Sumathi Sundram - UEA 1 Defining and measuring Knowledge Capital in Health Care Presenter: Sumathi...

Sumathi Sundram - UEASumathi Sundram - UEA

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Defining and measuring Knowledge Capital in Health Care

Presenter: Sumathi Sundram

University Of East Anglia - Health Economics Group / Norwich Business School

Co – Author: Dr Pinar Guven- Uslu

University of East Anglia – Norwich Business School


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ContextContext

Purpose of ResearchPurpose of Research

Concept ;Theoretical Frameworks Concept ;Theoretical Frameworks

Methods Methods

Some Results Some Results

ConclusionConclusion

Knowledge Capital in Health Care


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Primary Care Trusts Primary Care Trusts - HMOs- HMOs

PolicyPolicy - Centralised, national- Centralised, national

FundingFunding - Top down to PCTs- Top down to PCTs

Care ProvidersCare Providers - Public Sector, - Public Sector, mainlymainly

Private Sector, limited Private Sector, limited

UK context of Health Care


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Maximise Investment in HealthMaximise Investment in Health

Define and measure Knowledge Capital in health Define and measure Knowledge Capital in health care organisationcare organisation

Stock of embedded knowledge generating Stock of embedded knowledge generating capacitycapacity

Method to define and measure knowledge capital Method to define and measure knowledge capital in monetary and non monetary termsin monetary and non monetary terms

Purpose of Research


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Knowledge Capital

Edvinsson & Sullivan define :

“Intellectual/ Knowledge Capital as the

knowledge that is constantly being developed

in organisations together with its’ ability to

convert these assets into revenue”


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Theory of Knowledge creating organisations

Meritum Project categorisation

Theoretical Frameworks


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Research/ Knowledge Creation in Research/ Knowledge Creation in HealthHealth

““Public Good” certain outputs non- rival, non Public Good” certain outputs non- rival, non

excludableexcludable

Research & Development key driver for Health Research & Development key driver for Health

ImprovementImprovement

Economic potential of public sector research Economic potential of public sector research

establishments establishments

Research key resource in healthcare servicesResearch key resource in healthcare services


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Why Knowledge Capital in Health

Theoretical basis for management of knowledge creation

or research in health

Difficulty in agreeing resource allocation basis

Lack explicit recognition of phenomena

R&D capacity part of knowledge capital base

Optimal path of investment in health to maximise all

benefits (inc) knowledge generation/ research capacity


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MethodologyMethodology

Literature Review Literature Review

Mixed Methods - Bottom up costing & Mixed Methods - Bottom up costing & Qualitative methodsQualitative methods

Semi Structured Interviews- 2 Stages Semi Structured Interviews- 2 Stages

Operational and Financial reports analysisOperational and Financial reports analysis


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Adapted from Nonaka, Nomura and Kametsu , & Umemoto (1999)

Experiential Knowledge

Conceptual Knowledge

Routine Knowledge

Interacting &

Capturing

Identifying & Sharing

Selecting & Adapting

Tacit Knowledge

Explicit Knowledge

Tacit Knowledge

Explicit Knowledge

Systemic Knowledge

Organising &

Formalising Research & Health and Social Care delivery

Primary Knowledge

Secondary Knowledge

Application Knowledge

Practical Knowledge

socialisation

Externalisation

Combination

Internalisation

Knowledge Creation Cycle – Health


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Emerging Condition

Pulmonary Hypertension Pulmonary Hypertension – Cusp of Research – Clinical CareCusp of Research – Clinical Care– Provision in care pathway, specialist tertiary/ Provision in care pathway, specialist tertiary/

specialist community services support specialist community services support – Defined as a National Specialist serviceDefined as a National Specialist service


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Case Study HospitalCase Study Hospital

Specialist Cardio Thoracic Hospital

One of 5 National Centres for1

Pulmonary Hypertension (PH)

Heart & Lung Transplant,

Sleep Studies

International & National Center for Pulmonary Thromboendartecomy (PTE)

Patients from England, Wales and Scotland

1.Department of Health National specialist commissioning group “Service specification for the national pulmonary hypertension services (NPHS) January 2003 http://www.dh.gov.uk/assetRoot/04/13/08/99/04130899.pdf


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Patient pathways –Pulmonary Hypertension services

Identify and cost resources - services & research

Cost the resources for Pulmonary Hypertension

Cost vs reimbursement per NHS (HRGs)

Purpose – Bottom Up Costing


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Pulmonary Hypertension Pulmonary Hypertension

Activity Profile: 2005/06

Assessments: FCEs ( Finished consultant Episodes)

Thoracic Day ward 62

Inpatient 66

Total Assessments 127

Follow–ups: FCEs & Attendances

Inpatient FCEs 186

Thoracic Day ward attendances 291

Outpatient attendances 303


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Pulmonary Hypertension – Multi- Disciplinary TeamPulmonary Hypertension - costed resource profile Unit/Avg Total Total

