Could an Integrated Delivery System be a cure for fragmentation in Catalonia?

An Integrated Delivery System (IDS) defined by Alain C. Enthoven  is an organized, coordinated, and collaborative network that:

(1) links various healthcare providers, via common ownership or contract, across 3 domains of integration—economic, noneconomic, and clinical—to provide a coordinated, vertical continuum of services to a particular patient population or community

(2) is accountable, both clinically and fiscally, for the clinical outcomes and health status of the population or community served, and has systems in place to manage and improve them.

With all of the following  characteristics:

1. Shared values and goals; 
2. Aligned incentives; 
3. Physicians leadership; 
4. Comprehensive records; 
5. Shared practice guidelines; 
6. A culture of teamwork; 
7. Integration across care settings; 
8. And a focus on populations as well as individuals.

Here there is the article explaining what is an IDS. A. Enthoven (2009) Integrated Delivery Systems: The Cure for Fragmentation: 

Alain C. Enthoven said in 2007 in a Nuffield Trust (UK) seminar:
"Integration is about relationships between people. These relationships are not informal friendships. They have to be worked on and built professionally if clinical integration is to be meaningful and sustained through good and bad times. Effective integration takes years to develop, and is not a quick fix".

We should explore more this idea in Catalonia.

photo: (*) Photosolde
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don't give up to read original articles

The goal of this blog is to share information tendencies about health, innovation, evaluation, data and how to manage organizations.

With only a small synthesis of the information, trying to give you an impartial perspective, I share the link that will take you directly to the original article.

Are not used reading a scientific or technical paper? Don’t worry!

Here there is an interesting article written in Science that give you some ideas how to read and understand a paper: How to read a scientific paper

Photo by Alfred Eisenstaedt, 1963 LIFE.

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open data in health care organizations

Open data definition: Data that is easily accessible, machine-readable, accessible for free or at negligible cost, and with minimal limitations on its use, transformation, and distribution.
See the video: #opendatafilm 12m

Why Open Data in health care organization?

Transparency. 
In a well-functioning, democratic society citizens need to know what their health organizations are doing. To do that, they must be able freely to access data and information and to share that information with other citizens.

• Transparency isn't just about looking for what the managers or the personnel are earning (an old fashioned idea). It is also about people empowering themselves to be better able to make decisions about their lifes: choosing the hospital with better treatment outcomes after analyse and compare different data procedures.
• Transparency isn’t just about access, it is also about sharing and reuse — often, to understand material it needs to be analyzed and visualized and this requires that the material be open so that it can be freely used and reused. Open data helps organizations to create data more efficient.

Participation.
Citizens are not able to engage with their health organizations.
By opening up data, citizens are enabled to be much more directly informed. This is more than transparency: it’s about making a full “read/write” society, not just about knowing what is happening in the process of governing or managing a health care organization but being able to contribute to it. Patients, their families and citizens in general push the organization to be more responsive.

[Want to know how a Catalan Health Care organization are tackling open data?: SAGESSA Open Data]

Other useful information: 
Health Open Data Catalan Health Service
The Open Data Era in Health and Social Care NHS England (2014)

photo: galaxy IDCS 1426 (NASA)
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Great teams: exploring, engaging and breaking down the silos

Building great teams the article written in 2012 by Sandy Pentland, one of the 7 most powerful data scientist in the world, explores using data the patterns from great teams.

Successful teams share several defining characteristics:

1. Everyone on the team talks and listens in roughly equal measure, keeping contributions short and sweet.
2. Members face one another, and their conversations and gestures are energetic.
3. Members connect directly with one another—not just with the team leader.
4. Individual reasoning and talent contribute far less to team success than one might expect.
5. The best way to build a great team is not to select individuals for their smarts or accomplishments but to learn how they communicate and to shape and guide the team.
6. The most valuable form of communication is face-to-face.
7. The best-performing and most creative teams sought fresh perspectives constantly, from all other groups in (and some outside) the organization.
8. Successful teams, especially successful creative teams, oscillate between exploration for discovery and engagement for integration of the ideas gathered from outside sources.

Nowadays some of these ideas should be used inside organizations and inside "political parties". Why do we not try to breakdowm the silos?

photo: (*) Photosolde

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merry christmas and happy new year 2016

designed by: Soldevila. disseny, comunicació i art
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Public-sector outsourcing is distinct from privatization: the desirability of outsourcing in the provision of public services

The desirability of outsourcing the provision of public services depends on their characteristics and market conditions.

This sentence is made by Panu Poutvaara from IZA World of Labor who recently has published an article about public sector outsourcing.

Pros:

• The competition effects of privatization make private provision more efficient than public provision.
• Outsourcing public services can lower costs and increase consumer choice.
• Competition in service provision stimulates innovation, and more efficient use of resources.

Cons:

• Private-sector cost minimization efforts risk worsening the quality of public services, depending on the type of service outsourced.
• Some public-sector employees may lose their jobs.
• Natural monopolies cannot be privatized without risking a hold-up problem or corruption.

What happen within health care sector?

The health sector picture is more complicated.

• Adverse selection is particularly strong in the health sector, and information asymmetries are arguably higher in the health sector than in other sectors like education. Outsourcing to private institutions could lead to the exclusion of the sickest individuals in an effort to reduce costs. 
• Public competition by comparison:

1. The introduction of patient choice triggers a change in the choice of hospitals, with patients choosing higher-quality hospitals as measured by the mortality rate for heart-attack patients
2. Hospitals facing more competition due to lower market concentration shows an increase in quality without an increase in cost. 

Taking to account for those who likes to confound apples with pears

Public-sector outsourcing is distinct from privatization.

• Outsourcing, broadly defined, entails the private-sector provision of public goods or services under procurement contracts or vouchers that offer consumers of public services a choice of private-sector providers.
• Privatization entails the sale or other transfer of ownership of a public business or entity to a private entity.

Access to the article

IZA World of Labor is a private independent nonprofit economic research institute that analyzes global labor market using evidence based information.

photo: banksy 
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Board meetings should be the place and time to engage board members

Board meetings provide an opportunity to actively review a company’s performance, analyse business processes, and strategize for the future.

But board meetings can also be frustratingly disorganized at times, too frequent (or infrequent, depending on the company), and a waste of everyone’s time if they’re not run properly.

As a manager who spends lots of time preparing the board meetings you probably have to think about these simple questions:

• Does everybody know all the meeting's annual calendar in advance?
• Does everybody know the time they will have to spend in each meeting to avoid people leave it in advance?
• Are you presenting a good metrics? Are they standardized?
• Are the presentations always done in the same model specially the financial and performance reports
• Are the discussions and the time spend in each item listed good enough?

Here there is an interesting article to read from Lisa Kay Salomon: "Designing Better Board Meetings: Securing Strategic Return on Time".

Acces to the article

Nat Farbman. The LIFE Picture Collection/Getty Images 1947. At Temple Public House, club members hold formal beer session. 
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