Adonis Diaries

Posts Tagged ‘health care system

Re-designing for better problem solutions in health care system?

The wider determinants of health developed by Public Health England show that in fact, things like someone’s education, their job, who their friends are, how they get on with family, and where they live can actually determine how long they will live – even if they’re using the same doctor as someone living down the road but who is likely to live 10 years longer.

In the last two decades, design has been demonstrating a refreshing approach to addressing such complex problems. This is because design provides the opportunity to re-frame problems and solutions.

It explores ways of doing things that haven’t been tried before, to address problems that haven’t been well understood before. But in this age of complexity and multiple dependencies, problems are constantly and rapidly changing too, and so must solutions.

We need to move away from the romantic notion that a solution – whether it’s a service, product or policy – needs to go through a one-off and well-polished design process, beyond which it will continue to be relevant forevermore.

Reality is very different.

So we’re making the case here that as designers, we have a mission to build the capabilities of non-designers who work within the organisations that are transforming our future. This means they are equipped with the problem-solving mindset to constantly interrogate, improve and innovate as realities quickly evolve, and things that worked yesterday soon become obsolete

Why this is important

Urgency for prevention and early intervention: There is a sense of urgency to preempt problems before they happen in order to save time, resource and often even lives.

The recent NHS Sustainability and Transformation Partnerships (STPs) demonstrate this urgency. With an ever-increasing population, public services are at breaking point. But since two-thirds of deaths among those under 75 are a result of preventable illness, there is a growing recognition that keeping as many people as possible healthy is the most sustainable investment.

This is where a lot of the STP plans are focusing their energy. Because design offers a lens into the future and a provocation for possible realities, it provides those committed to prevention and early intervention with the ability to understand future problems and to design solutions that can forestall them.

Systemic complexity

We can no longer think of products, services and policies outside of the systems they exist within and interact with. For example, we worked with the Healthy London Partnership on a deep dive to understand the root causes of childhood obesity and to try out new ways of addressing this chronic challenge.

Our insight revealed that a one-pronged approach will never do. We need to create positive and synchronized triggers at different points in the system: we need behavioral nudges that change the habits of individuals, we need social movements that influence and inspire whole communities, we need levers that transform physical obesogenic environments, and we also need legislation and regulation such as the Sugary Drink Tax to reduce temptation.

Design invites diverse people across the system to confront problems collaboratively, by creating solutions that leverage the collective power of everyone’s experience, expertise, resource and authority.

Ongoing transformation:

In a time of austerity, we just can’t afford to keep slowly chipping away at the problem through little tweaks and tricks in the hope that it will one day disappear. We need to completely and continuously re-imagine how things might work better.

When working with a national charity, we realised that funding for children’s centres was at risk, and that they were struggling to reach diverse families.

This meant we needed to completely transform the service, into one where children’s centres can go (literally ‘in a box’) into the homes of those who most need them, for a ninth of the cost and nine times the reach.

A design approach to problem-solving offered staff the opportunity to experiment with transformational ideas at a small and safe scale, fail quickly, learn fast and build confidence in the direction of travel.

What capabilities

Organisations need to develop a number of problem-solving capabilities to future-proof their solutions. In a recent Touchpoint article, my colleagues Jocelyn Bailey and Cat Drew argue that these capabilities are presumably less about skill and more about mindset and culture. Armed with the right mindset, organisations can then develop (and even invent) the unique skills, methods and tools to solve all types of diverse problems. This mindset is characterised by:

Deep human understandingthe approach invites curiosity and determination to explore what lies beneath people’s actions, decisions and perceptions.

Re-framing challengesthe insight revealed through deep human understanding can help reframe the challenge to get to the bottom of the hidden root causes, rather than the visible symptoms.

Working with othersa design approach to problem-solving is humble. We admit that we don’t know it all, and we invite others who have experienced the problem in different ways or who are experts in related issues across the system, to come on board and shape the journey.

