Keren Shechter Azulay
Maccabi Healthcare Services, Israel
Title: The Four Big Lies of every modern public health care system
Biography
Biography: Keren Shechter Azulay
Abstract
Background:
The OECD estimates that every modern health care system is characterized by:
1. Over-treatment; Up to 30% of the surgery procedures are unnecessary.
2. Hospital-acquired infection (HAI): Over 50,000 inpatients will die from acquired infection diseases that are not related to their primary disease every single year in USA (over 5,000 in Israel).
3. Financial needs are beat the patients' best interests: 25% of the inpatients in the internal units aren’t supposed to be admitted.
4. Revolving doors: 1 out of 12 inpatients will return to the hospital in less that 30 days
5. Choose wisely- cost effective: The "contribution" of the classic health system to life expectancy and wellness is estimated to be less than 10%.
Although the Israeli healthcare system is considered as a miracle and was rated (Bloomberg rate- September 2018), as the sixth most efficiant healthcare system in the modern world, unfortunately the poor outcomes mentioned above, are related to our thriving healthcare system as well, So why does it happen to highly qualified people like us (physitions, managers, nurses, and regulators). How come we stand by and do nothing?
Therefore, we face painful consequences; heavy price of illnesses, deaths, infections, waste and poor health.
It happens because we are use to hear those big four lies/ myths , that are constantly being told to us, and lead to a severe reality of poor efficiency in our public systems;
Lie no.1- Lack of resources: We are dealing with systems that run billions of dollars every single year with over 30% of unnecessary procedures and over treatments.
There is no possibility of any financial shortage.
Lie no.2 - The best interest of the patient first: There is a built-in financial conflict of interests between hospitals and health funds; 25% of the patients that enter the hospitals shouldn’t be there!! They are exposed to unnecessary procedures and dangerous infections.
Lie no.3- As patients are we safe: Do we have, as the medical decision makers the whole medical data and information that are needed to see the whole picture. Of course not.
Lie no.4 -The system is being managed: We surely know how to run separately the links of the healthcare system (hospital, HMO’s, laboratories, pharmacies and so on), but we do not know how to manage it as a whole and a holistic system. Nobody is responsible to the whole patient journey. Although we focus in our great improvements in hospitals, health funds etc. we ignore the real mission; to tie up the loose edges of hospitals, patient- home rehabilitation options, social needs, dead end bureaucracy, which are critical to maximize the treatment and patient health. Who manages that? This is nobody’s mission.
Our goals:
Our goals are to create a simple solution to manage the patient journey via improving the interfaces between the classical links of the healthcare system (hospital-community-home services) by forming an INTEGRATIVE CONTINUITY OF CARE UNIT.
Our KPI’s:
ï‚· Reduce revolving doors by 20 %
ï‚· Reduce Infection cases (reducing the hospitalization time by 10%)
ï‚· Unnecessary procedures (reducing the hospitalization time by 10%)
* camper to the national figures
ï‚· Increase Health outcomes (lower the annual tendency of hospitalizations for complicated patients by 10 %)
ï‚· Increase the rehabilitation activities by 50%
ï‚· Choose wisely - costs and health value (lower the annual tendency of hospitalizations for complicated patients)
ï‚· Increase medical staff and patients’ satisfaction
Our Methods:
Using a rare occasion of opening a new public hospital in our district (It happens ONLY once every 40 years in any modern country).
Creating an INTEGRATIVE CONTINUITY OF CARE UNIT - This unit is based on multi-disciplinary team; physicians, nurses, physiotherapists, social workers and administrators that share IT systems.
This unit Represent the patient community health services but is located inside the hospital units.
Contacting the patient immediately and proactively once he/ she is admitted to the hospital.
Contacting the hospital doctor / case manager to complete medical info or when approvals are needed to improve patient protocol.
Sharing medical data from the community health services , hospitals, social municipal services, public social insurance, so that the medical decision makers have 360- degree -information to reduce over treatments; for example reduce unnecessary radiation tests , bureaucracy, shorten the patient waiting time for medical procedures if necessary, and close gaps to complete the patient journey.
Making sure that the patient won’t stay more than necessary inside the hospital and coordinate services and facilities at home or rehabilitation solutions to promise the continuity of care , prevent unwanted lose and suffer and increases patient wellness.
Results:
1. High efficiency, revolving doors 35% less
2. Reduce the potential of infection; Inpatient days 43% less
3. Rehabilitation costs are doubled +100%
4. Moving to the safe zone : 1 of every 4 rehabilitation cases gets its care in a safe clean environment :at home
5. Patient satisfaction - medium satisfaction. We haven’t succeeded to achieve a patience full awareness (and appreciation) to the NEW Integrative Unit yet.
6. Medical staff satisfaction - very high satisfaction ( score 6.5 of 7)/ high trust have been reported between community doctors and hospital physicians.
The modern healthcare system has great achievements worldwide when it comes to measuring separately the classical links of the system like hospitals, funds and so on.
However the million dollar question of efficiency which is responsible for: 30% over treatments, high rate of infections, illness etc. is hiding in the interfaces among those links, that no one in the modern healthcare systems is responsible for.
We must change our old habits; hospitals have to break their own walls and show transparency. They have to stop being “factories” that produce surgeries and take responsibility for the rehabilitation of the patients who are released from the hospitals.
The HMOS have to become more proactive and available in the evenings and during the weekends, so that their patients will be released smoothly from the hospitals.
The huge challenge is to improve the interfaces between those links by promising-the continuity of care and maximizing the patient journey is still an unsolved problem worldwide.
Our great challenge is to collaborate and manage the interfaces between hospitals, Community services, and home rehabilitation solutions, as patients experience it. This new INTEGRATIVE CONTINUITY OF CARE UNIT is making a big difference by changing this important mission from nobody’s mission to somebody’s mission. No need for special technology, no great innovation but a new kind of leadership, trust and collaboration to win the financial, guilds, ego interests and focusing on the patient’s best interests. We defiantly want it as our No.1 priority!