A person-centred, health systems approach to transforming services for integrated health and

21 Pages·2016·2.23 MB·English

by  Erica Barbazza

A person-centred, health systems
approach to transforming services for
integrated health and social care:
lessons from the WHO European Region

Juan Tello

Health Services Delivery Programme Manager
Division of Health Systems and Public Health
Integrated Health and Social Care, Week of Health and Innovation 2016
05 October, 2016, Odense Congress Centre, Odense, Denmark
Focus on
people
Identifying key challenges
Hours of self-care
= 8757 in a year
SDR, diseases of circulatory system,
Hours with 0%– 6o4f ,p poepru 1la0t0io 0n0 a0g e(2d0 6151+) years
professional/NHS = 3 in a (2011)
year
PEOPLE
K ey considerations: system perspective
LTC expenditure projected to increase just 1% of GDP
Different approaches for establishing accountability
in OECD countries to between 2-4% of GDP by 2050
Functional Financial Both
Multi-agency teams; Pooled budgets and Both function and
placements of transfer payments financial integration
individual staff
across agency
boundaries and co-
location
PEO P LE
Tertiary care
Secondary care
Primary care

Public social services
Private social services
Systems from the patient’s perspective…
Health services Social services
Consultant
Out-of-hours Dementia
doctors advisory nurse
GP
Live-in carers
Occupational
therapist Continence adviser PEOPLE Transit support-
services
Alzheimer’s social
Equipment service
outreach worker
Oxygen Volunteers
Physiotherapist service
Social worker
Dietician
In the driving seat: entry points
for system integration
Why

IHSD? Disease burden Average % of
of largely preventable
preventable NCDs hospitalizations for
in the Region1 hypertension in Relative risk Studies finding
countries studied2 reduction in improved patient Some evidence
readmissions3 satisfaction3 on cost-
80% effectiveness
73%
35% 50%
$$
1. WHO Regional Office for Europe (2011); 2. WHO Regional Office for Europe (2016); 3. Nolte & Pitchforth (2014)
Accountability for outcomes of integrated services
OUTCOME PROCESS INPUT
Life expectancy overtime Nurse to physician ratio in the European Region over time
From Deaths
3,5
3
2,5
To Diseases 2
Health Social 1,5
1
care care
To Disability 0,5
0
2000 2002 2004 2006 2008 2010 2012
European Region
EU members before May 2004
To Discomfort CEUIS members since May 2004
CARK
Ratio
The European Framework for Action on Integrated
Health Services Delivery
POPULATIONS AND SERVICES DELVIERY SYSTEM
INDIVIDUALS PROCESSES ENABLERS
Identifying health needs Designing care Rearranging accountability
Aligning incentives
Tackling determinants Organizing providers & settings
Preparing a competent workforce
Promoting responsible use of meds
Empowering populations Managing services delivery
Innovating health technologies
Engaging patients Improving performance Rolling out e-health
CHANGE MANAGEMENT
Strategizing with people at the centre Implementing transformations Enabling sustainable change
E ntry points for transformations?
MEDICINES TECHNOLOGIES
GOVERNANCE
COMPETENCIES PEOPLE ACCOUNTABILITY
WORKFORCE
FINANCING INFORMATION