When the system hampers innovation in healthcare

25 Feb
BARCELONA 15.01.2016 GEMMA BRUNA FOTOGRAFIADA EN BCN. FOTO LAURA GUERRERO
Sandra Bruna

It often occurs that old habits, bureaucracy and certain fossilized procedures hamper the chances that innovative projects, which have been proven effective for patients, may be extended from one organisation to another. Which are the causes that lead to this situation? And which tools can be offered to professionals?

This was one of the issues on the table in the session “Innovation in management: what are the keys to success?” organised last February 17th by the Catalan Society of Healthcare Management (SCGS) and the Agency for Health Quality and Assessment of Catalonia (AQuAS).

The event, which was chaired by the director of the Catalan Health System Observatory, Anna García-Altés, counted with the participation of the coordinator of the Observatory of Innovation in Healthcare Management in Catalonia (OIGS), Montse Moharra, the head of the Anaesthesiology Department of Hospital Vall d’Hebron, Domingo Blanco, and the founder and Global Business Development Manager of Doctoralia, Frederic Llordachs.

Domingo Blanco described the experience of the online pre-surgery programme started in 2006 by Hospital de Viladecans, which since has proven that not only unnecessary consultations in the centre can be reduced when planning a surgery, but it also helps avoiding repeated tests.

The team led by Dr Blanco, who is presently striving to extend this experience, is dodging some obstacles, such as the difficulty of gathering the patient’s complete clinical record. “There is no unified clinical record, there are difficulties to connect primary care and the hospital, and there still is a lot of fragmentation”, he admitted.

Despite the great savings for the healthcare system obtained with this online programme, it is far from being generalised. He hints at the reason. “There is a resistance against change, and the enemies of innovation are healthcare professionals themselves. We lack courage and also the support from organisations”, he added.

OIGS, a place to share innovation in healthcare

Within the structure of AQuAS, healthcare professionals can find the Observatory of Innovation in Healthcare Management in Catalonia, a space to share innovative experiences in management, fostering a collaborative environment and the exchange of knowledge.

The OIGS currently includes 180 innovative experiences that have already been implemented in the health system, and have generated change, and which can also be transferred, as well as 37 certified experiences, as explained by its coordinator, Montse Moharra.

The OIGS also offers a place for learning on innovation in management, with more than 600 professionals participating, an assessment quality certification procedure for the experiences, and the identification of strategic alliances and good practice.

The use of ICTs and the ePatient

The founder of Doctoralia, Frederic Llordachs made an appeal for the participation of healthcare professionals and to anticipate the patients’ needs thanks to the use of ICTs, in a world where 80% of the population has an Internet ready mobile device.

“Patients do already demand that you schedule their visits using WhatsApp, and they look up health topics on the Internet. We are talking about an increasingly more empowered ePatient, who wants to be the centre, who demands autonomy in decision-making and who is more and more expert,” he pointed.

25% of users search the Internet for information on healthcare topics, and 35% of people in Spain use the web to schedule visits with healthcare professionals, while they forsake other media, such as the telephone. Within this setting, Llordachs advocated to jump the obstacles, and that healthcare professionals themselves generate the change.

A contributor from the audience stated the need to guarantee transparency and to include innovation projects in result-based services purchases, and also in the writing of healthcare agreements.

At the time of carrying out an innovative project, a key element is that it originates from a need, that it is placed under a continuous improvement, and that it is eventually assessed, to test its results and possible benefits.

Post written by Gemma Bruna (@gemmabruna), journalist specialised in health and head of Communications of the Catalan Society of Healthcare Management (@gestiosanitaria).

Animal (non-human) testing

18 Feb
Joan MV Pons
Joan MV Pons

It is striking that there are more data on the animals used in experimentation than on humans (patients or not) who take part in clinical trials. Certainly, in both cases, the regulations are stern and there are different organisms which ensure the safety of participants in experimentation.

Recently data on the experimental use of animals in Spain were published. Overall, the number of applications has been over 808,827 throughout 2014: 526,553 rodents (mostly mice), about 190,354 fish (more than a third were zebrafish) 44,169 birds and 23,881 rabbits, to name the most used animal species. It should be noted that a quarter of those, and despite being mostly mice, are genetically modified animals. The vast majority (75%) are used for what is called basic research and translational and applied research.