Learning by doingthe only way to test innovation is to give it a go. Design is a process of solving problems through doing, learning, improving and scaling. Starting small and imperfect can mitigate the risks of failure, and with every iterative cycle and every improved version, more investment and scale can be justified.

image: https://www.uscreates.com/wp-content/uploads/2017/11/uscreates_prototyping-1024×683.jpg

PrototypingHow to go about this

There are various ways that organisations can build the problem-solving capabilities of their workforce.

Last year, I wrote an article with Joyce Yee in the Service Design Impact Report that reviewed different design capability models that the public sector draws on. There is not a one-size-fits-all model, and each presents its own benefits:

Structured training: this varies from one-day workshops to bootcamps. These are best for beginners who would like a taster of the mindset to assess whether it provides potential for the nature of their organisation’s challenges.

Experiential learning: in other words, learning on the job. Often this takes the form of design experts facilitating a series of problem-solving sprints within an organisation, based on a real challenge. Staff are invited to shadow the process, reflect on learning, and experience the benefits first-hand.

Coaching: this model is suited for more experienced organisations who have potentially benefited from structured training and/or experiential learning. They would be keen to lead the problem-solving process themselves, with the support of a design coach for strategic guidance, alignment, and constructive provocation.

Internal disruption: a popular example of this is the lab model, where an organisation invests in an innovation team embedded within, with a role to create and grow a movement and a culture that embraces a design mindset to problem-solving.

In today’s complex and rapidly evolving world, organisations need to start thinking differently about how they are future-proofing what they do and how they do it. They need to invest in people, not solutions. By better equipping their people with a problem-solving mindset, they are creating the enablers for ongoing improvement, innovation and future relevance.

Joanna Choukair Hojeili is Design Director at Uscreates. She is a social designer, author, speaker and lecturer with over 15 years of practical experience in the UK, the Middle East and the United States.

She leads on the development and delivery of service design, user centred innovation, design research, business modelling, communication and digital design projects. Joanna has worked with over 50 public and third sector organisations – including Nesta,

The Healthy London Partnership, the Health Foundation and South London and Maudsley NHS Foundation Trust – to help them better understand and address their challenges. She has expertise across a broad range of social challenges including health and wellbeing, social integration, social action, employment, education and social enterprise.

Joanna has a Ph.D. in design for social integration in design for social integration and is an RSA fellow. She is an associate lecturer at the University of the Arts London, Kingston University and Ravensbourne University.

Read more at https://www.uscreates.com/capability-training/#rtyugoxJFYpkkelH.9

Internationally Comparing U.S. Health Care System  

Mirror, Mirror on the Wall, 2014 Update:

How the U.S. Health Care System Compares Internationally

Publications Fund Reports Mirror, Mirror on the Wal…

Executive Summary

The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. under performs relative to other countries on most dimensions of performance.

Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror.

Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity.

In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland (Exhibit ES-1).

Expanding from the seven countries included in 2010, the 2014 edition includes data from 11 countries. It incorporates patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care.

It includes information from the most recent 3 Commonwealth Fund international surveys of patients and primary care physicians about medical practices and views of their countries’ health systems (2011–2013).

It also includes information on health care outcomes featured in The Commonwealth Fund’s most recent (2011) national health system scorecard, and from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD).

Overall health care ranking

Click to download Powerpoint chart.

The most notable way the U.S. differs from other industrialized countries is the absence of universal health insurance coverage.

Other nations ensure the accessibility of care through universal health systems and through better ties between patients and the physician practices that serve as their medical homes.

The Affordable Care Act is increasing the number of Americans with coverage and improving access to care, though the data in this report are from years prior to the full implementation of the law. Thus, it is not surprising that the U.S. underperforms on measures of access and equity between populations with above- average and below-average incomes.

The U.S. also ranks behind most countries on many measures of health outcomes, quality, and efficiency.

