Judging from the turnout of the last Diagnosis salon, Global Health remains a popular topic for many doctors-in-training. Chaired by Pam Garside and held in conjunction with the Institute of Global Health Innovation at Imperial College, the salon boasted an all-star line up: Ara Darzi, former Parliamentary Under-Secretary of for Health; Richard Smith, former editor of the BMJ, now Director of United Health’s Global Chronic Disease Initiative; and in an unbilled cameo, Liam Donaldson, former Chief Medical Officer for England.
Ara Darzi’s talk focused on the convergence of health challenges between different health systems and the need to share successful innovations. Drawing on his experiences as a health minister and Director of Imperial’s Institute of Global Health Innovation, Lord Darzi made the case for revising traditional views of global health innovation.
Using examples like the Aravind Eye Care System in India, which is pioneering low cost, high quality ophthalmic care to some of India’s poorest populations, Lord Darzi highlighted the globally dispersed nature of innovation in health service delivery. In an argument reminiscent of the ‘reverse innovation’ advocated by GEs Jeff Immelt and ‘Jugaad innovation’ studied by Radjou, Prabhu and Ahuja, Lord Darzi challenged the audience to look beyond the traditional models of health system innovation, to discover new ways of adapting systems of care to meet healthcare and economic demands. (It was not clear whether Lord Darzi was ever aware of Pam Garside scribbling the words ‘Healthbox’ behind him in big letters).
‘Turning the World Upside Down’ was a theme that continued as Richard Smith challenged the salon to rethink what future priorities should be for global health. During a whirlwind tour of contemporary global health challenges, taking in the rising burden of chronic non-communicable disease, as well as a salutary introduction to the importance of Michael Marmot’s work on the social determinants of health, Dr Smith highlighted how changing patterns of global morbidity demanded a new approach to priority setting for global health.
The post-2015 development agenda will see the Millenium Development Goals superseded by the Sustainable Development Goals. With the SDGs still in development, Dr Smith argued that now is the time to be rethinking how we measure the success of global health endeavours. ‘Well-being’ he suggested might replace traditional measures of economic and health progress such as GDP or QALYs; an idea already being considered by the UK Government as part of its recent efforts to develop measures of national well-being.
With such high-profile and thought-provoking speakers, discussion was vibrant and wide-ranging. Amid nihilistic arguments of economic determinism in global health and less nihilistic arguments that all the world needs is more psychiatrists, Sir Liam Donaldson lent his considerable experience in global health, bringing a welcome clarity and insight to proceedings. What was more impressive however was how late into the evening discussions continued for many attendees. Proof again of both the draw of global health as a topic and the success of Diagnosis’ salon format.
Saturday, January 19, 2013
Sunday, January 13, 2013
Summer internships at HSJ and BUPA by Mr Ruslan Zinchenko 4th year Medical Student UCL
Spending four weeks at the Health Service Journal was an invaluable opportunity for me, and gave me a chance to experience many aspects of journalism and the news industry. Being an international student I have always struggled to convey information and concepts in writing. There were plenty of opportunities to practice this at the HSJ, and obviously this allowed me to greatly improve my writing skills. Questioning to find out information was an everyday job as well, and I had to interview a number of important people, who were heavily involved in health policy. In this task active listening and understanding relevant points was crucial as I found out with time. I was also required to present to an audience made up of my colleagues during team meetings on Wednesdays. This was a useful hour during which I could get feedback on the work and research I was doing from experienced journalists. Their contribution helped to keep me on track and also helped with difficult situations. Everyone was friendly and willing to teach you, despite being overloaded with work, which I thought was great! In addition, as part of my research I had to analyse numerical and graphical information, something that I don’t get a chance to do at university as part of my course, and is a useful skill to have in the current competitive job market. Lastly, my research made the front cover of the journal (of course after some intense editing from my senior colleagues), which was something I never expected to happen, and knowing that your work is going to be read by thousands of people and make an impact was a nice feeling.
During my 6 weeks at BUPA I was given several projects as well as a number of side jobs. Since BUPA is an insurance company, I had to switch on my business acumen straight away. I was required to think strategically and try to see the wider picture, which was much more difficult that I have ever imagined. You always hear people say: “look at the bigger picture”, but when you actually come to doing it, you are overwhelmed with the complexity of the situation. My manager was quite keen on me taking initiative and always pushed me to think about problems in my own way rather than follow the standard corporate approach. Having never worked for an insurance company before I had to absorb new information quickly, which was good practice for the future, as we will always find ourselves in novel environments. As part of my projects I had to gather information and come up with creative solutions for BUPA in the near future. This generating of entrepreneurial ideas was something that I have always enjoyed, and an opportunity to do in the real world whilst working on real projects was exhilarating. Lastly, BUPA is an organisation with a lot of people, which meant that I had to collaborate with others to achieve goals, as well as adapt to their needs and styles.
