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Health service or illness service? Rebranding healthcare.

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Health service or illness service? Rebranding healthcare.

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Farla Medical, one of the UK's largest supliers of medical technologies, commodities and consumables shared best practices from the UK. Including in infection prevention and control, tooling HRH and improving heath service delivery efficiencies.

Farla Medical, one of the UK's largest supliers of medical technologies, commodities and consumables shared best practices from the UK. Including in infection prevention and control, tooling HRH and improving heath service delivery efficiencies.

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Health service or illness service? Rebranding healthcare.

  1. 1. Health Service or Illness Service ? Daring To Make A Difference Working Together Can Achieve Measurable and Sustainable Change Mike Smith August 2019 3rd Health Sector Development Partner Forum
  2. 2. Who am I – Why am I here?
  3. 3. W.I.F.M ? What Will You Do Differently ?
  4. 4. Going M.A.D Making a Difference
  5. 5. Meeting Aim : Disruptive Thinking • Challenge the Status Quo • Being a team player is commendable and exercising diplomacy— admirable, but simply going along to get along is an ineffective strategy “What if bucking the system meant resolve, not just for me, but for others whose voices may be muted?” • Get Uncomfortable • If you’re feeling content with the ways things are, chances are you won’t be motivated to change them • Forget What Other People Think • Striving to secure praise and avoid blame is a recipe for disaster. • Welcome Failure – Celebrate Successes • Imagine going through life and never making any mistakes. What would be the point, really? • Enjoy the journey • Be bold – With Wild Abandon • What’s the worst thing that can happen when you stick out your neck? • Manage Risk • Personal, Business / Institutional
  6. 6. • Disposable Bed Pans and Bottles • Disposable instruments v Reusable Instruments • Profiling Beds and Mattresses • Procedure Packs • Taking a pulse v Pulse Oximetry • Moist Wound Healing • ISC v Urethral Catheterisation • Stoma Care - Pauls Tubing • Hand Gels • Negative Pressure Therapy Personal Challenges
  7. 7. The World Health Organisation Defines Health…. "not merely the absence of disease or infirmity, but a state of complete physical, mental, and social well-being“ • Wellness has been defined more as the action an individual takes to meet the above definition of health U.H.C Universal Health Coverage
  8. 8. What Does Great Look Like ? Endeavours to achieve the best clinical outcomes within controlled cost. Ideally, it is based on evidence-based practice, involves a multidisciplinary care team and is designed to meet local needs and constraints. “HSDPF was created to foster partnerships that augment the creation of a coordinated, cohesive and coherent health system that supports a one-health approach at community and primary level and increases financing and partnerships for delivery at these levels. These partnerships have the capability for sustainably and domestically financing: interventions towards the dual communicable and non-communicable disease burden, improving public health outcomes, health systems strengthening and disaster risk reduction”
  9. 9. Some Facts To Share According to recent data, the health care utilisation rate in Kenya is approximately 77% for those who are sick, meaning that a large percentage of the population does not seek care despite being ill. The three most significant barriers to entry in the Kenyan health system are : The cost of care The availability of suitable care within a reasonable distance Confidence in Facility Health Service Delivery ** lack of confidence – consistency
  10. 10. How Can we improve Health Care? Or…… What is Stopping us ?
  11. 11. If you always do what you’ve always done, you’ll always get what you’ve always got!
  12. 12. How Much Do You See of an “Iceberg”?
  13. 13. Focus On What You “Can’t See” **SG & A Selling of Goods and Administration
  14. 14. Consistency Supply Standards Efficiency Time Management Use of Available Resources Quality Reliability Ease of Use The Real Cost
  15. 15. A Model for Improvement Project Identification Getting a baseline Did project make a difference Will project sustain Evaluating worth of the project
  16. 16. In Every Day Life….
