2013-05-23T23:23:22-04:00 Dr Mark Britnell http://www.huffingtonpost.co.uk/author/index.php?author=dr-mark-britnell Copyright 2008, HuffingtonPost.com, Inc. HuffingtonPost Blogger Feed for Dr Mark Britnell Good old fashioned elbow grease. tag:www.huffingtonpost.com,2013:/theblog//3.3115122 2013-04-19T08:13:33-04:00 2013-04-19T11:08:40-04:00

Dr Mark Britnell http://www.huffingtonpost.com/dr-mark-britnell/ World Health Organisation in 1948, World Health Day helps to highlight an area of public health concern each year on the 7th of April. Sharing information on how different countries tackle problems, such as high blood pressure - the theme this year - is undeniably a progressive development. Healthcare systems around the world are under increasing pressure and I believe that the only way we can face up to these challenges is to share experience, in line with this internationalist approach to problem solving.

To this end, I was involved with organising a conference in October 2012, which brought together 40 senior executives and clinicians, representing some of the world's largest healthcare organisations from 22 countries, to share insights, ideas and outlooks. While each society faced different population dynamics, disease outbreaks, health and welfare challenges, each healthcare leader was open to sharing and learning from parallel experiences. Inspired by the progressive spirit behind the recent World Health Day, we have decided to pool the findings from the conference and share them with the world in Something to Teach, Something to Learn. Delegates identified five major trends reshaping healthcare today.

Firstly, those picking up the bill for healthcare - whether they are governments, public sector bodies or insurers - are becoming more selective and value focused. Re-shaping patient behaviour, with more focus on prevention, is also part of the dynamic. Secondly, providers need to rethink their approach as it is becoming clear that major transformational change may be ahead. There is an imperative to engage patients in new ways so that they become active partners in their care, rather than passive recipients. This factor - the third trend identified by delegates - requires new systems and patient-centric policies. Fourthly, the rise of the 'high-growth health systems', from rapidly developing countries in Asia, Africa and South America, is changing global outlooks. These high growth health systems are innovating fast and lessons can be derived from their experience. Finally, delegates highlighted that sustainable change and better value are increasingly being seen as a direct result of new approaches to integration.

Reflecting on the conference, I was struck by the importance of implementing a strategic vision, drawing on the expertise of the hard working people - the most valuable assets - within health services such as the NHS. In these challenging times it is crucial that organizations make enough time to conceptualise long-term strategic plans, not just short term goals. Organizations must focus on patient value and outcomes: on what patients really need and want. We need new ways of working, and a new dialogue, in which the patient's voice is amplified.

Leaders who face up to this challenge will look beyond process targets. They will allow space for their staff to innovate and experiment in order to create new models of care. They will empower their teams, collaborate and share information. Recognizing that we all have something to teach and something to learn - in line with the spirit of World Health Day - will be crucial for success in the changing dynamics of the new healthcare paradigm.]]> tag:www.huffingtonpost.com,2013:/theblog//3.2908760 2013-03-19T13:38:39-04:00 2013-03-20T11:36:19-04:00

Dr Mark Britnell http://www.huffingtonpost.com/dr-mark-britnell/ 'Healthcare in Africa' event, I was struck by the importance of putting the patient's perspective at the heart of healthcare systems during this dynamic period of change and development.

Calls for universal health cover grow ever louder in Africa, and the NHS is seen as a beacon of what could be created. All over the African continent, countries are experimenting with new care models, often driven through a scarcity of health workers. For example, the number of nurses per 10,000 population in Africa is estimated by the World Health Organisation to be 11 compared to 68 across the European region. Africa carries 25% of the world's disease burden but accounts for only 1% of global health expenditure and 3% of the world's health workers.

Patient-centric care is important to all people and the focus, at this time, in South Africa is on access to care, starting with Universal Insurance. In South Africa, a comprehensive National Health Insurance (NHI) system is being developed to cover 48 million people. The NHI is part of a ten point plan to improve public hospitals, infrastructure, the quality and quantity of health workers and reduce HIV and maternal deaths. The government plans to introduce the NHI gradually, given the cost and logistical implications.