In conclusion, I would like to say how grateful I am to DIN for organising these two internships for me, which gave me an opportunity to experience something else to medicine and develop a number of skills which are just not taught in medical school.
During my 6 weeks at BUPA I was given several projects as well as a number of side jobs. Since BUPA is an insurance company, I had to switch on my business acumen straight away. I was required to think strategically and try to see the wider picture, which was much more difficult that I have ever imagined. You always hear people say: “look at the bigger picture”, but when you actually come to doing it, you are overwhelmed with the complexity of the situation. My manager was quite keen on me taking initiative and always pushed me to think about problems in my own way rather than follow the standard corporate approach. Having never worked for an insurance company before I had to absorb new information quickly, which was good practice for the future, as we will always find ourselves in novel environments. As part of my projects I had to gather information and come up with creative solutions for BUPA in the near future. This generating of entrepreneurial ideas was something that I have always enjoyed, and an opportunity to do in the real world whilst working on real projects was exhilarating. Lastly, BUPA is an organisation with a lot of people, which meant that I had to collaborate with others to achieve goals, as well as adapt to their needs and styles.
In conclusion, I would like to say how grateful I am to DIN for organising these two internships for me, which gave me an opportunity to experience something else to medicine and develop a number of skills which are just not taught in medical school.
Friday, November 23, 2012
Internship at HSJ - July 2012 by Mobolaji Ajekigbe, 4th Year Intercalating Medical Student, Imperial College London.
I was introduced to HSJ editor Alastair Mclellan on day 2, who promptly briefed me on the interview I was to carry out with an executive at $50 billion turnover health care provider Kaiser Permanente.
Day 3 began with a news team meeting in which members, myself included, were expected to bring ideas for publication to the table.
Despite the steep learning curve, I was immediately made to feel part of the news team, and was encouraged to participate in discussion on the publication’s focal areas of health care management and policy.
I was also encouraged to ask around for projects. My eventual niche involved researching the reconfiguration of health services in Greater London, particularly the impact of urgent care centres (UCCs): which A&Es they were attached to – or, in the case of North West London, which A&Es they were slated to replace - and their effect on demand.
Another benefit from being amongst the award-winning news team was hearing expert analysis as stories broke or were being developed, before it became news in the conventional sense. In addition to UCC, I also had the pleasure of deciphering an almighty list of acronyms (DH, CQC, CCG, NaPC, QIPP, NPfIT…) that are clearly never-ending.
Amongst myriad transferable skills, I also learned the thrills and pitfalls of investigative journalism: contacting press offices, for example, and how to successfully conduct interviews via email and telephone as well as face to face. Meanwhile, 3 essay-barren years of medical school had clearly ravaged my writing skills from their GCSE English peak, and they required an overhaul: how to go about writing an article in the first instance, and then how to tailor content to the target audience of a for-profit publication. Suffice it to say that seeing 2 articles published later in the year was worth it.
Another highlight was attending the Darzi's Fellows clinical leadership conference at The King's Fund, where Alastair chaired a fiery debate on the NHS and privatisation, which involved Ali Parsa, chief executive of Circle.
In the short-term, the insights gained from my time at HSJ have provided a boost whilst studying the intercalated Management BSc at Imperial. I imagine completing the internship after the BSc would provide added (though not necessarily better) perspective.
In the long-term, they may yet steer me towards a career in health management or policy, in tandem with the clinical medicine that I enjoy. Regardless, I think all medical students could benefit from more lateral exploration of NHS issues, which (at the time of writing) medical school curricula do not cater for.
The internship required initiative - lots of looking for things to do, as opposed to being told what to do - and as such is probably not for everyone. Disclaimer aside, I sincerely thank Alastair and the HSJ team, and Harpreet Sood and the Diagnosis team for the privilege, and can only recommend applying.
Day 3 began with a news team meeting in which members, myself included, were expected to bring ideas for publication to the table.
Despite the steep learning curve, I was immediately made to feel part of the news team, and was encouraged to participate in discussion on the publication’s focal areas of health care management and policy.
I was also encouraged to ask around for projects. My eventual niche involved researching the reconfiguration of health services in Greater London, particularly the impact of urgent care centres (UCCs): which A&Es they were attached to – or, in the case of North West London, which A&Es they were slated to replace - and their effect on demand.
Another benefit from being amongst the award-winning news team was hearing expert analysis as stories broke or were being developed, before it became news in the conventional sense. In addition to UCC, I also had the pleasure of deciphering an almighty list of acronyms (DH, CQC, CCG, NaPC, QIPP, NPfIT…) that are clearly never-ending.
