A flagship policy for the Scottish Government is their integrated approach to Health and Social Care. They define the policy here, Audit Scotland offers a guide and ‘Digital Stories‘ are offered to explain these new programs.
As they describe for the 2017 – 2022 Strategy:
Person-centred health and social care is at the heart of our strategic agenda in Scotland. We are developing a new, integrated Digital Health and Social Care Strategy that will build on achievements to date and set out future development and priorities.
The types of real-world challenge and “Digital Health” realities they face in achieving this program were explicitly defined in one of the latest CivTech challenges : Number 7 – How can we make the NHS waiting time system more efficient and effective?
Matching available health service capacity to demand is a long-recognised challenge that affects health boards in Scotland. The management of these processes is manual, remaining unchanged for many years.
Solving this challenge is not simply about replacing current processes. We want to engage a company that can modernise, automate and optimise demand management for hospital services. We need a team that can bring a completely new point of view to the problem and bring a product or technologies that have the potential to scale across Scotland.
The Shared Value Agenda
The latest management practices combined with the latest technology advances offer the ideal framework for addressing these challenges. Given the organizational complexity, technology alone cannot address the systemic challenges.
The most notable of these approaches is the ‘Shared Value Agenda‘ from legendary management guru Michael Porter, a framework intended to unite businesses, government and social organizations towards common goals that span across commercial and social needs. Ie. exactly what is being asked for.
In his Harvard article Strategies for Fixing Healthcare, Michael describes the framework for Healthcare.
Instead as the name suggests the core ethos is one of identifying how multiple organizations might benefit from the same social outcome, including and especially profit-oriented businesses. It’s an approach of’ integrative policy making’, a whole systems approach that identifies interconnecting impacts and causes, and addresses them at a whole system level.
In this presentation from Harvard, and this one for the OECD, Michael explains that the traditional departmental or single policy goal approach only constitute “local optimizations”, ie they might improve the patient throughput for one section not the total journey.
This may sound obvious however Michael describes situations where management programs may be designed in a piecemeal fashion, such as emphasizing one goal that is too narrow, such as ‘Increasing Access to Care’ or just cost-cutting without appreciation of the impact upon the ability to achieve the desired goals.
Without a holistic design perspective these can be interpreted in such a way as to be counter-productive to the overall system goals, and so the Value Agenda provides a means for regulating this aspect and instead building all activities around a core goal of patient, citizen or customer-centric measures for management.
The relationship between Health and Social care provides the ideal context for a simple but powerful example of this problem – For example aggressively seeking to reduce the Welfare bill simply pushes the problem elsewhere, driving up the use of hospital beds due to malnutrition. A local cost saving that increases overall costs, and directly causes inappropriate use of Healthcare facilities.
IPUs and the Virtualization of Healthcare
This approach can be married with the latest tech innovations to maximize the success of both, in particular where technology enables improved cross-enterprise collaboration, and in a form conducive to better patient care that move on from traditional ‘monolith’ legacy ICT approaches.
Video collaboration and media file storage (eg. PACS images) are great examples. Traditional approaches of on-site legacy technologies incur considerable more expense, due to specialist nature, and they are ideal for now servicing via very low cost commodity Cloud services.
Michael describes the key foundation for the Value Agenda as the use of an enabling technology platform, including specific working models for implementing the design notably including IPUs.
These are virtual teams that span multiple organizations and departments, and define specific ‘process pathways’, project teams drawn from multiple disciplines dictated by the needs of the patient treatment. Porter highlights that most healthcare delivery is organized around the traditional hierarchical approach, with costs and resources tied to departmental units.
In contrast IPUs are aligned around patient journeys and cut across all the organizations needed to deliver them, and can be achieved by a variety of virtualized Cloud services, in particular video and team social collaboration tools. We’ll be showcasing a variety of these as part of this ongoing series.
This Scottish Government update on ‘The Modern Outpatient‘ explores these types of dynamics in action.
Small Pieces Loosely Joined
This approach isn’t only for Healthcare – This is a general systems model approach and technology, that could be applied across all of the public sector, for the same benefits.
In their paper ‘Small Pieces Loosely Joined‘ the Policy Exchange explores an example, highlighting the case study of Greater Manchester implementing the ‘Whole Place Community Budget’:
“Greater Manchester’s pilot focused on changing the way services were delivered to families with complex needs. In two neighbourhoods – Wythenshawe and Gorton/ Longsight, a new delivery model was tested with 240 families, and compared to a ‘business as usual’ approach for another 240 families.
The new model involved establishing a single virtual team (including representatives from the council, health organisations, schools and work programme providers), to take care of all referrals for complex families. The families were given one individual to work with who agreed with them what kind of help they needed, including referrals to other services. Having just one team helped stop the duplication of effort and counter-productive results of working in bureaucratic silos. “