At the same time, there is significant scope to improve the delivery of care with a focus on quality and the patient experience. Making improvement part of daily work in health care - as opposed to a set of projects - is important. Supporting staff with on-the-job coaching, that provides them with the skills and confidence to challenge the status quo, is also crucial. The Aravind Eye Care System in India, the Narayana heart hospital in India and the delivery of obstetric care with Tecnicos in Mozambique are all examples of innovation in countries where health care is also developing at pace - examples that could help to inform and inspire innovation in countries such as South Africa. A key area of innovation in NHI policy is the re-structuring of primary healthcare. By taking advantage of outreach-type services that already exist, and creating news ones, I believe the rollout of NHI will see a far more community-centred, patient-centred approach to primary care that could improve patient education as well as patient health.

The further development of health care systems in Africa, such as NHI, will undoubtedly have a significant impact on the health of millions of people, for generations to come. Ensuring the patient experience is a core value in the development of these new, and maturing, health care systems is an opportunity to truly embed a patient-centric culture. A culture in which patients play an active role in planning their own treatment. A culture in which resources are used efficiently and patients have a voice. A culture in which patients are treated with the dignity and respect they deserve.]]> tag:www.huffingtonpost.com,2012:/theblog//3.2277670 2012-12-11T12:06:46-05:00 2012-12-13T08:14:35-05:00

Dr Mark Britnell http://www.huffingtonpost.com/dr-mark-britnell/
Obama-care currently divides a nation and was one of the key differentiators between the presidential candidates in the USA. The future of the Health and Social Care Act is a political minefield in the UK as successive governments have tried to reform the NHS and met with mixed success. Meanwhile China is facing the complexities of increasing healthcare provision, while tackling issues of access. For those of us involved in finding solutions to global health care challenges, it is all too easy to get bound up in the technocratic details of policy and implementation. However we need to get back to first principles and be clear about priorities. At the top of my list is that the most valuable asset in any health service is its staff - its people.

In Value Walks, a report on healthcare across the globe, KPMG estimates that in developed countries, health systems may be facing a workforce shortage of over 20% by 2022, as populations age, patient demand increases and the health workforce shrinks because of retirement. Some people say that "cost walks on two legs", but this is a negative, damaging and short-term view. In fact value walks on two legs. This report takes this idea forward by highlighting five approaches that successful organisations have adopted to create a value synergy in which staff productivity improves, work attractiveness increases, and professional motivation blossoms.

Buurtzorg, an aged care provider in the Netherlands, is an interesting example of an organisation taking a strategic view of health provision. The Buurtzorg team placed more power in the hands of well trained nurses, encouraged the use of the latest techniques, and let them organise care and place the patient at the centre of their efforts. These moves have dramatically increased productivity while improving clinical effectiveness and morale.

When managing a healthcare provider real differences to the quality and cost of patient care result from the design of the clinical care process, the degree of innovation in the business model and the motivation of staff. Working with trade unions and professional bodies can further enable organisations to take a strategic view of their collective position. Having spent 20 years working for the NHS in the UK, I truly believe that successful healthcare organisations are those that have a strategic and long-term focus on patient value; consciously empower healthcare professionals and give them greater autonomy; systematically apply leading-edge business and care process redesign methods; improve clinical and management information so it is routinely used in day to day activities; and have unambiguous staff performance management and accountability frameworks.

People are the beating heart of healthcare provision. Patient value is created by dedicated staff caring for patients. To address the potential workforce shortage we must empower staff, motivate healthcare teams and care for those who care for us.]]> tag:www.huffingtonpost.com,2012:/theblog//3.2222881 2012-12-01T05:41:42-05:00 2012-12-04T07:51:17-05:00

Dr Mark Britnell http://www.huffingtonpost.com/dr-mark-britnell/ Ricky Gervais, Michael Owen, Theo Walcott, Damian Lewis and Patrick Taggart, who are taking part and doing their bit to get people talking about issues men often avoid talking about.