£ £ £

Multi- Disciplinary Team - Assessment & FollowupConsultant physician -(2 Wte) sessions 304,200 SpR + Res Registrar- net of Deanery contribution) 166,036 Specialist nurse coordinator wte 42,624 Specialist Nurse 42,624 Social worker band 7.3 wte 4,791 Dietician wte 4,791 Physiotherapy wte 4,791 Palliativecare 19,500 Secretary/admin wte 61,750 Pharmacy support wte 20,800 Radiologist session 15,600 Data coordination &Audit/evaluation 12,350

Post discharge Nurse 21,312 Total Cost of Multi- Disciplinary Team - Assessment & Followup 721,171 721,171


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Pulmonary HypertensionResource Profile

Assessments

Inpatient or Day ward

Establish PH cause and stabilise

Establish severity

Between 3 to 5 days stay

Suitability for surgical intervention

Emergency inpatient Transfer

Patient Education

Follow ups

Outpatient , Day ward or Inpatient

Monitor progression of symptoms

Monitor and adjust drugs

up to 7 day stay if inpatient

Emergency inpatient Transfer

Readiness for surgical intervention

Patient Education


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Pulmonary Hypertension - TariffPulmonary Hypertension - Tariff

Payment by Result Tariff – Reimbursement HRGs

D06 - minor thoracic conditions requiring <2days stay), D07 – Fibre optic Bronchoscopy (requiring <2 days stay)E14 – Cardiac Cath and angiography without complications and co-morbities)E37- other Cardiac Diagnoses (ranging from viral carditis to haemorrhage, not elsewhere captured)E38 – Electrophysiology and other Percutaneous Cardiac Procedures>18 E39 – Electrophysiology and other Percutaneous Cardiac Procedures>19 E40 – Other Cardiothoracic or Circulatory procedures >18E41 – Other Cardiothoracic or Circulatory procedures >19E99 – Complex Elderly with a Cardiac Primary Diagnosis P25 – Cardiac Conditions (includes Aortic Stenosis, multiple valve disease, Primary Pulmonary Hypertension etc) Q12 – Therapeutic Endovascular ProceduresQ19 – Vascular access for renal replacement therapy


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Costed Profile vs ReimbursedCosted Profile vs Reimbursed

Pulmonary Hypertension - costed resource profile ( 2005-06) No Unit/Avg Total Total Nature of CostYear 2005-06 £ £ £Total Cost of Multi- Disciplinary Team - Assessment & Followup 721,171 721,171 Fixed costTotal Variable Cost Assessment - Thoracic Day ward Attendances62 1,161 71,955 Total Variable Cost Assessment - Inpatient FCEs 65 3,926 255,221 327,176 Variable cost- Assessments

Total Assessment cost(inpat and Outpat)/unit costs(incMDT input)65 5,033 679,244 Propotion of Fixed cost + Variable cost

Total Followup cost/ unit cost- inc MDT input 780 2,163 1,687,191 Propotion of Fixed cost + Variable cost

Total (inc central/overhead costs) excluding PH drug cost 2,366,435 Total Cost Exc Drug

Total Pulmonary Hypertension Services Income Plan 05-06 + 1,675,625 Reimbursed on PBR tariff

Shortfall ? 690,810

Knowledge Capital contribution ?


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7 years Annualised

Donations & Interest £103.7k £14.8k

Research £544.1k £77.7k

Total £647.7k £92.5k

Other Funding Generated

PH Team


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Dimensions of Knowledge Capital Meritum project

Adapted from Meritum project

Staff time, specialist training posts, research staff

Relational Capital & Public Goods in Health Capital

Human Resources Capital

Tangible Capital

Knowledge Capital

National Capacity in Health

National protocols, leadership of professional body, national patient pool, specialist training materials, Patient education and material, Patient Support groups

Equipment, databases, computers, Specialist Medical equipment

External research funding, Patient Donors, National, Global Leadership in field


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Healthcare service

Funding not reflective of resources used

Targets not accommodating complexity

Additional outputs not recognised

Culturally seen as lower status

Challenges (1)- National Policy


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Challenges (2)- National Policy

Knowledge creation

Lack of Commissioner understanding

Interdependency not explicitly recognised

Research outputs not part of main performance

management

NHS Funding not for joint outputs


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Conclusion

Knowledge Creation & healthcare delivery interdependent

Policy and management needs to be integrated

Bottom up costing process useful for resource recognition

Services funding not enough for knowledge generation

Tool for planning better utilisation of knowledge capital


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Knowledge Capital Defining and Measuring

Thank You Thank You

For Defining and measuring Knowledge Capital bottom up costing useful tool

Sumathi Sundram - UEA 1 Defining and measuring Knowledge Capital in Health Care Presenter: Sumathi...

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