  17. 17. Marginal Gains An epidemiologist with the Ondo State Government, Dr Stephen Fagbemi, has reiterated the need for Nigerians to cultivate the habit of washing their hands regularly, saying it was capable of saving the country from a lot of diseases Infection Prevention / Control Do you really know how to clean your hands? Without leaving the bits between your fingers? If you do things like that properly, you will get ill a little bit less. They're tiny things but if you clump them together it makes a big difference. Fagbemi, in an interview with our correspondent, said diseases, such as malaria, diarrhoea, hepatitis A, cholera, typhoid, and measles could be avoided by regular handwashing
  18. 18. • Habit • Make washing hands an action automatically taken upon entering or leaving a patient care area, as well as before and after patient care. • Active feedback • Leadership plays an important role in continually communicating with staff member, patients and relatives about their hand hygiene compliance. Leaders can provide feedback by reminding staff to wash hands, engaging staff with real-time performance data, providing proper training and acknowledging and celebrating improved hand hygiene. • “No one excused” • Every staff member needs to be held accountable and responsible for proper hand hygiene. Identifying hand hygiene as an organizational priority communicates that everyone is expected to follow suit. • Data driven • Monitoring adherence to hand hygiene policy and analysing that data can help identify areas for improvement and spur the creation of ideas on targeted solution implementation. • Systems • Hand hygiene compliance is a system-wide effort, and protocols should be ingrained throughout the organisation. The infrastructure of systems should be designed in such a way that it is easier to adhere to proper hand hygiene, with infrastructural features such as easy access to hand hygiene equipment, technologies to help staff remember to wash hands and patient care areas set up in a way that is conducive to hand washing Strategies to Improve Outcomes
  19. 19. What Does Great Look Like? The Granny Test
  20. 20. Change
  21. 21. Moving From Illness to Health and Fitness
  22. 22. What Does Great Look Like ?
  23. 23. Potential Cost Savings : Single Use vs Reusable Thoughts Availability of Water / Cost Rivers contaminated ? Track and Trace Large amounts of water, Detergent, Steam, Electricity Ecological Effects Thoughts Waste Disposal? Costed Patient Journeys Variance v Planned Patient Outcomes
  24. 24. Advantages of Procedure Packs
  25. 25. Linked to Wound Healing Continuum TurningtheModelonItsHead DaringToBeDifferent
  26. 26. Farla-Led Success Criteria Health Change Outcome Led Employ a single project team Benefits Realisation Change is about delivering benefits The project team is responsible for delivering clearly specified benefits not for creating systems, structures nor introducing technologies. There should be no other success criteria! Business change projects should always be driven by benefits that support strategy A Sense of Urgency Organisational change with patient pathways / service redesign delivered with urgency Describe the clinical need - why the change project is necessary Specify the time-scale within which the project must deliver the benefits Successful organisations set a challenging schedule and stick to it – even when expert opinion suggests this is unachievable Time-Boxing Time-boxing is used to push the project team to make decisions about what is really needed Detailed analysis has the effect of putting the brakes on change. Quick Wins - Motivation Large scale organisational change = momentum + a sense of achievement + bags of optimism Time-boxing encourages quick wins, ensuring results are achieved at speed
  27. 27. Questions: Contact Details: mike@farlainternational.com
  28. 28. Who Are Farla Medical ?
  29. 29. Thank you Health Service or Illness Service Daring To Make A Difference Working Together Can Achieve Measurable and Sustainable Change Clinically Led Outcome Driven Care
  30. 30. Common Clinical Issues In All Aspects of Care : • Demand will outstrip supply • High turnover of all levels of staff • Not enough qualified staff • Different levels of ability • Some with no registered nurses • Reduced funding • Difficulty in access to education and training • Too many products • Too much inappropriate use of products • Too much waste Global Challenges Global Solutions “Daring to be Different”
  31. 31. The World Not Ready For An Aging Population Comorbidities by Age Range Global Healthcare Spending Growth
  32. 32. The Future Is Here Now
  33. 33. Why “Dare To Be Different”? • Wound care global market value over $23B by 2022 • UK Market value £500M • Over 170 wound care companies (60 UK) • Too many products to choose from : commoditisation • Lack of specialist support • Care delivered by non specialists • Need for better outcomes • Improved cost • Over complicated decision making Develop “New Care Models”
