health services at the crossroad

The Planning and Management of Health Services

Working on the interface

José Francisco García GutiérrezOPS/PAHOHSS/HR

Nassau, 24 November 2011

My apologies ….but we do need to get to know each other

NameWork

ExpectationsHobbies

To understand my discourse

Rememberinga friend anda good man

Tony Judt

Tony Judt remembered

From MACRO to MESO and MICRO

…and certain digressions

Evidenciators, Calidators, Implementators,

Proceseitors, Genderators & Determinators

What´s next?

Small

digressions

A new syndrome:

Power Point Toxicity

Funny but banal !

From MACRO to MESO and MICRO

…and certain digressions

Moving into the mud!

ManagersHealth professionals

Patients

Citizens

Moving into the mud!

ManagementGood clinical practicePatients Patnerships

Citizens Engagement

HEALTH MANAGERS

The dark side of the force?

Manager´s Triangle

Budget control Priority goals Social peace

Are you willing to add anything else?

Citizen´s Triangle

Accesibility (24/7) High quality care Unlimited care Low cost (or free!)

The low moral among the professionals

FROM

2

Julian Tudor Hart

“My medical education began three times. What I learnt at medical school was no use in the hospital. What I learnt in the hospital was no use in general practice”

MEDICINE 2.0

Jay Parkinson at work!

Changing practice

Cambio de prácticas clínicas

Are you wearing a wrist watch ?

… why ???

From Baby-Boomers to Generation 2020

The Side B

If reform is the answer…

What was the question?

Is HEALTH a consumer good?

…and health care?

IF YOU ARE THE PATIENT,

What type of care do you want to receive?

The other framework

The other framework

ModelPaterna-listic Informative Shared

Ro le

No informed

Partially informed

Well informed

Active

Undecisive

Pasive

Information

That Old Dilemma

From desire to realityo

From reality to desire

Pictures of the future of health care

Dangers of predicting the future

Sam Goldwyn Mayer

“ I never make predictions, especially about the future.”

Why bother with the future?

"If you think that you can run an organisation in the next 10 years as you've run it in the past 10 years you're out of your mind."

CEO, Coca Cola

Why bother with the future?

“The future belongs to the unreasonable ones, the ones who look forward not backward, who are certain only of uncertainty, and who have the ability and the confidence to think completely differently.”

Charles Handy (quoting Bernard Shaw)

Why bother with the future?

The point is not to predict the future but to prepare for it and to shape it (more or less)

Myself (sorry!)

The future of health care systems

STREET VISIONS

Fee for service for the rich

Marks and Spencer style managed care for the middle classes

Safety net service for the poor

“McDonalization” of medicine

“Two roads diverged in

a yellow wood.

And sorry I could not

travel both” Robert Frost

Where do we want to go?

Official Frameworks Patient centered Evidence based Supported by systems

Safe & On time Effective & Efficient & Equitative

Six Lines 4a New Code

Safe and reliable care Service redesign and transformation

Leadership and business management

Clinical improvement and innovation

Patient partnerships Learning, education and culture

Final thought

If you aren’t confused you don’t know what’s going on

Jack Welch, former CEO General Electric

THANKS

4YUR

ATTENTION