Amongst myriad transferable skills, I also learned the thrills and pitfalls of investigative journalism: contacting press offices, for example, and how to successfully conduct interviews via email and telephone as well as face to face. Meanwhile, 3 essay-barren years of medical school had clearly ravaged my writing skills from their GCSE English peak, and they required an overhaul: how to go about writing an article in the first instance, and then how to tailor content to the target audience of a for-profit publication. Suffice it to say that seeing 2 articles published later in the year was worth it.
Another highlight was attending the Darzi's Fellows clinical leadership conference at The King's Fund, where Alastair chaired a fiery debate on the NHS and privatisation, which involved Ali Parsa, chief executive of Circle.
In the short-term, the insights gained from my time at HSJ have provided a boost whilst studying the intercalated Management BSc at Imperial. I imagine completing the internship after the BSc would provide added (though not necessarily better) perspective.
In the long-term, they may yet steer me towards a career in health management or policy, in tandem with the clinical medicine that I enjoy. Regardless, I think all medical students could benefit from more lateral exploration of NHS issues, which (at the time of writing) medical school curricula do not cater for.
The internship required initiative - lots of looking for things to do, as opposed to being told what to do - and as such is probably not for everyone. Disclaimer aside, I sincerely thank Alastair and the HSJ team, and Harpreet Sood and the Diagnosis team for the privilege, and can only recommend applying.
Friday, November 16, 2012
Internship at Bupa – Summer 2012 by Daniel Ketley, 5th Year Medical Student, University College London Medical School.
I began my placement at Bupa with a mixed sense of excitement and trepidation. Having entered medicine straight from school I had no experience of the corporate environment, and had no idea what to expect, or what I would be doing.
I was based at Willow House in Staines, where the people I worked alongside were incredibly friendly and accommodating. Within a few hours I felt part of the team and had been given my first task.
My first project was with the healthcare commissioning team. I was given a project brief and had to develop my approach to the task and plan my work accordingly. The task seemed daunting at first, however I realised that my training at medical school had equipped me with the skills I needed; I just needed to apply them in a slightly different context to what I was used to.
The project was immensely rewarding as I took the task from a project brief through to a completed document which was very satisfying. As a medical student I often offer opinions on what I would do if I were the doctor in a particular clinical case; in this instance I not only had to evaluate the options and offer an opinion, I had to take the process one step further and reach a decision for the report which was something I had not done before.
My second project was working alongside the policy development unit. In contrast to the first project where I worked independently, in this case I was part of an established team which brought its own challenges. I was able to learn an awful lot from the more experienced members of the team, whilst at the same time build and develop my own thinking and skill set.
My time at Bupa taught me a great deal about how healthcare in the UK is organised in both the private and public spheres, as well as the challenges facing healthcare commissioners in the future. I no longer see my time at Bupa as an internship, I think of it as an essential part of my medical degree. The skills and exposure it gave me I have taken back into the clinical environment and will use as a doctor later in my career.
I was based at Willow House in Staines, where the people I worked alongside were incredibly friendly and accommodating. Within a few hours I felt part of the team and had been given my first task.
My first project was with the healthcare commissioning team. I was given a project brief and had to develop my approach to the task and plan my work accordingly. The task seemed daunting at first, however I realised that my training at medical school had equipped me with the skills I needed; I just needed to apply them in a slightly different context to what I was used to.
The project was immensely rewarding as I took the task from a project brief through to a completed document which was very satisfying. As a medical student I often offer opinions on what I would do if I were the doctor in a particular clinical case; in this instance I not only had to evaluate the options and offer an opinion, I had to take the process one step further and reach a decision for the report which was something I had not done before.
My second project was working alongside the policy development unit. In contrast to the first project where I worked independently, in this case I was part of an established team which brought its own challenges. I was able to learn an awful lot from the more experienced members of the team, whilst at the same time build and develop my own thinking and skill set.
My time at Bupa taught me a great deal about how healthcare in the UK is organised in both the private and public spheres, as well as the challenges facing healthcare commissioners in the future. I no longer see my time at Bupa as an internship, I think of it as an essential part of my medical degree. The skills and exposure it gave me I have taken back into the clinical environment and will use as a doctor later in my career.
Thursday, November 8, 2012
Internship at Patients Know Best, July 2012 by Tobi Isaac Obisanya, 4th Year Intercalating Medical Student at Imperial College London
During my 4 week internship at Patients Know Best, I learnt about and got involved in the raw process of starting and establishing a business; to summarize it quickly. But this was not just any business, this was one that was changing paradigms in the way patient care is done.
