Across Borders: Different Time Zone, Same Emphasis on Improvement Methods, Working Across Sectors, and Social Determinants to Improve Outcomes
Just down the block from 10 Downing Street, where the British political leaders continue to work towards resolution on Brexit, I spent the early part of last week with UK’s top health policy minds at the Public Policy Project’s 2019 health care conference, “Delivering Innovation in Healthcare and Life Sciences,” organized by World Healthcare Journal, Accountable Care Journal, and Hospital Times. Focused around the work being done by the National Health Service (NHS) to transform the massive single-payer system for the 21st century, there were both senior NHS officials and outside experts weighing in on the key issues facing the NHS — improving outcomes at scale, better meeting the needs of the aging & more medically-complex population, building the workforce needed to deliver care, and transforming for the digital age.
While we in the US might think that the NHS is just as far away a comparative model to the U.S. health system as possible, what was clear from the day was that the two systems are more alike than different. While our funding sources differ, the NHS is facing the same structural challenges that health care in the U.S. faces — how to improve health outcomes for populations at scale and reduce costs, in the 21st century.
Welcoming the group & setting the tone for the day was Stephen Dorrell, a former UK Health secretary and member of Parliament, delivering key points to set the stage for the day’s conversation. As kind as he was blunt, Dorrell professed that “the NHS doesn’t have an innovation problem, it has a second adopter problem,” noting the tremendous innovation and creativity happening everyday within its footprint, but these innovations have a hard time being disseminating and being adopted at scale. Dorrell also noted that the NHS must work across sectors more, look across country boarders for solutions to tough problems, and redefine the real goal of healthcare away from healthcare outcomes towards broader societal metrics.
The keynote was delivered by Dido Harding, chair of NHS Improvement, who comes to the NHS as a relative “outsider,” not having spent her entire career in healthcare. But with that comes significant insight about how other sectors learn, improve, and scale, which will prove invaluable to the NHS as they move forward their improvement agenda.
Harding laid the foundation of her comments around the fact that leadership — from Skipton House (the headquarters of NHS England) all the way down to local authorities and providers — must focus on “seriously learning how to work together,” reminding us all that the work of improvement begins with a strong set of skills and shared language that are commonly shared. Harding also noted that the world’s best performing health care institutions have an improvement approach that she coined “East Coast/West Coast,” in reference to the opposite US coast mindsets — bringing together the rigor of continuous improvement methodology (East Coast) with a healthy dose of love (West Coast). Later on during her comments, when pressed to name an example of how she sees the system moving, she noted a recent clinic visit where she happened upon a group of nurses engaged in a 15-minute continuous improvement cycle. She was there to attend a high-level meeting, but admitted it’s on the front lines where you can see change taking hold.
Harding also spoke clearly and unequivocally about the need to work with other sectors in order to reach population health goals. “If you’re trying to genuinely deliver better health outcomes, you cannot ignore education, housing, local government, private industry,” she said. She pointed out that many examples exist on the ground in local communities, but that at the national level, the governmental entities must continue to work to align themselves for maximum impact.
I was honored to share the stage with a set of panelists focused on air quality — both indoor and outdoor — and how utilizing the framework of social determinants of health can help our heath systems understand how forces outside the four walls of clinics or hospitals shape health outcomes and what to do about it. What I appreciated most about the structure of the panel was that we had representatives from each key sector of the solution puzzle: Stephen Holgate, a clinical professor of immunopharmacology who studies asthma, respiratory illnesses, and the clinical impact of poor air quality; Paul Dawson, VP of Health at Dyson, makers of air quality machines that people put in their homes, including connected ones; Myself, bringing the perspective of how to structure productive cross sector partnerships; and Rosamund Roberta, mother of Ella Roberta, a 6-year-old who ultimately died of asthmatic seizures linked to poor air quality in London. Together, we had a lively conversation about what it takes to address the social determinants of health like air quality, how to engage public systems in the work of systems change, and how policy can feed the movement.
Key Takeaways:
While the conference had an abundance of key lessons and interesting takeaways, what struck me the most were the huge similarities between the key issues the UK’s NHS and the US’s multi-payer systems are facing. In short, the payer debate misses the key delivery challenges that even single-payer countries are facing. Here are some of the top common challenges & common solutions I discovered:
1) Scale as an Inherent Advantage & Disadvantage: Both the NHS and US’s large public programs like Medicaid and Medicare serve huge populations over massive geographic boundaries, with thousands of providers. Scale remains a challenge (standardization, spreading of knowledge) and an opportunity (local innovation bubbles up, flexibility in approaches.)
2) Working Cross-Sector as a Strategy for Outsized Results: The era of silo-specific work is over; both countries see the huge opportunities in working together, but both are still struggling with how to do it, how to incentivize it, and emerging best practice.
3) Improvement as the Foundation: Both US and UK systems are bought into the systems-level reforms needed, but they also both share a commitment to using a rigorous approach to improvement. You’ll find IHI fans on this side of the Atlantic as well as back home.
4) Data isn’t a Panacea — Yet: It was perhaps comforting to hear the same kinds of anguish around data use and confusion that I so often hear back home. Data — big data, small data — still remains a mostly unharnessed resource for the system and local providers.
