competitive environment: what is it and how to thrive … agath_ competitive... · 21 march 2013...
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21 March 2013 RCPsych+St Andrew's Healthcare 1
Psychiatric Leadership in Action: Delivering High Quality Care for All
Competitive environment: What is it and how to thrive in it
Dr Kostas Agath, EMBA, FRCPsych
Consultant Psychiatrist, NWDAS, CNWL NHS FT
Medical Director, Addaction
21 March 2013 RCPsych+St Andrew's Healthcare 2
Overview
1. Competition: Drivers and Features
2. Role of Psychiatrist
3. New Leadership Paradigm
21 March 2013 RCPsych+St Andrew's Healthcare 3
Why is Competition out there?
• Wanless Report:
Unless communities are fully engaged and empowered, health services will be unaffordable in 20 years.
[DH 2002. Securing Our Future Health: Taking a Long-Term View.
The Wanless Report. DH, 1 January 2002]
21 March 2013 RCPsych+St Andrew's Healthcare 5
What is Competing With What?
• 5 minutes with your neighbour.
• Report back to the floor
21 March 2013 RCPsych+St Andrew's Healthcare 7
Rainbow Model of Determinants of Health (Dahigren 1995)
Age, Sex &
Constitutional
FactorsAgriculture
& food
production
Education
Work
E
nvi
ronm
ent
Living & working conditionsUnem
ployment
Water &
Sanitation
Health
care
services
Housing
21 March 2013 RCPsych+St Andrew's Healthcare 8
The Health Inequalities….
• Hot off the Press..
UCL Institute of
Health Equities:
“Working for Health
Equity: The Role of
Health Professionals”
(March 2013)
21 March 2013 RCPsych+St Andrew's Healthcare 9
Health Secretary views…
Jeremy Hunt has backed a
report calling on health
professionals to tackle the
social and economic
causes of ill health - not
just the medical.
…NHS has a legal duty to
reduce health inequality…
(BBC, 18 March 2013)
21 March 2013 RCPsych+St Andrew's Healthcare 10
Inequalities decision making in practice
• 5 minutes with your neighbour:
– There is a proposal to close an A&E to save money towards building accommodation for young people sleeping in the streets. What do you do?
– A old age psychiatric firm is to disbanded to save money for an initiative for underprivileged children. What do you do?
21 March 2013 RCPsych+St Andrew's Healthcare 11
Marmot Review: 6 policy drives
1. Give every child the best start in life
2. Enable all children, young people and adults to
maximise their capabilities and have control over their
lives
3. Create fair employment and good work for all
4. Ensure healthy standard of living for all
5. Create and develop healthy and sustainable places
and communities
6. Strengthen the role and impact of ill health prevention
21 March 2013 RCPsych+St Andrew's Healthcare 14
Minimum Pricing….
• 5 min with your neighbour:
– Are you surprised that the government is
backtracking on pursuing minimum pricing on
alcohol?
– What were the chances of a different
government to pursue with the
implementation?
21 March 2013 RCPsych+St Andrew's Healthcare 15
Research Vs Policy
• Research evidence plays a minor role in National
Policy making (Muscat 2008)
• Crisis Intervention Teams: ? effectiveness
(Johnson, 2011)
• Service lines: Introduction in FTs years before the
Tariffs
21 March 2013 RCPsych+St Andrew's Healthcare 17
What is Quality?
• 5min with you neighbour
• Bonus points if you said that it is:
– ARBITRARY measure
– COMPOSITE measure
– Articulated only within a FRAMEWORK.
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What is Quality in Health Care?• ‘Structure, process, outcome’ model Donabedian (1980)
• Quality Elements Maxwell(1984)– Acceptability
– Accessibility
– Appropriateness
– Effective
– Efficiency
– Equity
• Clinical Governance Pillars DH (1998-2009)
• Standards of Care Quality Commission (CQC, 2010)
• NHS Quality Strategy (+HEAT) (Health and Social Care, Scotland, 2010)
• Features of Quality Care: Darzi Review (DH 2007)– Fair – Personalised –Effective - Safe
• QIPP Agenda [Quality – Improvement – Productivity – Prevention] (DH 2008)
• Quality Accounts [board responsibility-safety-effectiveness-patient feedback] DH ‘10
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Leadership Vs Management
• 5 min with your neighbour:
• How can we differentiate the one from the other?
• Examples?
21 March 2013 RCPsych+St Andrew's Healthcare 21
Leadership Vs Management
• Both responsible for decision-making when problem-solving, but:
• Leadership: what is the appropriate question?
• Management: what is the appropriate process?
[Grint & Holt, King’s Fund, 2011]