towards informed and innovative commissioning commissioning workshop for library & knowledge...
TRANSCRIPT
Towards informed and innovative
commissioningCommissioning Workshop
for Library & Knowledge Services October 2013
1. Commissioning defined2. Context3. Evidence-based commissioning4. Understanding the customer5. Best value6. How can librarians evolve to meet the need?
Sue Lacey Bryant
The library as a platform for change
• Health is a knowledge- based industry• Health is a people based industry• What more can librarians do to help?• “What more can I do to help?”
Sue Lacey Bryant
1. Commissioning defined
“the process of allocating public resources to achieve the greatest gains in health within a
defined population”
Simon Lenton: Introduction to developing and commissioning pathways www.networks.nhs.uk/
Sue Lacey Bryant
Shift in approach to commissioning 20th Century
• Hospital centred• Challenges met by growth
• Clinician-centred• Benefits of treatment• Quality improvement • Focus on individual • Patient compliance; public &
patient engagement • High carbon usage
21stCentury• Care closer to home• Transformation; innovation;
whole system; redesign
• Patient-centred• Prevention; risk stratification • Reduce waste; increase value• Population perspective• Patient as co-producer
• Low carbon usage
Sue Lacey Bryant
2. Context: key facts
The NHS in England:• Deals with over ? patients every 36 hours• Serves ? people• Employs ? staff• Budget of ? £ Billion• Av. CCG is commissioning care for ? people; • Av. CCG has been allocated ? £m in 2013-14Life expectancy rising Infant mortality falling
Sue Lacey Bryant
Key facts
The NHS in England:• Deals with over 1m patients every 36 hours• Serves 53m people• Employs 1.35m staff• Budget of £95.6 billion• Av. CCG is commissioning care for 226,000 people; • Av. CCG has been allocated c £300m in 2013-14Life expectancy rising Infant mortality falling
Sue Lacey Bryant
Where in the world are we?
• NHS ranked 2ndafter Holland• 2nd patient equality & safety• Scored highly on access
• Best system in terms of efficiency, effective care and cost-related problems
2010 : NHS cost £2,021 per
person in UK - less than half than the £4,926 per head in US
• 2nd to last for 'long, healthy, productive lives‘
• Bottom for life expectancy of patients at age 60
22.5 yrs vs 24.6 in Australia
• Much higher death rates from conditions amenable to medical care.
In 2003 rates were 25% - 50% higher than Canada and Australia
Sue Lacey Bryant
Platform for change
• Harsh financial climate: find £20 billion efficiency savings by 2015
• Berwick report: give patients quality care
every time
Sue Lacey Bryant
Pressures
• Unprecedented demand
• Ageing population– more complex health needs– Increasing demand
• Patient involvement– No decision about me without me
Sue Lacey Bryant
Priorities
• Stemming the increase in emergency admissions
• Service reconfiguration; making the shift from hospital to community care; seamless care
• Addressing inappropriate variations in clinical practice; clinical safety and quality
• Improving Public Health; reducing inequalities
Sue Lacey Bryant
Primary care at the helm
• GPs manage the lion’s share of NHS medical work
• High level of patient confidence and satisfaction
• One year's care by a GP costs c1/10th of a day in hospital
• CCGs responsible for £65 billion of the £95b commissioning budget
• Increasing choice and service integration
Sue Lacey Bryant
3. Evidence-based commissioning
“the process of allocating public resources to achieve the greatest gains in health within a defined
population”
Simon Lenton: Introduction to developing and commissioning pathways www.networks.nhs.uk/
Sue Lacey Bryant
Evidence based commissioning
Redesigning services in the NHS can be an incredibly complex task, with differential demands for information and evidence originating from the nature of the task itself
Emerging research suggests that, for redesigning and commissioning or recommissioning services, equal attention may need to be paid to both clinical and non-clinical evidence.
Emmanouil Gkeredakis & ClaudiaRoginski: The need for clarity in evidence based commissioning. HSJ 23 May 2011
Sue Lacey Bryant
Top Tips for gathering evidence
• Consider the different forms of evidence needed for different tasks
• Value plurality of evidence (from authoritative bodies & local knowledge)
• Be proactive• Ask advice from people who have already
tackled the challenge
Derived from Emmanouil Gkeredakis; Claudia Roginski: The need for clarity in evidence based commissioning. HSJ 23 May 2011
Sue Lacey Bryant
Pressing need for innovation
“We need to radically transform the way we deliver services. Innovation is the only way we can meet these challenges”
“Put simply, we must make innovation a priority. We know that the NHS can spread new ideas at pace and scale when it puts its mind to it, and we need to do more of this.”
“ Innovation ... needs to be replicable – and replicated – across similar settings. So innovation is as much about applying an idea, service or product in a new context, or in a new organisation, as it is about creating something entirely new. Copying is good.”Sue Lacey Bryant
The value of library and knowledge services to QIPP
David Nicholson. HSJ. 10 Sept 2009
Sue Lacey Bryant
“What I hear around the country is that we have masses of information but we need to turn that into something that is intelligible and can be used for strategic decision making. We need to look at how information links together to get a holistic picture of the situation.”
