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World Class Commissioning is an aspiration. It is how Primary Care Trusts ought to be. It's a claxon calling us to action.
If World Class Commissioning is really about "adding life to years & years to life" then it seeks to deliver:
1. Better Health - Greater Prevention
2. Better Care - Greater Treatment
3. Better Value - Greater Optimisation
1. Proven Plans
2. Evidenced Competencies
3. Measured Outcomes
A difficulty is that healthcare is complex. It has multiple Inter-dependencies,there's lots of variation in Demand & Delivery and , inevitably, we witness severe competition for & Rationing of Resources. To be successful with such a system we must solve a paradox. We need to create tried and tested methods that have never been done before!
To acquire the needed plans, evidenced competencies and measurable targets, we need to look for tools for help.
There are both simple and sophisticated Management Tools we might consider using to engineer the level of Service Improvement rightly associated with World Class Commissioning:
PDSA is for Low Cost, Low Risk, & Easily Reversed Actions
But not for Important Decisions, Strategic Choices or Structural Changes
MS EXCEL - great for Sorting, Presenting & Validating Data
But not for modelling Time Dependent circumstances & Variable Patient Needs
PEN & PAPER - great for initial Sketches & Notes
But not for enterprise-wide, integrated Process Mapping
NPFIT - great (maybe) for Data processing & Data availability
But not designed to answer "What-if?" questions
Also, if you are clever at Maths, you might apply Queuing Theory or System Dynamics for simple resource optimisation. For the rest of us, and for problems with real-life complexity and discontinuities, Simulation Modelling is most promising. Simulation Modelling is a tool for important decisions, making strategic choices, and considering structural changes.
The Department of Health decrees simulation modelling within the Competencies of World Class Commissioning.
1. Healthcare is full of Variation ? treating Patients is not like building cars
2. Staff & Facilities are highly Utilised ? we see the Queues and the Waits
3. Spreadsheets are poor at handling lots of variation
4. A good simulation Flow Model will actually help you to visualise your problem and help you understand the dynamics of your system and the interactions of its components.
5. Strategic Choices can be Contrasted / Eliminated
6. You Test before you invest much bigger funds!
In fact, our Percept methodology is designed to focus simulation modelling on solving many of the problems encountered by World Class Commissioners.
1. Examine your Strategic Investment Choices
2. Handle lots of Patient Variation & Process inter-Dependencies
3. Help you to see these Dynamics & gain new Insights
4. Identify your key Data and gain realistic Confidence Intervals for possible Outcomes
5. Prove which Process Improvement ideas are effective & sustainable
6. Optimise the Cost of your Resources & your Service Level Agreements
A further, very important benefit is that all stakeholders are involved throughout the process. GPs, Practice Nurses, Community Nurses, Counselling specialists and Acute Care staff all make their professional input to the project at the start. The project results show how their input has been used and hence they are committed to the success. This leaves you with a stronger team working towards an agreed and measurable target.
Our Patient Flow simulation models are already being used by local NHS leaders because they can:
1. Integrate your Community Partnerships
2. Reflect your use of Patient feed-back
3. Assimilate the Clinical Input you receive from colleagues
4. Evidence Needs Assessment & Knowledge Management
5. Help you to prioritise your Strategic Investments
6. Challenge & stimulate your Providers
7. Test innovative service improvement ideas
8. Document your required Services & Outcomes
9. Scope Primary, Acute Secondary, and Mental Healthcare
10. Incorporate Activity Based Costs & PbR Tariffs
A very important aspect of World Class Commissioning is that stakeholders, including all Service Providers, must understand and agree the extent of their commitment. A presentation outlining this "Whole Service Commissioning" can be seen at World Class Whole Service Commissioning(PDF)
OPTIMISED RESOURCES : GREATER PATIENT CARE