  34. 34. How Will Farla(Care) Dare To Be Different? • Clinically Led - Consultative Approach : New and Innovative • Define the real needs of the customers • Understand the real needs of the customer, patients and family • Engage with stakeholders and key decision makers • Link to NHS Plans / National Wound Care Strategy / CET / HEE / AHSNs • Simplify Messaging / Terminology : WYSIWYG • Freeing “Time To Care” • Involve the patient – Self Care Models • Audits and Training Needs Analysis • Implement new ways of working “Evidence Based” • Locally – Regionally – Nationally – Globally • Journal Submissions / Awards • Best Practice Statements • GS1 Care Pathways • Scanning4Safety • NICE approvals GIRFT(E) Getting It Right First Time EVERYTIME
  35. 35. How Will We Achieve This? Identify best practise Reduce variance Develop new models / pathways of care Reduce waste Share best practice and implement nationally (and internationally) Integrate and improve care and communication across all settings Reduce hospital re-admission & HAI NHS Plan : FOM / STPs (Future Operating Model / Sustainability and Transformation • These break down the barriers in providing care • between family doctors and hospitals • between health and social care service • With the intention to result in better care for patients • particularly those with long-term or complex needs • The strategy also aims to improve the efficiency and productivity of hospital services • through closer collaboration between hospitals Develop “New Care Models”
  36. 36. Packaging and Modelling : Innovative Collaboration Bags not boxes Easy to store, view product Hydrogel Gelling Fibre Foam Antimicrobial (e.g. Silver) Super Absorbent Dressing type Hydrocolloid Film Dressing
  37. 37. Delivering Better Outcomes Daring To Be Different Clinically Led Outcome Driven Care Preserve LifePreserve Prevent the Condition becoming worsePrevent Promote recoveryPromote
  38. 38. Extra Slides
  39. 39. Cost of Wound Care
  40. 40. Cost of Care Economic Estimation of Country Specific Hospital Costs Taghreed Adam, David B Evans and Christopher JL Murray HOSPITAL COSTS Cost per bed day by hospital level* Int $ 2005 LCU 2005 Primary 19.64 373.60 Secondary 25.62 487.40 Tertiary 34.99 665.73 Cost per outpatient visit by hospital level* Int $ 2005 LCU 2005 Primary 5.55 105.65 Secondary 7.88 149.86 Tertiary 11.65 221.68 HEALTH CENTRE COSTS Cost per visit at health centre by population coverage for a 20 minute visit ** Int $ 2005 LCU 2005 50% 7.29 138.72 80% 8.59 163.45 95% 13.04 248.02
  41. 41. Single Use V Reusable Time Saving - Readily available – set up time – turnaround time – standardisation – reliability - Staff Training - Life Saving - Dangers posed by ‘prion diseases’ such as Variant Creutzfeldt-Jakob disease (vCJD) other spongiform encephalopathies. SSI’s Cost Saving - Cleaning – Sterilization – Staff Time – Maintenance – Storage - Loss – New Technology – New procedures – Facilities
  42. 42. Savings: “poorly organised clinical equipment can waste significant amounts of time otherwise available for direct patient care.” At a time when the NHS and other healthcare providers are under increased scrutiny and are operating on ever tighter budgets, it is evident that new efficiencies and processes are needed. BMJ Quality Improvement Reports 2015; 18th May 2015 This problem is not a new one nor is it insubstantial. According to a 2009 survey by Nursing Times, “more than one-third of nurses spend at least an hour finding items of equipment during an average hospital shift.” This could mean that nurses spend up to 40 hours per month looking for equipment with which to treat patients. Nursing Times Feb 10th 2009
  43. 43. Some Solutions To The Challenges We Face
  44. 44. Infection Control In Africa. Nosocomial Infection. • The effectiveness of prevention and control efforts is dependent on health care services and the prevalence of disease. • Funding for health care, the perceived economic impact of infection control, and trained administrators determine the availability of health services and the spread of disease. • The challenge is to provide cleanliness, aseptic techniques in patient care, and protection for the health worker. If the hospital infection rate is as high as 15% of admissions and each case requires an additional 7 days of hospitalization, the estimated costs nationally could exceed US $110 million. • Africa has a massive infectious disease burden, in addition to HIV and tuberculosis. • The spread of Ebola fever shows how out-of-control infections can become. • Most African countries are unequipped with infrastructure to handle surveillance of the new resistant bacterial strains resulting from indiscriminate use of antibiotics. • In Zimbabwe, infection and prevention control was proved possible and cost effective. • Education was provided at the village level in basic hygiene, home nursing, construction of fly-proof pit toilets, and a safe water supply. • Training of trainers expanded the process of education. • The "Infection Control Manual" provides the manager with the principles and background knowledge for prevention and control of infections. The Infection Control Association of Southern Africa is a useful source of information, standards, and support base.
  45. 45. Preserve LifePreserve Prevent the Condition becoming worse Prevent Promote recoveryPromote
  46. 46. KISS Principle
  47. 47. Communicate … Communicate … Communicate
  48. 48. The Future is here NOW…..
