Tuesday, 22 January 2013

3 reasons why UK healthcare should not copy US innovations and improvement methods

I've nothing against the US, it's healthcare system and the methods used by various US organisations to improve their outcomes and processes. I don't live there so my opinion on their healthcare system doesn't matter. What is my business is the importing of US methodologists and solutions into a different context.  At a high level, learning new methods such as the Improvement Model is helpful, but at a more concrete level, copying "what worked in the USA" into the NHS will always be fraught with difficulties.

Reason 1: The USA outcomes are worse than the UK.
The IOM has released a new report US Health in International Perspective; shorter lives, poorer health. The facts are stark. US citizens die younger than their peer countries, despite paying more. Crucially, the report suggests that 20% of avoidable mortality is due to poor healthcare (rather than system related issues or behavioural choices).  Specifically, the US is worse than many countries in infant mortality & low birthrate, injuries and homicides,obesity & diabetes,  heart disease, chronic lung disease.

So why are we copying "solutions" from a system which is providing for worse outcomes than ours?

Yes, it can be argued that some care processes have better outcomes, but even then, there are difficulties. For example, it's widely touted that men with prostate cancer live longer than men with similar condition in the UK. If you look into the detail, yes, US men get diagnosed earlier - but they die at a similar average age as men with prostate cancer in the UK; the US men just had longer with the diagnosis, the treatment and the cost. More details on this and similar topics on the Cancer Research Science Update Blog.

Reason 2:  US model is based on cash for activity
The incentive for the majority of healthcare services is to provide more activity as a means of generating more income. This leads to overtreatment. Sharron Browlee's book "Overtreated; why too much medicine is making us sicker and poorer" is an excellent expose on this topic.

I had a debate with a US improvement consultant yesterday about why the NHS may not be rushing to implement rapid response systems in hospitals. We have a different value system, we have a different set of economics, and a different culture about death and dying. Solutions that work in US hospitals may not be the best ones for our NHS. Yes, we still need to resolve some of the underlying issues - but I hope we can do so in a way that fits our own culture, social and economic constraints.

Reason 3: The opportunity for delivering change & improvement in publically (and part-private..) funded health system far outweighs the private led US model.
Even though the NHS is under pressure to privatise part of the healthcare services, the fact that we do have a publicly driven system, connected to social care as well - means we have an incredible opportunity to devise solutions to problems that are truly radical. While we fuss about the speed at which patients are supposed to get electronic access to their records, and how to link them with hospitals - at least we have electronic records. We have register of people with conditions, and many good primary care organisations use these to do their best for the health of their local population.

I sometimes feel that whilst we are in the embrace of US-led improvement and change methodologies we are not devising ones that will make the most of our specific context. A good start is the NHS Change Model, which is sufficiently bland yet comprehensive, to provide useful and reasonable guidance for change.  It's not earth shatteringly clever - but it is one for the NHS, by the NHS, and I believe will be helpful for the NHS.


1 comment:

Harry Longman said...

Surely the reason for adopting or not an improvement method from anywhere should be: what works? And perhaps it works there but not here, or vice versa, but origin from the USA should not prejudice our view either way.
Difficult to do in practice, because a lot of what we do may result from our own prejudices or the loud noise it makes.