U.S. physicians face particular difficulties receiving timely information, coordinating care, and dealing with administrative hassles. Other countries have led in the adoption of modern health information systems, but U.S. physicians and hospitals are catching up as they respond to significant financial incentives to adopt and make meaningful use of health information technology systems.

Additional provisions in the Affordable Care Act will further encourage the efficient organization and delivery of health care, as well as investment in important preventive and population health measures.

For all countries, responses indicate room for improvement. Yet, the other 10 countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States.

These findings indicate that, from the perspectives of both physicians and patients, the U.S. health care system could do much better in achieving value for the nation’s substantial investment in health.

Major Findings

  • Quality: The indicators of quality were grouped into four categories: effective care, safe care, coordinated care, and patient-centered care.
  • Compared with the other 10 countries, the U.S. fares best on provision and receipt of preventive and patient-centered care. While there has been some improvement in recent years, lower scores on safe and coordinated care pull the overall U.S. quality score down. Continued adoption of health information technology should enhance the ability of U.S. physicians to identify, monitor, and coordinate care for their patients, particularly those with chronic conditions.
  • Access: Not surprisingly—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost.
  • Patients in the U.S. have rapid access to specialized health care services; however, they are less likely to report rapid access to primary care than people in leading countries in the study. In other countries, like Canada, patients have little to no financial burden, but experience wait times for such specialized services.
  • There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; however, the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.
  • Efficiency: On indicators of efficiency, the U.S. ranks last among the 11 countries, with the U.K. and Sweden ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of administrative hassles, avoidable emergency room use, and duplicative medical testing.
  • Sicker survey respondents in the U.K. and France are less likely to visit the emergency room for a condition that could have been treated by a regular doctor, had one been available.
  • Equity: The U.S. ranks a clear last on measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling a prescription or skipping doses when needed because of costs.
  • On each of these indicators, one-third or more lower-income adults in the U.S. said they went without needed care because of costs in the past year.
  • Healthy lives: The U.S. ranks last overall with poor scores on all three indicators of healthy lives—mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60. The U.S. and U.K. had much higher death rates in 2007 from conditions amenable to medical care than some of the other countries, e.g., rates 25 percent to 50 percent higher than Australia and Sweden.
  • Overall, France, Sweden, and Switzerland rank highest on healthy lives.

Summary and Implications

The U.S. ranks last of 11 nations overall. Findings in this report confirm many of those in the earlier four editions of Mirror, Mirror, with the U.S. still ranking last on indicators of efficiency, equity, and outcomes.

The U.K. continues to demonstrate strong performance and ranked first overall, though lagging notably on health outcomes.

Switzerland, which was included for the first time in this edition, ranked second overall.

In the subcategories, the U.S. ranks higher on preventive care, and is strong on waiting times for specialist care, but weak on access to needed services and ability to obtain prompt attention from primary care physicians. Any attempt to assess the relative performance of countries has inherent limitations.

These rankings summarize evidence on measures of high performance based on national mortality data and the perceptions and experiences of patients and physicians. They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data.

Patients’ and physicians’ assessments might be affected by their experiences and expectations, which could differ by country and culture.

Disparities in access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home. Under the Affordable Care Act, low- to moderate-income families are now eligible for financial assistance in obtaining coverage.

Meanwhile, the U.S. has significantly accelerated the adoption of health information technology following the enactment of the American Recovery and Reinvestment Act, and is beginning to close the gap with other countries that have led on adoption of health information technology.

Significant incentives now encourage U.S. providers to utilize integrated medical records and information systems that are accessible to providers and patients. Those efforts will likely help clinicians deliver more effective and efficient care.

Many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, but the U.S. can also learn from innovations in other countries—including public reporting of quality data, payment systems that reward high-quality care, and a team approach to management of chronic conditions.

Based on these patient and physician reports, and with the enactment of health reform, the United States should be able to make significant strides in improving the delivery, coordination, and equity of the health care system in coming years.

us health care ranks last


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April 2021
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