Leaders in today’s world should admit to constant changes in their organisation and so commitment to continuous change is expected of them. Health organisations are not an exception. Forecasting of healthcare demand due to the growing and ageing population shows that in most western countries neither the capital nor the qualified health professionals will be available to meet that demand. However, pressure comes on to increase the capacity of the tertiary services offered which, in turn, increases the demand for capital and human resources. If either the capital or the human resources are not available, it becomes apparent at that point that the platform has been burning for a long time and there is not much of it left to stand on (Leigh JP, Fries JF 1992).That is unless there is a significant change in the way healthcare is delivered.
Traditionally, most leaders depend on available evidence, concepts or approaches that have proven successful. In the process, most of the leaders leading the tertiary health care organisations choose to focus their efforts on short term treatment measures for the patients rather than on the long term prevention strategies which will keep them away from the hospitals. These strategies are mainly driven by the national and state funding policies where the majority of the funds are available for the clinical services rather than for the prevention programs (Schroeder SA, Cantor JC 1991). Also the leaders in health organisations choose these concepts mainly because the outcome is immediately visible rather than focusing their efforts on prevention strategies where the results tend to take long to be evident. Many people expect to see results before a change has really got underway. What is more distressing is the lack of attention by the health leaders on preventing illness, which is potentially the most effective way of controlling the health care costs and so achieving the best care for the patients with little money. In theory, the lesser the illness and accidents in the society, the lesser the health care costs for the health care organisations (Fries et al, 1993).
The strategic directional document, Trends in Service Design and New Models of Care: A Review released by the Ministry of Health, NZ, 2010 provides a ‘high-level summary of emerging worldwide trends and international responses to the pressures and challenges facing the health sector. These trends emphasize shifts in service delivery across the health system, based on the premise that an aligned, system wide approach, focused on the patient rather than the disease, is required to ensure equitable and inclusive health service delivery and to meet increasing demand within a constrained environment.’
In the 20th century, as we all know, there is a reduction in acute illness, but an increase in chronic diseases. This increases the demand for the additional long term medical services thereby fuelling inflation in medical costs. The solution for chronic diseases is clear: prevent them (Fries JF, 1985). Lifetime medical costs are directly related to health habits (McGinnis JM, 1992). For example, the lifetime health cost of smokers despite their shorter life spans is higher than the health costs for the non-smokers by approximately one third (Manning WG et al 1991 & Hodgson TA 1992). In short, we are confronted by health systems, which are not well matched for current and future health needs (Fried LP et al, 2012).
It is critical that as healthcare leaders, we manage the ever-increasing demand for services. If demand continues to grow at projected rates, we will not have sufficient physical and workforce capacity to maintain service delivery, even at current levels. Projected demand for acute services will ‘crowd out’ non- urgent services, waitlists will grow and the quality of service delivery will be adversely affected. To manage demand we need to keep doing the basics well like, ‘constrain expenditure to within the funding received, reduce waste and duplication and improve the quality of patient care by adopting a standardised approach, prioritise resources to meet increasing demand and to deliver the maximum health benefits, re-allocate funding between discretionary and non-discretionary services to manage demand driven growth, take a whole health system approach to reduce unnecessary hospital admissions and manage acute demand and find innovative ways to ensure funding / resources support the new ways of working and the shifts in where and how services are delivered’ (CDHB, 2014).
As leaders, we should continue to focus on initiatives that have contributed to our past successes: like reducing variation duplication and waste; doing the basics well; and developing our workforce capacity. However we also should put our efforts into supporting united systems with a strong focus on primary and community-based service delivery. We need to continue to strengthen investment in clinical leadership. By enabling clinical input and leadership in operational processes and decision-making, we can make robust and clinically acceptable efficiencies across the whole system. Clinical leaders and providers in the front line of health care are in the best position to decide how services should be delivered in order to improve quality and technical efficiency, and it is only with their support that change will be long-lasting (West Coast DHB, 2014).
In conclusion, prevention is much cheaper than treatment (Rogers EM, 2002). It is anticipated that focusing on the prevention concepts as part of a patient management process will promote fast and timely care of patients in tertiary care settings with minimal health care costs. Conventional concepts are best used in slow-growing industries and in industries where they are playing catch up to a future that is already laid out for them. Even though the concepts like frugal innovation, low-tech innovation and LEAN management work well, the ideal way to go ahead in the health sector is to focus our attention on prevention approaches.
Fried LP, Piot P, Frenk JJ, Flahault A & Parker R (2012). Global public health leadership for the twenty-first century: Towards improved health of all populations. Global Public Health Vol. 7, No. S1, Pg. S5-S15.
Fries JF (1985). The Compression of Morbidity. World Health Forum Vol. 6, Viewed on 5 May 2015. http://whqlibdoc.who.int/whf/1985/vol6-no1/WHF_1985_6(1)_p47-51.pdf
Hodgson TA (1992). Cigarette smoking and lifetime medical expenditures. Milbank Q, Vol. 70, Pg. 81-125.
Leigh JP, Fries JF (1992) Health habits, health care use and costs in a sample of retirees. Inquiry, Vol. 29, Pg. 44-54.
Manning WG, Keeler EB, New house JP, Sloss EM, Wassermann J (1991). The costs of poor health habits. Cambridge, Massachusetts: Harvard University Press, 223.
McGinnis JM (1992). Investing in health: the role of disease prevention. In: Blank RH, Bonnicksen AL, eds. Emerging issues in biomedical policy: an annual review. Vol. 1, New York: Columbia University Press, Pg.13-26.
Ministry of Health (2010). Trends in Service Design and New Models of Care: A Review. Ministry of Health. Viewed on 5 May 2015. www.nationalhealthboard.govt.nz
Rogers EM (2002). Diffusion of preventive innovations. Addictive Behaviors, Vol.27, Pg. 989–993.
Schroeder SA, Cantor JC (1991). On squeezing balloons-cost control fails again. The New England Journal of Medicine, Vol. 325, Pg.1099-100
West Coast District Health Board (West Coast DHB) (2014). The future of West Coast Community Health Services. Viewed on 5 May 2015. http://westcoastdhb.org.nz/about_us/ projects/greymouth_community_health_services/default.asp