Working with Dr Al Ubaydli & the PKB team was inspiring, and I would say that I learnt three things from this placement.
One, you need to be passionate about what you do. Dr Al Ubaydli's passion for his work is his best asset because it is only through a true conviction in what you are doing that you will ever be able to get people to one invest in it and two for it to grow and become a sustainable organic organisation.
Two, it takes a good understanding and research of the market/environment in which you want to function to have an impact and carve out a legacy in it.
Three, it takes time to establish anything; a business, a well functional system or idea. Patience & continued belief in yourself & your idea is vital.
It is fair to say that aside from it being all about business, there were also important life lessons taken. I also assisted the companies CFO to create a tangible visual depiction of the companies vision & business plan using IT which was exciting and allowed me to add value to their efforts to raise capital. I completed the internship before beginning my intercalated year in Business and Healthcare Management at the Imperial Business School which I would highly recommend to all medical students.
My time at PKB has been invaluable and given me an edge even in the first 2 weeks of the course, as there were many aspects of business & healthcare I explored during my internship. Although interning at a still growing company can be a bit hectic and your role can be uncertain/undefined at times - it has been an invaluable experience to be a part of and to understanding how this pioneering company is doing the great work it is currently doing and building a bright future for patient care in the ever-changing NHS landscape.
Link to Patients Know Best website
Working with Dr Al Ubaydli & the PKB team was inspiring, and I would say that I learnt three things from this placement.
One, you need to be passionate about what you do. Dr Al Ubaydli's passion for his work is his best asset because it is only through a true conviction in what you are doing that you will ever be able to get people to one invest in it and two for it to grow and become a sustainable organic organisation.
Two, it takes a good understanding and research of the market/environment in which you want to function to have an impact and carve out a legacy in it.
Three, it takes time to establish anything; a business, a well functional system or idea. Patience & continued belief in yourself & your idea is vital.
It is fair to say that aside from it being all about business, there were also important life lessons taken. I also assisted the companies CFO to create a tangible visual depiction of the companies vision & business plan using IT which was exciting and allowed me to add value to their efforts to raise capital. I completed the internship before beginning my intercalated year in Business and Healthcare Management at the Imperial Business School which I would highly recommend to all medical students.
My time at PKB has been invaluable and given me an edge even in the first 2 weeks of the course, as there were many aspects of business & healthcare I explored during my internship. Although interning at a still growing company can be a bit hectic and your role can be uncertain/undefined at times - it has been an invaluable experience to be a part of and to understanding how this pioneering company is doing the great work it is currently doing and building a bright future for patient care in the ever-changing NHS landscape.
Link to Patients Know Best website
Tuesday, October 16, 2012
Problem solving at its best: What it’s like being a doctor in Sierra Leone. By Dr Elizabeth Tuckey, Junior Doctor, A & E West Hertfordshire Hospital NHS Trust & Mr Vernon Sivarajah
The premise of the NHS ‘equal access for equal medical need’ is a distant reality in developing countries. The World Health Organisation estimates that 70% of people in developing countries don’t have access to basic health services.
Like many doctors I have always wanted to work for an Non-Governmental Organisation (NGO) and help to provide medical care to people who need it most. Those of us who have looked into it have found that larger organisations like Medicines Sans Frontier require a minimum six-month commitment which can never normally fit in with our training or annual leave. Thus, many doctors never get a chance to scratch that itch.
But there is another way. I have just returned from a ten day visit to Sierra Leone. A small charity called the Better Lives Foundation runs three medical camps a year, in a small purpose built hospital 88 miles from Freetown in Yonibana.
Sierra Leone is one of the poorest African countries in terms of infrastructure; devastated by a ten year civil war that finished in 2002, there is virtually no clean water and electricity is scarce. The life expectancy is shockingly short at just 42 years and over 80% of medical care is provided by outside agencies.
I was going to take part in the Hernia camp and the goal was to perform thirty hernia operations in ten days with a team of doctors and nurses whom I met at Heathrow airport. None of our team - the anesthetist, the consultant general surgeon, the specialist registrar, the theatre sister, or myself had ever been to Sierra Leone before and no one knew what to expect, except that there was a declared cholera outbreak and it was the end of rainy season.
On arrival at the camp it was straight to work. We had to turn a couple of dusty disorganized rooms into an operating theatre, a pre-op assessment area and a post-op ward. It was clear this was going to be a team effort. The camp wasn’t due to open until our second day but there was a queue when we arrived and after a long clinic looking at unbelievably large hernias we filled up our operating list. The need was obvious. Most of our patients were manual laborers with years of heavy lifting behind them and the lack of preventative surgery contributed to the high prevalence of hernias, often untreated from birth.
