Professor Michael Thick, Chief Medical Officer and Chief Clinical Information Officer, IMS Maxims
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Prof Michael Thick Chief Medical Officer and Chief Clinical Information Officer IMS MAXIMS Clinical leadership and keeping patients safe.
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Transcript of Professor Michael Thick, Chief Medical Officer and Chief Clinical Information Officer, IMS Maxims
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