Cancer accounted for 7.6 million deaths, around 13% of all deaths, in 2008 according to the World Health Organization and prostate cancer is the most common cancer in men in the UK. According to Prostate Cancer UK, over 40,000 men are diagnosed with prostate cancer and 250,000 men are currently living with the disease. Since its launch in Australia in 2003, Movember has generated support and fundraising activity in almost every corner of the world, from the USA to Hong Kong and from Canada to South Africa, Singapore, Switzerland and beyond.

Finding out that I had cancer had a huge impact on me and my family. I took a long hard look at my life and made some choices to try to ensure my kids would be more secure, whatever was set to happen to me. I also became more aware of the steps I could make to improve my health. The depth of respect and gratitude I have, to the fantastic NHS teams who cared for me during my treatment, is indescribable. I will always be in their debt.

Cancer isn't an easy thing to talk about and, as men, we can feel embarrassed to share our health issues. It is all too easy to ignore a health worry, until it becomes a major problem, but the impact can be devastating. That's why I feel it is important to get people talking and thinking about men's health and growing a 'Mo' is part of this.

Having lived through this experience, I want to play a role in raising awareness, and in generating a debate on how health services for cancer can be improved across the globe. From healthcare delivery to health service management and post-operative care, I believe there is more we can do, globally, to take on this disease. The more we talk, and share knowledge and experience of best practice from different countries, the more chance we'll have of tackling cancer. Prostate cancer doesn't respect national boundaries and it is a very good job that Movember doesn't either. In an age where mass, social movements are creating change, it is a good job we're doing the same in the fight against cancer.]]> tag:www.huffingtonpost.com,2012:/theblog//3.1763402 2012-08-10T06:17:49-04:00 2012-10-10T05:12:15-04:00

Dr Mark Britnell http://www.huffingtonpost.com/dr-mark-britnell/ 87% in 2008 and 96% in 2011, according to the World Health Organisation. These changes are likely to have taken about half a billion extra people into healthcare cover - an epic achievement.

However, although insurance coverage is broad, it is not particularly deep. In fact, some commentators believe that patients still have to bear more than 50% of care costs. Spending just 5.06% of its GDP on health in 2010, according to World Bank economic indicators, China has been playing catch-up over recent years (average life expectancy at birth of 73 in 2010, according to the World Bank). The share of public expenditure of total healthcare costs increased from 39% in 2005 to 54% in 2010 (similar levels to government expenditure on health in the USA). Private spending accounted for the remaining amount, with a staggering 80% of this latter total coming from out-of-pocket payments.

World Bank figures also suggest that private insurance across China only accounts for a meagre 3% of total healthcare spending (China has not granted licenses to foreign private health insurers from entering the market). Individuals can be placed under disastrous financial pressure during times of ill-health. In fact, World Health Organisation surveys show that the incidence of catastrophic medical expenses are significant and an estimated 13% of the population can face financial ruin, or difficulties, due to episodes of ill-health. More generally, it has been estimated that household expenditure on health in China is increasing significantly.

Further, commentators often point to this fact as the reason for the relatively low domestic consumption of goods and services by individuals in China (they save for a rainy day), fuelling further reliance on export led growth. In the long term, it is argued, China will need to re-balance this trend if its growth is to be more sustainable and the fruits of economic growth are to be more 'socially shared'.

The reform of China's public hospitals is the pivotal issue for the control of healthcare expenditure, improvement in care quality and, ultimately, improved access to decent healthcare. In my recent visits to Beijing, Shenzen and Shanghai, it was clear that there is considerable enthusiasm for these reforms although this is tempered by some anxiety over financing levels and management support. For example, some hospital directors wonder whether the government will pick up the bill. Similarly, there is considerable enthusiasm for improved management techniques but a lack of supply of 'know-how'.