Over the next few days we began operating and were struggling to get through our planned lists with the expected delays of an unfamiliar environment. Nevertheless patients kept turning up and it was evident that the demand for operations exceeded the number we were able to perform. We started to question our initial approach. Should we have booked patients on a first come first serve basis? The issue being that some people had to walk for days to attend camp and word had only reached distance villages after we started.
Would we have been better off booking smaller hernias and getting through more operations? We had started by prioritizing patients with large hernias whom we perceived to be in the greatest need of surgical intervention. But these operations were more complex, requiring longer operating times and with greater risk of complication. Then there were the patients who had attended previous camps with their medical notebooks documenting the hope of an operation if they returned this year. Should we have prioritised these patients?
We considered setting up another operating table in theatre and running two operations at once. But that wasn’t a practical solution and we had to face up to the difficult reality. We had to turn patients away, despite overwhelming medical need with it’s accompanying patient desperation. It was heartbreaking and against the instinct of a doctor, especially without a robust justification as to why one patient would be operated on over another.
In contrast to these frustrations, I found the way our team approached equipment shortages, time constraints and organisational challenges to be truly inspirational. None of us felt that we should compromise our UK standards just because we were in a developing country. We needed to operate as we would at home or not operate at all, and with this as our goal we found a way around each of our problems. We ran out of sterile drapes and thought we would need to cancel operations but improvised using patient gowns as sterile fields with make-shift holes cut into them. We developed a post-op scrotal support system made out of crepe bandages that we found more efficient than the expensive alternatives used in the UK. We rewired the diathermy machine into a health and safety hazard but fully functional piece of kit to prevent intraoperative bleeding. We conducted a group consent session to save precious operating time. And when the generator gave up one evening we used our head torches as operating lights and we treated an acute asthma attack using a polystyrene cup as spacer device instead of a nebulizer.
These innovations and many others provided a great sense of satisfaction. Outside the constraints of a large organization, in situations of overwhelming need, with limited resources, doctors are forced to be pragmatic to enable the show to go on. It is under these conditions that a doctor flourishes. Finding life saving solutions to problems and watching them implemented to enhance the life of another is central to why doctors choose the career they do. Nevertheless it is a feeling, perhaps, that we aren’t able to replicate in our day to day jobs where medical care is rightly protocol driven, innovations are less immediate and change is difficult to bring about. The normal response of a surgeon operating in suboptimal conditions is to go red in the face and get extremely frustrated with the system. In Sierra Leone suboptimal is the norm and finding innovative solutions is a necessity to the provision of safe medical care.
The difficulties our team shared over those ten days brought us together and created a strong team spirit, with a great sense of comradeship, equality and creativity that disregarded the fact we were all newly acquainted and was something I have rarely experience in my training as a doctor.
I don’t know if we prioritised the right patients. I dread to think of the fact that some of them will experience complications that we are no longer able to treat and I feel sorry for those patients we had to turn away. Thankfully, as a people, they graciously face hardship and show an appreciation which is unrivalled by patients in the UK. I would recommend the experience to anyone. There are multiple organizations that need doctors and other support staff to donate manageable amounts of there time to help provide a small amount of relief for the people who are less fortunate than ourselves. If I was you I’d sign up now.
Better Lives Foundation – Three 10 day camps a year with a need for medics, surgeons, dentists, anesthetists and general volunteers.
Operation Hernia – One 12 day camp a year with need for surgeons anesthetics and general volunteers.
United Planet – Multiple sites. Recruiting volunteers from a wide range of professions 2 weeks to 2 years.
Volunteers Overcoming Poverty – actively recruiting healthcare professionals in 2012 to a range of projects.
Like many doctors I have always wanted to work for an Non-Governmental Organisation (NGO) and help to provide medical care to people who need it most. Those of us who have looked into it have found that larger organisations like Medicines Sans Frontier require a minimum six-month commitment which can never normally fit in with our training or annual leave. Thus, many doctors never get a chance to scratch that itch.
But there is another way. I have just returned from a ten day visit to Sierra Leone. A small charity called the Better Lives Foundation runs three medical camps a year, in a small purpose built hospital 88 miles from Freetown in Yonibana.
Sierra Leone is one of the poorest African countries in terms of infrastructure; devastated by a ten year civil war that finished in 2002, there is virtually no clean water and electricity is scarce. The life expectancy is shockingly short at just 42 years and over 80% of medical care is provided by outside agencies.