Informes anuales de la utilización de animales en la investigación y docencia

Is this too many or too few? What are the latest trends? Despite recent changes in the way we collect information, data show an increase over previous years, which does not seem to quite support the principles that should inspire animal testing, which were collected by the Royal Decree 53/2013, the so-called 3 Rs replacement, reduction and refinement.

Aside from quantity, quality also is important and there is a remarkable lag in  initiatives to improve data collection and reviews of experimental studies compared to human clinical research. We are referring to the CAMARADES (Collaborative approach to Meta-analysis and Review of Data in Experimental animal Estudies), which is essential before starting a new study, and the ARRIVE guidelines (Animal Research: Reporting In-Vivo Experiments) to improve the design and publication of animal experimentation, and ultimately, to reduce the risk of biases.

One might wonder, how many biomedical research funding agencies, in their peer review process, call or require the use of these guidelines when assessing projects involving animal experimentation? Surely we could also discuss the implementation of the guidelines CONSORT (Consolidated Standards of Reporting Trials) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) in the case of clinical trials in humans.

It seems clear that the higher the risk of bias, the more overestimation of effects,  thus it is not surprising that the subsequent proposals for translating this into human experimentation end up being disappointing.

The field of neuroscience is full of such cases of failed transfer, usually for involving imperfect animal models, or less than careful study designs and too prone to bias.

A recent paper by Malcolm R. Macleod from the Centre for Clinical Brain Sciences, University of Edinburgh, published in PLoS Biology, insisted on those qualitative aspects often found in animal research. It also underlined that reporting the risk of bias is not related to the journal’s impact factor, which again emphasizes this measure as a poor indicator of the quality of research.

Post written by Joan MV Pons.

Programming the 2016 agenda… some (good) recommendations

11 Feb

2016 is loaded with interesting and innovative events regarding management, patient experience, health 2.0, overdiagnosing, integrated care and research impact. These are our recommendations:

Innovation in management: which are the keys to success
Barcelona, February 17th, 2016

What can be done so professionals exchange their experiences and learn from one another? What can be done to spread the knowledge on innovation generated by the health system? This session of the Catalan Society of Health Care Management (SCGS) will be held in the Catalan Observatory of Innovation in Health Care Management (OIGS), and it will discuss innovation in management topics.

Practising Community on Patients’ Experiences

Esplugues de Llobregat (Barcelona), February 18th, 2016

What is person-centred care in practice? Hospital Sant Joan de Déu will hold a session with workgroups that will deal some topics of interest, such as what person-centred care involves, the presentation of practical cases of participative design techinques for patients’ experiences, and one session on this technology as a lever to help improve patients’ experiences.

Health 2.0 Europe 2016
Barcelona, May 11th and 12th, 2016

Health 2.0 Europe 2016

European and international innovation focused on the patient-practitioner relationship, consumers’ health, data analysis, and more. More than 120 participants and 600 attendants from all over the world will gather to experience live innovative solutions for the European health care systems. Those with an innovative experience included in the OIGS register can benefit from a 15% discount in the registration fee.

ICIC16 – 16th International Conference on Integrated Care
Barcelona, May 23th – 25th, 2016

ICIC16

A gathering of researchers, clinicians and managers from all over the world. This international conference offers a chance to share experiences and the most recent evidence on the integration of public healthcare, health and social services. Among other issues, it will deal with the challenges of the population’s ageing, the integration at hospital care level of mental care services and rehabilitation services, and the new tools mhealth and digital health. Clinical leadership and models of joint work between patients, caregivers and the community will also be discussed.

EHMA Annual Conference 2016: New Models of Care. Reinventing healthcare: why, what, how

Porto (Portugal), 14-16 June 2016

The EHMA Annual Conference: “New Models of Care. Reinventing healthcare: why, what, how”  will bring together policy makers, health managers, health professionals and educators to discuss new models, approaches and solutions for facing challenges that healthcare Systems will experience  in the next decade and beyond.