I strongly believe that we all have something to teach and something to learn in approaches to the global challenges facing health professionals. Sharing information and examples of good practice will be key to whether the ongoing reforms in China will be judged a success. I have no doubt that China will rise to this challenge with the same determination and focus that has led to its remarkable economic transformation in the last thirty years. It is essential for global health and prosperity that China succeeds.]]> tag:www.huffingtonpost.com,2012:/theblog//3.1569309 2012-06-04T18:20:48-04:00 2012-08-04T05:12:12-04:00

Dr Mark Britnell http://www.huffingtonpost.com/dr-mark-britnell/ World Environment Day challenges every one of us to ask what role we're playing in the green economy. While the organisers identify 10 sectors for a greener planet - from forestry to tourism - I'd argue that healthcare systems, including the NHS in the UK, also have a leading role to play. Health systems can do more to fight climate change and shouldn't be let off the hook.

There is considerable room for improvement in healthcare's environmental footprint. For example, in the United States the health sector accounts for 8% of total greenhouse gas emissions, making it the second most energy intensive industry after fast food, while in the European Union the health sector creates 5% of total emissions, the equivalent of the region's aviation and shipping industries combined. While climate change has a profound effect on the health of individuals and communities, it's also true that the health sector can do more to help global sustainability and meet the aspirations of the green economy.

A recent global business leaders' event on climate change and sustainability sponsored by KPMG drew over 500 leaders from the corporate world, who heard speeches by Ban Ki-moon, Bill Clinton, and Michael Bloomberg, mayor of New York city. Their message was clear: governments cannot solve the sustainability crisis on their own, and business needs to take a lead. Speaking at the event, and listening to the other speakers, I came away with a clear sense that the health industry also needs to play a more prominent role in leading action on climate change.

In our recent report we identified 10 global sustainability "mega-forces" (climate change, energy, resource scarcity, water scarcity, population growth, urbanisation, wealth, food security, ecosystem decline, and deforestation) that are interconnected and important in health outcomes. Most health systems in the world have not shouldered their fair share of responsibility, nor have they fully realised their leadership potential in sustainability.

As a former chief executive of a large teaching hospital, I fully appreciate that clinical quality, financial performance, and waiting lists command most of the attention but that more action can also be taken on sustainability. As the world's fourth largest employer and one of the most energy hungry organisations, the NHS, I believe, has an excellent opportunity to step up to reduce emissions, create new jobs, and provide a global example of what health can do.

How? Firstly, energy production, consumption, and distribution are highly fragmented across the NHS. New combined heat and power generators and distribution services have vastly superior energy efficiency and dramatically reduce costs. A national network of leading edge combined heat and power plants with green waste management facilities would transform performance.

Secondly, the distribution chain between drugs and healthcare is antiquated and costly. Currently, drug companies have fragmented supply chains to hospitals, general practices, and retail outlets, with millions of vehicle movements across the UK. By working together the NHS and life sciences sectors can streamline the order, receipt, and distribution processes, thereby reducing the number of deliveries, the amount of packaging, and the cost.

Finally, we need to redesign the way care is delivered. There are millions of hospital outpatient visits each day, and many are vital. This creates a lot of, perhaps unnecessary, travel and adds to the overall carbon footprint. The latest developments in ehealth, telehealth, and telecare (devices that remotely monitor health status) offer us a glimpse at how we could reduce some of this travel. To its credit, the Department of Health for England launched the largest randomised controlled trial in the world of such technologies, and its three year evaluation has been published recently. With stunning reductions in mortality levels of 45%, emergency admissions of 20%, and costs of 8% the NHS has shown the rest of the world what is possible. More telecare can reduce emissions and improve health.

As the government looks for new ideas for economic growth and job creation, and Rio+20 looks for a greater commitment to sustainability, the NHS can truly lead the world in advanced energy systems, in lean delivery systems, and in new technologies. With innovation, creativity and the courage to act with scale and speed, the NHS could drive global change in healthcare sustainability. Given the scope to make a real difference to the future of our planet, let's not let healthcare systems off the hook this World Environment Day.]]>