Dr Shahid Ali, GP and Clinical Lead, Patients and Intelligence Directorate, NCB
What do commissioners ask?
• How have others done it?• Data on outcomes?• Benchmarking• Data and models to support development of
specifications• Key performance indicators?• Summaries
Sue Lacey Bryant
Examples - Evidence searches• Impacting on hospital use (re)admission, Outpatient Dept,
A&E, community care• GPs in A&E departments• Has anyone charged for DNAs?• Outcomes of MSK services• Service specifications inc. Community cardiology, MSK,
Urgent Care• What self care tools will we need to support our new MSK
Clinical Assessment & Triage services?• Predictive modelling tools • Return on Investment in telehealth/telecare• Why are our antenatal admissions so high?• Self management, decision aids• Outcomes based contracting
Sue Lacey Bryant
“Anne carried out three targeted data searches for me to support the CCG’s three Local Priorities in its Integrated Commissioning Plan (ICP). Rather than merely searching for relevant articles, Anne reflected on the problem areas, searched for evidence of a range of successful interventions achieved elsewhere and provided a new measurable solutions for the CCG to adopt. This saved me time in developing the ICP and added real value and a new angle of approach.”
Tim Deeprose: Interim Director of Commissioning, NHS Milton Keynes CCG, July 2013
Sue Lacey Bryant
What sources do commissioners value?Survey n=300
Very/quite important • Local public health
intelligence • Expert advice• Examples of best practice• Local policies• Guidelines• Government pubns• Benchmarking• Cost effectiveness
Not important/did not use• General published
literature• Professional association
guidance• Management studies• Academic research• Management consultants
Sue Lacey Bryant
HSJ 26 May 2011 p23-25
Core offer into CCGs & CSUs?Generic/At scale offer
• Horizon scanning• Tailored and targeted dissemination of evidence, by
stakeholder group• Concise summaries of key policy documents • Intranet/web knowledge zone
• Aligned with the strategic objectives of the organisation
Sue Lacey Bryant
Core offer into CCGs & CSUs?
Specialised services – for individuals ; for teams
• Investigative research and enquiry service covering clinical & cost effectiveness; best practice”; models of service
• Producing Easily read, synthesised reports ie. retrieve, select, appraise, summarise• SDI to key personnel - by profile • Supporting pathway review & service redesign • Information skills training
Sue Lacey Bryant
Targeted alerting services • Client focus; ensuring insights into CCG agenda• national policy drivers• transforming pathways• QIPP challenge; financial balance• supporting service redesign; models of delivery• promoting best evidence• promoting tools and resources• sharing best practice to drive innovation and enable
transformation
Sue Lacey Bryant
A bang for the buck
• Work to strengths: what are we really good at? • Collaborate to improve products & services? • Efficiency: at-scale delivery of back office• Understand which functions can routinely be
delivered remotely? Which require engagement?• Use strengths in networking to enhance impact• Help to overcome silo mentalities• Raise our expectations; demonstrate impact• Quality = clarity and standards Reflect on service specifications and KPIs
Sue Lacey Bryant
What does good look like?Performance area KPI Performance
scoreTimeliness Search reports to be delivered by…
Availability & Responsiveness
Routine queries to be dealt within….
Priority queries to be dealt with within …
Client Satisfaction Use baseline client survey to develop
Value for Money Incorporate planned efficiency of back office functions into delivery of service
Quality. Q - Is this the sum of the parts? Impact?
Meeting clearly defined standards
Delivery of added value
Sue Lacey Bryant
Benefits• Benefits:
o Cost effective;o Time effective o Expertise in sourcing, selecting, summarisingo Knowledge of resourceso Rapid response optiono Build a knowledge resource
• High quality service to support both strategy & operations• Scale up across the potential customer base
Sue Lacey Bryant
Criteria by which to assess CSS
Alignment: demonstrable commitment to achieving CCG objectives inc. high quality care Responsive: to the individual priorities of our CCG and the population on behalf of which we commission Agile: flexibility to support changing demands on CCG
Cost effective: value for money; added value
Innovation: sharing best practice; ‘lift & shift’ where practical
Business focus: robust arrangements to support multiple clients
Sue Lacey Bryant
Actions speak louder than words
3 actions from this session inc. the presentation and your group discussion
1.
2.
3.
Sue Lacey Bryant
6. How can health librarians evolve to meet the need?
Source: A visualização da imagem anterior desperta para a leitura do artigo: "Evolving Web, evolving librarian" de Amy and Robert Favini
balcaodebiblioteca.blogspot.com
Sue Lacey Bryant
Enhancing the role of librarians
Role enhancement involves expanding a group of workers' skills so they can assume a wider and higher range of responsibilities through innovative and non-traditional roles
Sue Lacey Bryant
Positioning librarians as catalysts for improvement
• Aligning with NHS priorities• Bringing research, education and practice
closer together• Spreading innovation• Multidisciplinary working• Changing skill mix: role substitution, role enlargement & enhancement
Sue Lacey Bryant