Preventing Overdiagnosis 2016
Barcelona, September 20th – 22th, 2016

Preventing Overdiagnosis

Barcelona will follow Washington, as AQuAS, together with Oxford University, will organise the next issue of this international conference, a space to share knowledge to help debate and reflect on overdiagnosing and its nature, its potential risks, its impact on people’s health and the cost of opportunity it may offer to healthcare systems. You can register at this link.

The International School on Research Impact Assessment
Melbourne (Australia), September 19th – 23th, 2016

ISRIA2016

Annual meeting point to improve abilities in the assessment of research impact. The the International School on Research Impact Assessment (ISRIA), co-founded by AQuAS in 2013, will reach its 5th edition being faithful to its original goals of fostering the science of research impact in all scientific fields and of supporting the sustainability of research system in all the world. Up to date, ISRIA has reached the figure of 300 participants from 17 countries in the three previous editions altogether.

Indicators for the health services assessment

4 Feb

What are indicators and how to set them?

In the clinical evaluation field, specifically for health care, an indicator in an instrument used to measure or assess specifici aspects of quality of care, and ultimately, the improvement of quality: assessment to improve.

The methodology used for creating or developing health indicators is distinct in that it combines different methodologies. In the first place, when elaborating indicators, the standard and most recommended procedure is to begin with a conceptual framework of reference, as this provides the premise for reflecting aspects of assessment, dimension, attributes, key areas of care specific to the field of study, as well as the target population. Moreover, the process of defining indicators takes into consideration two sources: scientific evidence experience and expert opinion.

A literature review enables authors to take into consideration scientific evidence and experience in the use of the indicator. A review of the scientific evidence ensures the validity of both the construct, (the indicator measures the intended target), as well as the guidelines (there is close correlation between an indicator and the outcome or another measure considered the gold standard). In addition, previous experience in the application of an indicator provides some basis as to its acceptability or use thereof. Generally, users find an indicator helpful if variations in the values it presents are ​​due to changes in the quality of care, and vice versa.

As far as expert opinion is concerned, it is important to highlight the advantages to using consensus methods during the process of identification and selection of indicators, a highly participative course of action. In general, the process is based on a consensus-centred approach (i.e., a group of professional experts which may, in addition, incorporate opinions from a group of patients and users), which is subsequently extended to a larger body of associated groups. Thus, the involvement of a significant number of participants in reaching a consensus on indicators reinforces the embeddedness of the assessment strategy and collective responsibility, furthering the eventual adoption and implementation of the indicators.

Figure 1. Combination of methodologies for developing indicators

Methodologies Developing Indicators

How to implement indicators?

Once the indicators have been defined, there are several different approaches to their implementation. These include performance analysis and comparison between units of analysis, or benchmarking, whether this refers to organizations, centres, services, teams or professionals. The first approach seeks to analyse the relationship between health outcomes (in quantity and quality) and the resources utilized, in other words, the value of health care. The objective is to identify the gap between what might be achieved using existing technology and resources (efficiency, the maximum achievable potential), and what is actually being achieved (effectiveness), adjusted due to the available resources and other variables which impact the outcome.

Figure 2. An example of mapping indicators used to analyse performance. In this case, the graph maps the ratio of observed/expected cases for the indicator subject to the study for Basic Healthcare Areas (ABS, as per the Catalan acronym).

Mapping

Source: Metodologia dels atles de variacions en la pràctica mèdica del SISCAT. Atles de variacions del SISCAT, número 0. Barcelona: Agència de Qualitat i Avaluació Sanitàries de Catalunya. Departament de Salut. Generalitat de Catalunya; 2014.

Finally, if the process is taken to the next level, we find ourselves in the realms of benchmarking, which allows us to make a comparative assessment. Basically, this involves using any product, service or work process within an organisation and which manifest best practises in the area of interest and using it as “comparator” or benchmark. The objective of this process is to transmit information regarding best practices and their implementation.

Figure 3. Sample mapping of an indicator used to make comparisons between units of analysis (benchmarking)

Comparisons

Source: Metodologia dels atles de variacions en la pràctica mèdica del SISCAT. Atles de variacions del SISCAT, número 0. Barcelona: Agència de Qualitat i Avaluació Sanitàries de Catalunya. Departament de Salut. Generalitat de Catalunya; 2014.

Post written by Mireia Espallargues, Noemí Robles and Laia Domingo.