dr jennifer dixon: efficiency
TRANSCRIPT
![Page 1: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/1.jpg)
EfficiencyEfficiency
Dr Jennifer DixonDirectorThe Nuffield Trust
24 March 2010
![Page 2: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/2.jpg)
We’ve been here before
![Page 3: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/3.jpg)
3
NHS demand and funding by year
70,000
80,000
90,000
100,000
110,000
120,000
130,000
2006
/07
2007
/08
2008
/09
2009
/10
2010
/11
2011
/12
2012
/13
2013
/14
£ m
illio
n
fundingdemand
Source: DH
What is different now is scale
![Page 4: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/4.jpg)
… resources static at best
Source: Appleby et al. How Cold Will it be? Prospects for NHS funding: 2011-2017 (King’s Fund and IFS, 2009)
Tepid Cold Arctic
![Page 5: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/5.jpg)
We are in better shape than before
Information and guidance
Quality
Financial management
Improvement techniques
Consensus
5
![Page 6: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/6.jpg)
We know there is waste
6
![Page 7: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/7.jpg)
£2.1bn from two NHSI products
![Page 8: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/8.jpg)
8 18
– Reducing day-before admissions by 95%
– Shifting more elective procedures to higher-margin day cases
– Improving recording and income capture
– Decreasing controllable DNAs
– Decreasing number of beds through decreasing the bed capacity buffer available to meet variable emergency demand
– Decreasing number of beds through streamlining elective demand
– Increasing discharge timeliness through addressing blocking social factors
– Increasing discharge timeliness through removing weekend holdups
– Matching staffing levels/mix to demand though higher staffing flexibility
– Improving outpatient profitability
– Increasing theatre utilisation
– Decreasing consumables costs ****
1
2
7
6
5
4
3
8
9
10
Through bottom-up analysis and cross site benchmarking, we identified several quick-win ideas, and others that require deeper systemic change
11
12
Quick wins(achievable within 6
months)
Longer-term opportunities
(achievable in 12 months;require process redesign
and/or significant behavioural change)
£1m in one surgical directorate
![Page 9: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/9.jpg)
Too many persons are admitted to hospitals for diabetes complications, highlighting the need to improve primary care
Diabetes acute complications admission rates, population aged 15 and over, 2007
1. Does not fully exclude day cases.2. Includes transfers from other hospital units, which marginally elevates rates.Source: OECD Health Care Quality Indicators Data 2009 (OECD).
![Page 10: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/10.jpg)
Avoidable admissions
10
LOS ICD10 Diagosis AcuteTrust
APR 2002 11 J440 Chronic obstruct pulmonary dis with acute lower resp infec Hospital EMAY 2002 4 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital EJUL 2002 8 J440 Chronic obstruct pulmonary dis with acute lower resp infec Hospital EAUG 2002 3 I500 Congestive heart failure Hospital FAUG 2002 2 J449 Chronic obstructive pulmonary disease unspecified Hospital FOCT 2002 3 J440 Chronic obstruct pulmonary dis with acute lower resp infec Hospital FOCT 2002 2 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital GOCT 2002 2 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital GNOV 2002 4 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital FDEC 2002 4 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital GDEC 2002 5 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital GJAN 2003 1 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital GFEB 2003 3 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital G
Month ofAdmission
![Page 11: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/11.jpg)
Rise in zero and 1 day admissions
11Source: Nuffield Trust
![Page 12: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/12.jpg)
Why waste?
Rigid working practices
Boundaries
Incentives
Leadership/motivation/culture
12
![Page 13: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/13.jpg)
Biggest efficiency frontiers
Prevent avoidable hospital costs– Secondary prevention (LTC, older people)
– End of life
– Primary prevention (obesity inactivity)
13
![Page 14: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/14.jpg)
Obesity among adults is increasing in all OECD countries.
1. Australia, Czech Republic (2005), Japan, Luxembourg, New Zealand, Slovak Republic (2007), United Kingdom and United States figures are based on health examination surveys, rather than health interview surveys.
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
We are here
![Page 15: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/15.jpg)
Emergency admissions increase with age..
15Source: Nuffield Trust
![Page 16: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/16.jpg)
.. and are in general medicine
16Source: Nuffield Trust
![Page 17: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/17.jpg)
Short term changes will get us somewhere
Operational efficiencies
Topslice
Cuts: staff, facilities, beds
Tariff (and non-tariff)
Wage settlements
Cuts in central budgets
17
![Page 18: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/18.jpg)
“The current care systems cannot do the job.Trying harder will not work, changing systems of care will.”
Need systems of care in which “clinician and patient andinstitutions… collaborate and communicate toensure appropriate exchange of information andco-ordination of care”
(Institute of Medicine, Crossing the Quality Chasm, 2001)
But change in landscape needed
![Page 19: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/19.jpg)
Meaning….
19
![Page 20: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/20.jpg)
… and probably a lot of…
20
![Page 21: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/21.jpg)
Migration path challenging
Highly centralised ‘national’ system
Culture and risk
Doctors
Information and analytics
Incentives
Commissioning
Competition and cooperation
21
![Page 22: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/22.jpg)
Information underexploited
22
![Page 23: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/23.jpg)
CostsCosts
Social care
Costs
Uniquely helpful data environment in UK
![Page 24: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/24.jpg)
Data linkage : Social & hospital care overlap
Population of over 55s registered in one PCT
94% of those with a social care contact have also had secondary care contact(s) in three years
Source: Nuffield Trust
![Page 25: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/25.jpg)
Data linkage Health and social care event timeline
Source: Nuffield Trust
![Page 26: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/26.jpg)
Individualised data to guide appropriate intervention…
Ongoing, individualised, real time data analysis to guide intervention:
Utilisation and demand management
Care coordination
Risk factor reduction
Source: Humana UK
![Page 27: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/27.jpg)
…and assess impact of interventions to reduce cost
27Source: Nuffield Trust
![Page 28: Dr Jennifer Dixon: Efficiency](https://reader034.vdocument.in/reader034/viewer/2022042715/55840683d8b42a126e8b48f2/html5/thumbnails/28.jpg)
Summary
Financial challenge big
NHS in better shape Efficiencies and cuts needed
But more significant change needed
No one tool
Key ingredients:– Physicians
– Information
– Incentives
– Entrepreneurialism/ risk cover
28