Care Design 2016

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#3 Manage for complexity

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Our third proposed redesign principle is to manage for complexity

We think we need to develop the capability to deal with the complexity of patient needs and match these to services e.g.

  • Understand the nature of demand
  • Multidisciplinary teams including social care and mental health
  • Ensure care is at the most appropriate level
  • Reduce care coordination challenges and hand-offs by multi-skilling professionals and care workers
  • Capture the benefits of generalists and specialists
  • Provide specialist advice more widely across the system – for example by the use of technology


This is what we think but what we really want to hear are your thoughts about this!

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  1. Victoria Hewitt
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  2. Heidi De Wolf
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  3. Wendy Lane
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  4. Candy Perry
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I recommend this simple exercise to try out when redesigning a service.  Draw your organisational structure or service configuration and decide where to put the patient.  If it's a hierarchy - where does the patient go? The top, bottom, somewhere in the middle?  If it's patient centred - what about all the patients you care for?  Can they all be at the centre? What if the physio (for example) is heavily involved in one case - can they be equally available to everyone who might need them?  If...

Victoria Hewitt
by Victoria Hewitt
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Victoria Hewitt

It's all too easy to oversimplify complex problems or to feel polarized regarding solutions -- to feel like we have to land on only one way of doing things. When I think of agile systems, I think of systems that are responsive to what people say they need (yes, that means that asking people about what they need and really listening to what they are saying, even when we don't like it). So, systems can be designed that are responsive, integrated and easy to access. Health systems appear simple...

Debra Barrath
by Debra Barrath
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Debra Barrath

There is a real temptation for people here to become focussed on trying to refine segmentation and models to a level of detail that is not helpful. If we take the view that the patient is the expert in their life and what quality of that life means for them; our service professionals (health and social care) are experts in what options are available, then what we need to pull off is a meeting of minds so the patient can make the right choices for them. What we need from our care models is...

Wendy Lane
by Wendy Lane
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Wendy Lane

In my experience complexity often arises due to the nature of family dynamics; the number of organisation interfaces needed to be navigated; and the patient's locus of control.  Understanding wider determinants of health, and the impact of psychological and social wellbeing on health is vital. Unless we ask those questions at the outset, we might tend to over-medicalise, and miss the point. Thinking about medically unexplained symptoms.....how complex are those presentations, and what's...

Caroline Poole
by Caroline Poole
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Caroline Poole

Can we really 'manage' complexity? In my view can only host complexity and work with it. There seems to be a great focus on data and possibly not enough on collective knowledge, wisdom and intuition. Management & capturing data are a past-focus activities. It captures and monitors the 'as is' which when analysed with a past-focussed mindset ends up being exactly the evidence needed to not change and keep the status quo. As such we need to focus more on collective and diverse...

Heidi De Wolf
by Heidi De Wolf
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Heidi De Wolf

Was surprised by the work of NAIC the other day when professor Young demonstrated that there was a correlation between better patient outcomes in intermediate care and the number of professionals/disciplines involved in their care.....worth considering to ensure the quest for multitasking individuals doesn't go to far

Debbie Westwood
by Debbie Westwood
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Debbie Westwood

Two points here: 1. Managing and leading for complexity and 2. Checking we are taking action against the actual problem and not an effect of the problem Clogged A&E, waits for GP appointments and elective waiting lists all receive media attention and management attention. Yet we know they are effects not causes. If we were genuinely taking a whole systems approach we would see that demand failure is everywhere. Services built but people don't use them or don't get referred to them...

Candy Perry
by Candy Perry
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Candy Perry

The health system is complex, not merely complicated. As such, it requires an approach to implementing leadership consistent with complex systems: one size does not fit all, there are no simple cause and effect relationships, and a focus on the whole is necessary to achieve intended outcomes. Viewing the series with a complex systems lens, five guiding principles emerge for implementing leadership to achieve sustainable health system reform. 1. CLARITY OF PURPOSE Under the current...

Hugh MacLeod
by Hugh MacLeod
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Hugh MacLeod

Complexity in health care is driven more by professional behavior and culture than by the complexity associated with individuals.

Thomas Nolan
by Thomas Nolan
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Thomas Nolan
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Life is complex, right? Humans often behave irrationally, especially when they are ill, exhausted and emotional.  So why do we spend so much energy trying to eliminate the uncertainty, ambiguity and complexity that is an inherent part of health and social care? We use terminology such as "pathway", "journey" and "flow", suggesting a linearity that is not reality.  We are setting ourselves up to fail when we don't accept those problems, which Grint (2008) so eloquently terms "wicked"...

Victoria Hewitt
by Victoria Hewitt
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Victoria Hewitt
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