At the first keynote for the Nuffield Trust Health Policy Summit 2016, Mark Britnell gives an overview of key characteristics of effective health systems.

1. #ntsummit
The perfect health system
Dr Mark Britnell, Chairman and Partner, Global Health Practice,
KPMG @markbritnell

2. Member of the World Economic Forum Global Agenda Council
60
200
Countries
Occasions
(© 2015 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or
bind KPMG International or any other member firm vis-à-vis third parties, nor does KPMG International have any such authority to obligate or bind any member firm. All rights reserved.
The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks of KPMG International.

3. The world is a book and
he who does not travel
reads only one page

4. (© 2015 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or
bind KPMG International or any other member firm vis-à-vis third parties, nor does KPMG International have any such authority to obligate or bind any member firm. All rights reserved.
The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks of KPMG International.
Primary care
of Israel
Community
services
of Brazil
Mental
health and
wellbeing of
Australia
Health promotion
of the Nordics
Patient and
community
empowerment
of parts of Africa
Research and
development
of the US
Innovation, flair
and speed
of India
Information,
communication
and technology
of Singapore
Funding
of Switzerland
Choice
of France
Aged care
of Japan
1 2 4 5 6
7 8 9 10 11 12
3
Values and
universal
healthcare
of the UK

5. How has transformation been achieved?
Time for organizational excellence to evolve
(HMOs est. 1911, 1933, 1941 and 1974).
Clalit: 54% population, 1,400 primary
care clinics, 8 hospitals, 420 pharmacies.
75% buy ‘gold’ top up – reduced waits, doctor
choice, home visits. Funds innovation.
1
Life expectancy: 82.1
% GDP on health: 7.2%
Competition between HMOs incentivizes
continuous service improvements.
Unified records since 2001 – unparalleled
opportunity for predictive/prescriptive analytics.
Collaboration between HMO providers
incentivizes shifting care to best value location.
.

6. How has transformation been achieved?
Provider chains offer remarkable economies
of scale – Narayana heart surgeons perform
3 times more procedures, at 10% of NHS
costs with comparable outcomes.
A four-step process behind success:
(1) Standardize clinical processes
(2) Capture these into IT systems
(3) Task shift to maximize skill mix
(4) Effective innovations spread across chain
Patient power: “Essentially we’re taking the
most passionate, most trustworthy person
and educating them by doing.” – Dev Shetty
2
Life expectancy: 67.7
% GDP on health: 3.9%
Broken promises on UHC – plans to double
public spending disappear into policy vacuum

7. How has transformation been achieved?
Steady push for aligned incentives and
slow-quick-slow implementation:
3
Life expectancy: 82.3
% GDP on health: 4.6%
Confirms KPMG research on key success factors:
Summary e-records across all hospitals2004:
2011: Single record across all public settings
2013: Six care clusters formed with a hospital
at the centre acting as mini-SHA
2015: All patients can access records online
1. Collaborative alignment: Clear leadership from
government over 12 years (MoH & AfIC)
2. Crowd-accelerated innovation: Clinical
transformation teams work in tandem with
developers
3. Creative dislocation: Clustering providers to
think along pathways of care.

8. How has transformation been achieved?
World’s oldest society, with over 25%
of population 65+. Will shrink by almost
1 million a year to 2050
Sluggish economic growth and fractious
politics, yet the political boldness to see
through necessary reform
Nationally set means test, but service
planning administered locally. ~10% copay.
4
Life expectancy: 83.3
% GDP on health: 10.3%
Has transformed the aged care sector, but
pressures still exist (18 day average LoS)
In 2000, 1-2% income tax instituted for
over 40s to pay for aged care insurance
(home, community and residential)

9. Achieving sustainable, large-scale change
Health systems the
world over have a
strikingly similar set of
ambitions for how to
achieve this
Yet few are
achieving these
aspirations.
All face the problem of
pockets of excellence
(showing it can be done)
but the majority resist
change
Every country wants
to deliver safe,
consistently good,
financially
sustainable care
The IoM has highlighted four key ingredients:
Designing care
from patients’
perspectives
Systems, not
organisations of
care
Enabling
regulatory and
financial
environment
A sustainable
vision
1 2 3 4

10. Three key barriers to change
Organisational
myopia
Transaction
trumps
transformation
Failure to engage
emotional side of
change
1
2
3

11. Three key barriers to change
1
Organisational
myopia
What is the scale of change required in the
healthcare sector in your country?
What is the scale of change
required in you organisation?
35%
36%
16%
6%
6%
73%
19%
7%
1%
1%
Fundamental
Moderate
Incremental
Very little
No change reqired

12. 1
Transaction trumps
transformation
2
85%
81%
74%
44%
56%
52%
44%
30%
22%
30%
81%
78%
85% 85%
74%
50% 52%
41%
56%
63%
33%
19%
93%
85%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Majorcost
reduction
Leanorother
improvement
methods
Developingnew
workforcemodels
Incomegrowthfrom
existingpayers
Mergers
Acquisitionsof
otherhospitals
Acquisitionsof
otherprovidertypes
Verticalintegration
Entryintonew
markets
inthecountry
Expansioninto
overseasmarkets
Focus&
specialization
Investmentin
healthIT
%ofresponses:
'Likely'or'VeryLikely'
Three key barriers to change

13. 2
Failure to engage the
emotional side of change 3
8%
4%
0%
58%
31%
0%
10%
20%
30%
40%
50%
60%
70%
Strongly
disagree
Disagree Neither
agree
nor
disagree
Agree Strongly
agree
“The delivery of healthcare is
currently structured more
according to organisational
structures and boundaries than
the needs of the patient"
Three key barriers to change

14. 2
Failure to engage the
emotional side of change 3
Are patient experience
measures used in the
performance appraisal of
clinical staff and
managers within your
organisation?
Clinical staff
Managers
46%
37%
17%
46%
42%
12%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yes No Don't know
Three key barriers to change

15. Nothing in life is to be feared,
it is only to be understood.
Now is the time to understand
more, so that we may fear less
Marie Curie
(© 2015 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or
bind KPMG International or any other member firm vis-à-vis third parties, nor does KPMG International have any such authority to obligate or bind any member firm. All rights reserved.
The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks of KPMG International.