Prof Michael ThickChief Medical Officer and Chief Clinical Information OfficerIMS MAXIMS

Clinical leadership and keeping patients safe.

Quality and Efficiency are the Prime Drivers of Reform…..

As of April 2013“The principle criterion by which contract delivery will be judged is Quality……”

and now “value”.

3 Dimensions of QualityHow successful is treatment, what are the outcomes?Safety, and avoiding unnecessary riskPatient recorded outcome measures – “How was it for you?”

……and now Productivity and cost

The 3 Dimensions of Quality

Patie

nt S

afet

yClinical Outcom

es

Patient Experience

66% of hospitals offer inadequate care

Targets – 13% inadequate, 61% require improvement

7% of Health and Social Care Providers “Inadequate overall”

“Worryingly wide” variations in quality of care

CQC Annual Report 2015

Adverse Safety Incidents

Nuclear Industry 1 : 100,000

Aviation Industry 1 : 10,000

Both improving year on year

….and what about Medicine?

Adverse Safety Incidents

1 : 10Unchanged in 30 years

Initial research suggests four very different groups of patients:

“Better safe than sorry”Seeks to minimise uncertainty

and manage risk

“Health starts with healthy living”

Seeks to maintain control over all aspects of health

“I’ll deal with it when it happens”

Seeks to minimise pain and inconvenience (including the inconvenience of using the

NHS)

“Really, I’m fine”Seeks to avoid perception of

self as weak or hypochondriac

I need to look after my health

My health looks after itself

Illness is a failure

Illness is a fact

High Disillusioned Sceptics

Enthusiastic Pragmatists

Low Habitual Cynics

NaïveIdealists

Negative Positive

Grip on reality

Outlook

-1.2000 -0.6000 0.0000 0.6000 1.2000 1.8000

-1.5750

-0.7875

0.0000

0.7875

1.5750

2.3625

N&Y RegionEnglandWales

Systematised concepts of

clinical work

Emphasis on clinical purism and opaque accountability

Individualistic concepts of clinical work

Emphasis on financial realism and transparent accountability

Professional Subcultures of Acute trusts in an international sample

Lessons!

TribalRepeatablePredictableTailored approach possible

So in reality what does this mean?

Technology’s potential to support the transformation of health and social care is dependent on:

Meaningful clinical engagement and clinical leadership

A demonstrable commitment to interoperability

A willingness to embrace disruptive technologies

€1 €10 €100 €1,000 €10,0000%

100%

Healthy, Independent Living

Chronic Disease Management Doctor’s

Office

Community Clinic

HOME CARE

Assisted Living

Skilled Nursing Facility

RESIDENTIAL CARE

Community Hospital

ICU

Specialist Clinic

CLINICAL CARE

COST of CARE/DAY

QUALITY

of LIFE

Traditional Health IT Focus

Development of the transformation

Number of tests available

Num

ber o

f peo

ple

test

ed

PCR and Chemistry based “dipstick”

methods win

Protein arrays, microfluidics & POC

drive uptake

Rapid DNA Sequencing, arrays, microfluidics drive

costs down

PCR, DNA Seq & bead based methods

drive simplicity

Gene Expression & <50 SNP tests

Protein expression & whole genome tests

<10 SNP tests

ICT solutions drive transformation

Today

2015

2008

2006

Trait Theory Style Theory Situational Theory Transformational Theory

Leadership Theories

Result Focus Capability Focus

BornHeroicCharacteristics

MadeBehaviours

MadeContextSituationalFlexibility

Born & MadeFollowersServant Leadership

Born & MadeSituational

Command and control!

“Towards a million change agents” Explores concept of “social movement” as means of bringing

about change. Literature review (Bate et al) There is a place for “heroic” leadership. BUT Evidence favours multiple, multilevel, dispersed and networked

leadership.

Satisfaction/Complacency

Denial/Rejection

Anger/Resistance

Acceptance/Curiosity

Enthusiasm/Hope

Commitment/Excitement

OPPOSED ENGAGED

CommunicationPriorities

•Conveyurgency•Give facts•Provideevidence•Convey bigpicture

•Listen•Showconcern•Restatefacts

•Listen•Demonstrateconcern•Restate facts•Conveycommitment

•Restate bigpicture•Communicatevision•Ask for help

•Involve•Celebrate wins•Inspire

•Feedbacksuccess•Inspire•CreateChampions

Communication & Resistance

Change - Resistance Model

The key characteristics of future systems.

Empower the less skilled to do “bigger” roles✓Clinical content will be the most important element✓It will be “active”, and incoming data will be matched to it to make decisions

Clinician AND Carers will expect✓Right data, Right information, Right place, Right time✓Patient accessible (governance of content and consent)✓Interoperability and mobile working

The key characteristics of future systems

Support national and local ways of working✓College, Society and agreed clinical pathways✓Local COE order sets and prescribing

Quality indices will require✓Content maintained to reflect “current” knowledge✓Recording of metrics of outcomes and quality ✓The ability to record care delivery✓Ability to record Patient Recorded Outcomes Measures

...is Affable, Able, and Available...Puts safety at the front of practise Insists on outcome measuresIs sensitive to ALL patient needsIs trained to appreciate leadership styleCan “follow”Knows technology is the servant of process

The clinical leader......

The iceman carried a series of tattoos to inform any “doctor” of his medical problems AND to identify relevant acupuncture treatment sites.

Patient sees doctor in 3200BC

The HRCT scan of the iceman missed the arrow head

The Future of Health

“…..The future is already here, it’s just not evenly distributed…..”(William Gibson)

Professor Michael ThickChief Medical Officer/Chief Clinical Information OfficerIMS MAXIMS

Michael.Thick@imsmaxims.com