libraries, this will lead to better care across the board. It’s also important to focus more on upstream interventions and maintaining wellbeing to reduce the pressures on acute services and promote good health.

ICSs have provided a unique opportunity to merge the health and social care workforce across the spectrum, and optimise the experience of these professionals. The improved collaborations through ICSs should also support a reduction in the fear of the workforce when it comes to adopting new products and services, such as technology, and working closely together to embed them into new models of care. Collaboration will be key to supporting an improvement in the lived experiences of the populations we serve.

This article was kindly sponsored by Tunstall Healthcare.

For more information, please visit www.tunstall.co.uk.

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Thought Leadership

21st Century Healthcare: why the details really matter to the NHS

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As the NHS sets up integrated care systems, the greatest worry must be how well it can connect executive intent to on-the ground activity.

Given its failure to manage major change in the past half century, how well equipped are boards to run the most interactive and responsive mode of care yet attempted, anywhere in the world?

First, some history. Brunel lived in an era of golden engineers who ran all aspects of the business. He knew when to build wooden bridges to complete a railway, so that the operators could launch the services that would fund better bridges later. He dealt directly with his backers and his father’s spell in debtors’ prison overshadowed his overworked and gilded career.

This hands-on approach persisted a surprisingly long time. The Ocean Railway (2004), for instance, tells how 19th century marine engineers drove the passenger experience with a hand on the technology and a seat on the board. They took financial risks and ran operations, building ships that would outpace the competition while carrying more passengers in ever greater luxury.

A rising corporatism isolated the working end – industry, innovation and integration – from the funding flows and strategy. By the ‘70s British Leyland epitomised how dangerously disconnected the two had become. Management and unions missed what was wrong, each focused on its part of the problem, and neither realising that build quality and process engineering were the new keys to success.

As this industrial scene disintegrated and the NHS was in its prime, a new breed of entrepreneurs – let’s call them e-Titans – was emerging, with roots in computing instead of steel. With a hand on the keyboard and a seat on the board, Bill Gates and Steve Jobs became household names, and we soon adopted Google even if we didn’t know who Sergey and Larry were.

The NHS is one of the 20th century’s golden legacies, but it’s not commercial, so what can it learn from this most commercially minded breed? First, it is notable that e-Titans are not focused on commerce alone but maintain a creative and active interest across society, including health and the environment. The NHS is all about knowledge, and so cannot neglect the e-Titans’ discoveries.

So, how have e-Titans changed the world? David Edwards (I’m feeling lucky, 2012: p18) describes Google’s CableFest ’99 – when Larry Page and a few engineers played jigsaw puzzles with servers to squeeze 4 motherboards per tray, stacked into 8-foot high racks. It’s not that this reverse-and-rebuild-engineering was extreme, it’s that a CEO would dive in to find the highest packing density. This hunger for efficiency powered Google away from the pack.

e-Titans remain fanatical about detail. In some senses, their style is closer to the 19th century than the 20th, and they certainly don’t believe you can leave innovation or process tuning to others.

Critically, and trillions of dollars of wealth creation later, e-Titans are rewriting the manuals. In Creativity Inc. (2014), Ed Catmull shows how companies can harness ingenuity, while Reed Hastings and Erin Meyer (No Rules Rules, 2020) are taking big investment decisions out of the boardroom to the fringes, where Netflix staff meet their clients.

Amazon’s online books sales did not just threaten poorly run bookstores: it shook an entire sector. A third-party logistics MD recently complained to me that he must compete, on meagre resources, for customers whose expectations are shaped by Amazon’s technology and processes.

So, as the NHS recovers from Covid backlogs and blockages, how can it connect its consolidated multi-billion-pound cash flows better to more timely and responsive care? Colin Bryer and Bill Carr (Working Backwards, 2021) explain how to build agile teams to deliver within colossal organisations that are often cash starved because they are growing so quickly.

The e-Titans may not have provided a set of universal or sustainable standards nor do they agree among themselves but they are converging around norms that are radically different from anything the NHS has experienced. Healthcare may be perceived to be immune from the curiosity of the e-Titans with their implacable love of data and efficiency, their hands-on innovative involvement, maybe even their social consciences.

The auto industry was not worried when an e-Titan announced plans for a better car. Whether Tesla booms or goes bust, it has already left its electric mark on the landscape with transport thought to be at least a generation away.

As with British Leyland in the ‘70s, the NHS’s challenge is whether we learn what it takes for ourselves or leave others to run the sector for us. We do not know what universal healthcare would cost as a knowledge industry deeply dependent on data and running supremely smart processes. At least, we don’t know, yet.

About the author

Prof Terry Young worked in R&D before becoming an academic, where his research focused on the value of medical technology and the design of health services. He is an Emeritus Professor at Brunel University.

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Fujifilm, News, Thought Leadership

Fujifilm primed for leadership in pulmonary solutions

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Pictured above: Samiran Dey, European Business Development Manager, Fujifilm Europe

An established pioneer in digital X-rays, flexible endoscopy, ultrasound and CT scans, Fujifilm Healthcare has been using these technologies to address pulmonary conditions for nearly two decades.