I was going to take part in the Hernia camp and the goal was to perform thirty hernia operations in ten days with a team of doctors and nurses whom I met at Heathrow airport. None of our team - the anesthetist, the consultant general surgeon, the specialist registrar, the theatre sister, or myself had ever been to Sierra Leone before and no one knew what to expect, except that there was a declared cholera outbreak and it was the end of rainy season.
On arrival at the camp it was straight to work. We had to turn a couple of dusty disorganized rooms into an operating theatre, a pre-op assessment area and a post-op ward. It was clear this was going to be a team effort. The camp wasn’t due to open until our second day but there was a queue when we arrived and after a long clinic looking at unbelievably large hernias we filled up our operating list. The need was obvious. Most of our patients were manual laborers with years of heavy lifting behind them and the lack of preventative surgery contributed to the high prevalence of hernias, often untreated from birth.
Over the next few days we began operating and were struggling to get through our planned lists with the expected delays of an unfamiliar environment. Nevertheless patients kept turning up and it was evident that the demand for operations exceeded the number we were able to perform. We started to question our initial approach. Should we have booked patients on a first come first serve basis? The issue being that some people had to walk for days to attend camp and word had only reached distance villages after we started.
Would we have been better off booking smaller hernias and getting through more operations? We had started by prioritizing patients with large hernias whom we perceived to be in the greatest need of surgical intervention. But these operations were more complex, requiring longer operating times and with greater risk of complication. Then there were the patients who had attended previous camps with their medical notebooks documenting the hope of an operation if they returned this year. Should we have prioritised these patients?
We considered setting up another operating table in theatre and running two operations at once. But that wasn’t a practical solution and we had to face up to the difficult reality. We had to turn patients away, despite overwhelming medical need with it’s accompanying patient desperation. It was heartbreaking and against the instinct of a doctor, especially without a robust justification as to why one patient would be operated on over another.
In contrast to these frustrations, I found the way our team approached equipment shortages, time constraints and organisational challenges to be truly inspirational. None of us felt that we should compromise our UK standards just because we were in a developing country. We needed to operate as we would at home or not operate at all, and with this as our goal we found a way around each of our problems. We ran out of sterile drapes and thought we would need to cancel operations but improvised using patient gowns as sterile fields with make-shift holes cut into them. We developed a post-op scrotal support system made out of crepe bandages that we found more efficient than the expensive alternatives used in the UK. We rewired the diathermy machine into a health and safety hazard but fully functional piece of kit to prevent intraoperative bleeding. We conducted a group consent session to save precious operating time. And when the generator gave up one evening we used our head torches as operating lights and we treated an acute asthma attack using a polystyrene cup as spacer device instead of a nebulizer.
These innovations and many others provided a great sense of satisfaction. Outside the constraints of a large organization, in situations of overwhelming need, with limited resources, doctors are forced to be pragmatic to enable the show to go on. It is under these conditions that a doctor flourishes. Finding life saving solutions to problems and watching them implemented to enhance the life of another is central to why doctors choose the career they do. Nevertheless it is a feeling, perhaps, that we aren’t able to replicate in our day to day jobs where medical care is rightly protocol driven, innovations are less immediate and change is difficult to bring about. The normal response of a surgeon operating in suboptimal conditions is to go red in the face and get extremely frustrated with the system. In Sierra Leone suboptimal is the norm and finding innovative solutions is a necessity to the provision of safe medical care.
The difficulties our team shared over those ten days brought us together and created a strong team spirit, with a great sense of comradeship, equality and creativity that disregarded the fact we were all newly acquainted and was something I have rarely experience in my training as a doctor.
I don’t know if we prioritised the right patients. I dread to think of the fact that some of them will experience complications that we are no longer able to treat and I feel sorry for those patients we had to turn away. Thankfully, as a people, they graciously face hardship and show an appreciation which is unrivalled by patients in the UK. I would recommend the experience to anyone. There are multiple organizations that need doctors and other support staff to donate manageable amounts of there time to help provide a small amount of relief for the people who are less fortunate than ourselves. If I was you I’d sign up now.
Better Lives Foundation – Three 10 day camps a year with a need for medics, surgeons, dentists, anesthetists and general volunteers.
Operation Hernia – One 12 day camp a year with need for surgeons anesthetics and general volunteers.
United Planet – Multiple sites. Recruiting volunteers from a wide range of professions 2 weeks to 2 years.
Volunteers Overcoming Poverty – actively recruiting healthcare professionals in 2012 to a range of projects.
Thursday, September 27, 2012
The Power of Data – is it Right Hands, Right Time? Or Wrong Hands, Wrong Time? By Dr Thishi Surendranathan, Beacon UK
Can you imagine a healthcare system where doctors and other health professionals can access the totality of a patient's healthcare record online? Or where doctors and patients communicate via secure e-mail to help manage care outside the doctor's office? Or where doctors share data on their activity in real-time for the purposes of enhancing performance?