  49. 49. What Does Great Look Like ? Endeavours to achieve the best clinical outcomes within controlled cost. Ideally, it is based on evidence-based practice, involves a multidisciplinary care team and is designed to meet local needs and constraints. ‘HSDPF was created to foster partnerships that augment the creation of a coordinated, cohesive and coherent health system that supports a one-health approach at community and primary level and increases financing and partnerships for delivery at these levels. These partnerships have the capability for sustainably and domestically financing: interventions towards the dual communicable and non-communicable disease burden, improving public health outcomes, health systems strengthening and disaster risk reduction’.
  50. 50. The Communication Model : It’s Good To Talk Early Stakeholder Engagement Regular Reviews Agreed Goals Measurement Celebrate Wins
  51. 51. The Chimp Paradox Professor Steve Peters is a Consultant Psychiatrist who specialises in the functioning of the human mind. His work, past and present, in the field of psychiatry and education includes: the National Health Service (NHS) for over 20 years; Clinical Director of Mental Health Services; Clinical Director at Bassetlaw Hospital; Forensic Psychiatrist at Rampton; Senior Clinical Lecturer of Medicine at Sheffield University for over 20 years; Undergraduate Dean at Sheffield University for over 10 years; and visiting Professor at Derby University. He holds degrees, higher degrees and postgraduate qualifications in medicine, mathematics, education, medical education, sports medicine and psychiatry.
  52. 52. The Cost of Health Care : How Does it Compare?
  53. 53. Kenya Health Check A country of approximately 37 million people, Kenya has struggled to build a health system that can effectively deliver quality health services to its population. Access to health care varies widely throughout the country and is determined on numerous factors, though in particular: Major divides between rural and urban communities, Between the moneyed elite and the poorer masses In Kenya, the poorer masses—those living below the national poverty line constitute approximately 52% of the population. According to the World Health Organization (WHO) 2007
  54. 54. Kenya Health Check Life Expectancy Kenya (both sexes) 54 years Global Average 68 years Child Mortality Rate approximately 121 per 1000 live births Double global average Prevalence of communicable diseases major factor in health outcomes HIV prevalence Urban Adults 10% Rural Adults 5.6% Co infection rates for TB and HIV 45% According to the World Health Organization (WHO) 2007 Malaria 13.6 of deaths in children under 5
  55. 55. Why Single Use Instruments Decontamination Single use instruments guarantee a completely clean and sterile instrument for every patient, which is used once and disposed of, removing the need for lengthy decontamination processes. Furthermore, compliance with the new HTM 2030 guidelines for National Decontamination will mean that small practices and surgeries now have to comply with the same standards as set for Sterile Service facilities in NHS Acute Trusts. • . Traceability Single use instruments are all individually traceable. The lot number that appears on the packaging is all the information that is required to trace the instrument back to its production batch and date. Logistics and Supplies Minor procedures are increasing in local clinics and GP surgeries. Single use instruments purchased directly from a medical device supplier allow a clinic to manage their supplies in line with their demand
  56. 56. Why Single Use Instruments Risk Management Managing the risk of infection is high on the agenda of all healthcare professionals. The dangers posed by vCJD, and other prion diseases, is a major consideration when talking about a move to single use instruments. The prion that infects a person with vCJD, found in neurological tissue, is thought to survive for up to 10 decontamination cycles, meaning that infected instruments could be being used in procedures. Recent findings suggesting that many more people could be carrying vCJD than was previously thought compounds concerns that the disease is being passed on through contaminated instruments. Cost Allocation In an increasingly cost aware health service it is important that the cost of each procedure can be accounted for accurately. When using single use instruments and procedure packs the cost is simple and easy to calculate. However attributing cost when using reusable instruments is not always accurate as the real cost of sterilisation is difficult to record as the costs can be hidden in utility bills and staffing costs. Waste With all single use instruments the environmental impact of disposal is often questioned, as currently to comply with EU Directives on the disposal of medical waste they go for incineration and landfill. However this has to be weighed up against the real effect of reusing items. A reusable instrument has to undergo the thorough decontamination regime which includes large amounts of water, detergent, steam, electricity etc. to prepare it for re-use. The impact on the environment of the use of these utilities and detergents during sterilisation has to be factored in equally when comparing the ecological effects of single use to reusable instruments. .

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