Yet, the company is better known in gastroenterology, and particularly for its advanced endoscopy products.

The acquisition of Hitachi’s diagnostic imaging business in March 2021 strengthened Fujifilm’s hand as a medical-imaging specialist and a comprehensive provider of healthcare solutions. Now, Fujifilm is leveraging cross-business synergies to pursue a bold new vision as a one-stop pulmonary solutions supplier.

That includes an expanded product portfolio, enhanced with innovations in fields such as image processing and artificial intelligence. With new additions such as the slim EB-710-P bronchoscope, Fujifilm offers a broad suite of pulmonology solutions extending right along the whole patient pathway, from screening to treatment planning.

Integrated, cutting-edge technologies that facilitate and clarify pulmonary screening and diagnosis can help improve patient outcomes in areas such as lung cancer, where survival rates still lag significantly behind other oncology settings. Streamlining patient pathways is also about tackling the capacity and efficiency issues that routinely confront time- and budget-constrained pulmonologists.

These issues, together with the inherent challenges of lung screening and diagnosis, are part of what has historically relegated lung-cancer detection to too little, too late. As Samiran Dey, European Business Development Manager for Fujifilm Europe, notes, hospital endoscopy units tend to have just one room out of five dedicated to bronchoscopy.

Fujifilm’s booth at ERS Conference, Barcelona (click to enlarge)

There are indications, though, that lung cancer is moving up the screening hierarchy. In its recent report on Strengthening Europe in the fight against cancer – towards a comprehensive and coordinated strategy, the European Parliament’s Special Committee on Beating Cancer called on the Commission and Council to consider including targeted lung cancer screening in this year’s updated guidance on cancer screening.

In England, lung-cancer screening pilots are being rolled out across the National Health Service in three phases under the Targeted Lung Health Check programme. Low-dose CT scans are available for anyone aged between 55 and 75 years who has ever smoked.

Unmet needs

This growing recognition of unmet needs brings the benefits of innovations such as the EB-710-P, or of 3-D visualisations to help plot a course through the lung to peripheral lesions, clearly into focus. Pulmonologists are also dealing with limitations of time and space, which is where Fujifilm assets such as faster image processing or compact, portable X-ray machines, come into their own.

Accessing all of this from a single supplier, with joined-up support services and data transfers, plus seamless transitions from disease detection through to surgical modelling, also underlines how important ease of use is to clinicians in the field. In Fujifilm’s experience, what matters most to pulmonologists is not so much technical ingenuity or image quality, but rather how these qualities determine useability.

As Dey comments, “it’s human nature, wanting things to run smoothly. Being able to have that integrated is the main issue for healthcare. Where things can talk to each other, especially the service side from industry, and they come from one provider, that makes it easier for clinicians to run their practice”.

It can also drive efficiency and, potentially, cost-efficiency gains. Fujifilm is not only offering distinctive products, such as the EB-710-P or its FDR Nano X-ray system, but offering them as part of an inclusive package of pulmonology solutions that helps clinicians to do more, better, and in less time.

New ambitions

Patterned on Fujifilm’s EndoSolutions strategy and its successful focus on gastroenterology, the new ambitions for pulmonology started taking shape more than a year ago, with the creation of a dedicated respiratory business unit and Dey’s appointment to head up European business development. Monthly R&D meetings followed, while expert meetings kicked off in September 2022.

A roadmap for the evolving business envisages Fujifilm as a unique solutions provider in a very substantial European pulmonology market. Along with Fujifilm’s one-stop offering, cross-business unit synergies will be a key differentiator in this respect. “What’s really unique is synergising what the cross-business units can offer,” Dey explains. “Over six months, I’ve found out that we actually do have a solution.”

That runs from screening with X-rays and CT scanners, to Fujifilm’s core diagnostics offering with bronchoscopy, and then on to software that facilitates treatment planning. “There are obviously many other companies out there doing many things,” Dey says. “But no one other company has that full solution. We are a one-stop solution for the lung-patient pathway.”

Something else that distinguishes Fujifilm in pulmonology is its commitment to training and education. The company’s mobile training hub, the Endorunner, “allows us to take our products and education to the respiratory community, as opposed to them having to come to us”, Dey observes. “We’re also kicking off two-day pulmonology courses, dedicated to training physicians and all of the staff in the bronchoscopy suite.”

Long-term vision

As Dey points out, “we’ve always been in pulmonology”. However, Fujifilm has realised that “with lung-cancer screening coming to light in European countries, the UK probably being the first, more focus is needed. We had a product range; now we have a broader product range, thanks to some new bronchoscopes. And we can offer solutions to the respiratory community.”

The Fujifilm team at ERS Conference, Barcelona (click to enlarge)

The long-term vision, Dey adds, is to be “the number one provider of pulmonary solutions to the healthcare market”, offering “the products, services and education physicians need for their lung patients”. At the same time, Fujifilm is determined to carry on innovating for even better pulmonology solutions.

That could eventually extend beyond treatment planning and into the surgical space. “We will never stop trying to find the full solution for the pulmonology pathway,” Dey says. “And, for these patients, surgery is still the gold standard.”

This is a sponsored article.

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