It already exists thanks to Kaiser Permanente, a not-for-profit health insurer and hospital chain based in California, United States. In this blogpost, I report back from a seminar-led by Kaiser Permanente's Murray Ross and Joy Lewis, and hosted by Reform in London on Wednesday 19th September.
For those of you clinicians and patients who are sceptical of taking home lessons from across the pond, where overall costs are horribly bloated by profit-making insurers and cherry-picking "fee-for-service" providers naming their price, I would advise you to pay closer attention to the high quality of its care, the level of patient satisfaction and the overall efficiency of the Kaiser Permanente operation.
For the fourth straight year, Kaiser Permanente is the only health plan in California to earn a 4-star rating - the highest possible - for overall quality of care by the California Office of the Patient Advocate, and has also achieved the highest possible rating for patient satisfaction. By virtue of its system of prepayment rather than fee-for-service, Kaiser has created a compelling model of integrated, high-quality, accessible health care.
As per Joy Lewis' introduction, Kaiser Permanente has 3 branches: a not-for-profit health plan, a not-for-profit community hospitals and 8 independent self-governed Permanente Medical Groups. With more than 7 million members in California alone and a further 2 million in 6 regions across the US, Kaiser serves a population greater than that of London.
Joy, who is Manager of Kaiser Permanente International, explained that the role of technology within the organisation is as an enabler, and nothing more. It's power depends on the users and the pervading cultures: without engagement from doctors the technology cannot be used to improve clinical effectiveness or improve the patient experience. It boils down to a simple equation:
Large new IT system + Old Organisation = Costly Old Organisation.
Could she have been referring to the NHS Programme for IT?
Murray Ross, Director of the Kaiser Permanente's Institute for Health Policy, went onto describe the role of data as one part of a triad of key components in Kaiser's success. These are:
1) Physician Leadership
2) Mindsets & Behaviours
3) Data & Reporting
The first part of the triad will be very interesting to those who are afraid that data will be used by managers as a malevolent tool to control doctors' behaviour. The overarching principle here is to preserve autonomy at the individual clinician level. Each of the medical groups providing care has an elected physician board i.e. the system relies on doctors leading other doctors. Promising leaders are identified early and each of these are given management training: further enhancing engagement of medical staff.
The second part of the triad refers to the culture of continuous improvement, knowledge-sharing and team-working that has enabled Kaiser to outperform its peers. Over decades, Kaiser has evolved a policy of pro-active, preventative, integrated care over reactive, fragmented care. The popularity of Kaiser amongst prospective physician recruits helps, there being a typical 10 applicants per post: Kaiser is able to pick and choose the most engaged and talented medics.
The last member of the triad is data and reporting. Over the past decade, Kaiser has spent over $4bn on an Electronic Health Record system developed by Epic. The most obvious benefit of this is that doctors can see ALL of their patients' medical information at the click of a few buttons: at the right place, at the right time. But just as useful to the organisation are the "matrix searches" possible on the vast amounts of data. Information can be pulled up by doctor, department, diagnosis and many other dimensions.
There a number of exciting consequences for this including:
Of these, the most anxiety-provoking for a British doctor may be the sharing of activity data "unblinded" amongst peers. However, the culture is not punitive, it is more about the development of good clinical practice. Doctors, who are usually all "A" students, naturally don't like coming last, so the mere sharing of data promotes competition by forcing doctors to simply ask: why? i.e. why am I different to those at the other end of the curve? The usual challenges include, "my patients are sicker" or "the data is wrong". Here it becomes especially important that Kaiser is built on physicians leading physicians. Outliers are recognised via a culture of openness and transparency, and, through discussion with and learning from their peers, those outliers improve their clinical practice.
Of course it would be difficult for the Kaiser Permanente model effectively provide high-quality, affordable care without appropriate alignment of incentives. Physicians working in the Kaiser system receive a 10% bonus if both the facility they work in and the individual physician achieves specific quality measures. There are no incentives based on volume, costs, utilisation or other financial measures. This idea is particularly relevant to NHS where the payment system mostly rewards activity.
The presentation closed with the observation that the affordability of latest health care reform in the United States was envisaged to depend on "delivery system reform", and the concurrent rise of the Accountable Care Organisation "...a group of physicians teamed with a hospital with joint responisbility for the quality and cost of care provided to a large (Medicare) population" as an alternative to lowering fee-for-service payment rates. This, according to Kaiser, is what they have already been doing for 60 years and, if successful, will change the way care is organised and delivered in the US.
It already exists thanks to Kaiser Permanente, a not-for-profit health insurer and hospital chain based in California, United States. In this blogpost, I report back from a seminar-led by Kaiser Permanente's Murray Ross and Joy Lewis, and hosted by Reform in London on Wednesday 19th September.
For those of you clinicians and patients who are sceptical of taking home lessons from across the pond, where overall costs are horribly bloated by profit-making insurers and cherry-picking "fee-for-service" providers naming their price, I would advise you to pay closer attention to the high quality of its care, the level of patient satisfaction and the overall efficiency of the Kaiser Permanente operation.
For the fourth straight year, Kaiser Permanente is the only health plan in California to earn a 4-star rating - the highest possible - for overall quality of care by the California Office of the Patient Advocate, and has also achieved the highest possible rating for patient satisfaction. By virtue of its system of prepayment rather than fee-for-service, Kaiser has created a compelling model of integrated, high-quality, accessible health care.
As per Joy Lewis' introduction, Kaiser Permanente has 3 branches: a not-for-profit health plan, a not-for-profit community hospitals and 8 independent self-governed Permanente Medical Groups. With more than 7 million members in California alone and a further 2 million in 6 regions across the US, Kaiser serves a population greater than that of London.
Joy, who is Manager of Kaiser Permanente International, explained that the role of technology within the organisation is as an enabler, and nothing more. It's power depends on the users and the pervading cultures: without engagement from doctors the technology cannot be used to improve clinical effectiveness or improve the patient experience. It boils down to a simple equation:
Large new IT system + Old Organisation = Costly Old Organisation.
Could she have been referring to the NHS Programme for IT?
Murray Ross, Director of the Kaiser Permanente's Institute for Health Policy, went onto describe the role of data as one part of a triad of key components in Kaiser's success. These are:
1) Physician Leadership
2) Mindsets & Behaviours
3) Data & Reporting
The first part of the triad will be very interesting to those who are afraid that data will be used by managers as a malevolent tool to control doctors' behaviour. The overarching principle here is to preserve autonomy at the individual clinician level. Each of the medical groups providing care has an elected physician board i.e. the system relies on doctors leading other doctors. Promising leaders are identified early and each of these are given management training: further enhancing engagement of medical staff.
The second part of the triad refers to the culture of continuous improvement, knowledge-sharing and team-working that has enabled Kaiser to outperform its peers. Over decades, Kaiser has evolved a policy of pro-active, preventative, integrated care over reactive, fragmented care. The popularity of Kaiser amongst prospective physician recruits helps, there being a typical 10 applicants per post: Kaiser is able to pick and choose the most engaged and talented medics.
The last member of the triad is data and reporting. Over the past decade, Kaiser has spent over $4bn on an Electronic Health Record system developed by Epic. The most obvious benefit of this is that doctors can see ALL of their patients' medical information at the click of a few buttons: at the right place, at the right time. But just as useful to the organisation are the "matrix searches" possible on the vast amounts of data. Information can be pulled up by doctor, department, diagnosis and many other dimensions.
There a number of exciting consequences for this including:
- the activity/behaviour of doctors can be measured against peers in real time
- care can be given proactively e.g. diabetes sufferers can be searched and all those requiring foot check/retinal screening/HbA1C check can be approached
- whole populations can be tracked/measured to develop screening programmes.
Of these, the most anxiety-provoking for a British doctor may be the sharing of activity data "unblinded" amongst peers. However, the culture is not punitive, it is more about the development of good clinical practice. Doctors, who are usually all "A" students, naturally don't like coming last, so the mere sharing of data promotes competition by forcing doctors to simply ask: why? i.e. why am I different to those at the other end of the curve? The usual challenges include, "my patients are sicker" or "the data is wrong". Here it becomes especially important that Kaiser is built on physicians leading physicians. Outliers are recognised via a culture of openness and transparency, and, through discussion with and learning from their peers, those outliers improve their clinical practice.
Of course it would be difficult for the Kaiser Permanente model effectively provide high-quality, affordable care without appropriate alignment of incentives. Physicians working in the Kaiser system receive a 10% bonus if both the facility they work in and the individual physician achieves specific quality measures. There are no incentives based on volume, costs, utilisation or other financial measures. This idea is particularly relevant to NHS where the payment system mostly rewards activity.
The presentation closed with the observation that the affordability of latest health care reform in the United States was envisaged to depend on "delivery system reform", and the concurrent rise of the Accountable Care Organisation "...a group of physicians teamed with a hospital with joint responisbility for the quality and cost of care provided to a large (Medicare) population" as an alternative to lowering fee-for-service payment rates. This, according to Kaiser, is what they have already been doing for 60 years and, if successful, will change the way care is organised and delivered in the US.
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