Incorporating the culture of assessment in innovative initiatives was the starting point and the challenge from which the Observatory of Innovation in Healthcare Management in Catalonia (OIGS) initiated the first edition of the Innovate and Assess training workshop, a programme to train “Agents of Change” with the focus set on assessment and innovation.
What were the contents of this initiative?
What is innovation, what is assessment and what is the OIGS’s process of assessment?
The management of change to provide tools to encourage assessment
A practical session in assessment
The conceptualisation of a proposal to implement the assessment of an innovative initiative
From the Agency for Health Quality and Assessment of Catalonia (AQuAS) and via the Community for Innovation of the OIGS, a process of assessment has been driven allowing the quality of methodology in innovative practices to be measured within the framework of the public healthcare system of Catalonia, offering professionals in health and organisations the opportunity to opt for the certification of their experiences as an added stamp of quality.
This workshop has enabled experts in innovation to get in touch with experts in assessment and share their knowledge with each other in order to improve the quality of assessment of innovation.
This training activity has been accredited with 2,0 credits by the Catalan Council of Ongoing Training for Healthcare Professions.
The main aim has been to create and facilitate the necessary tools to be able to carry out assessment and innovation in healthcare centres in an adequate manner.
On the one hand, Cari Almazán, Cristina Colls, Núria Radó, Dolores Ruiz-Muñoz and Maite Solans, experts at the AQuAS in different disciplines participated, working with professionals and provided their knowledge and recommendations from the point of view of assessment.
On the other hand, Dani Bernard, Ignasi Clos, Xavi Olba and Clàudia Pardo of Induct, offered their expertise in the field of innovation using dynamics and techniques such as user journey map and cubbing.
Cubbing
With the intention of boosting the number of certified innovative initiatives (as we mentioned, using criteria to measure the quality of methodology), as well as spreading the word about the Observatory as a support tool in the assessment of the Catalan healthcare system as a whole, the AQuAS provides assistance, or mentoring, to all those professionals that provide self-evaluations of their own experiences but who do not attain the required quality of methodology to obtain certification.
At present, the OIGS has become a point of reference within the Catalan healthcare system, and day after day it places value on the effort made by organisations that share and divulge their innovative experiences and who promote the assessment of innovation.
The existence of rural areas hard to reach, remoteness with respect to large urban centres, an extensive area of land, a low population density and something of a shortfall of paediatricians in the area are the characteristics of the Alt Urgell that have given rise to the Pediatrics initiative in the Pyrenees., an innovative initiative from the Observatori d’Innovació en Gestió de la Sanitat a Catalunya (OIGS).
With the experience acquired during these seven years, what improvements has the project provided in your opinion?
I think the most important has been stability and in ensuring a health care continuum for our boys and girls. We have been able to give 100% cover from the start in primary and hospital paediatric care and in on-going medical care including localised standby calls. This has meant excellent access for the population, with a 100% success rate of pre-arranged appointments for the same day, and, in addition, with a high success rate at primary level, with an increase in standards in the quality of care.
This has led to a drastic decrease in emergency visits to hospitals as well as in admissions and transfers beyond the borders of the territory. Although there are fewer admissions, a fact that brings with it an increase in the complexity of child admissions, the average hospital stays for these admissions have been reduced.
In keeping the umbilical cord tied to the Hospital Sant Joan de Déu for training paediatricians and in the referral our patients, it has meant that this rate of success has in fact increased in our territory.
In this way, children and their parents are always attended by the same paediatrician, or team of paediatricians, where all know the problem at hand and provide solutions following the same protocols that would be followed in the Hospital Sant Joan de Déu.
Another noteworthy element is that by integrating ourselves within the Maternal and Child Unit of the Alt Urgell, with obstetricians and midwives, we have widened the homogeneity of interventions to include the whole mother-baby area and this has allowed us to begin projects such as early postpartum discharges with follow ups by paediatricians/midwives together and postpartum support groups which have been very well received by the population.
The web set up in 2011 has also brought us closer to the population enabling us to spread information on paediatric subjects. In particular, the virtual doctor’s consulting room is a frequently used tool by parents to clarify doubts with great flexibility and without having to travel to the doctor’s rooms.
Good results and awards endorse the entity’s task that you began which has been able to guarantee efficient paediatric, primary and hospital care. What are the keys of this success?
I think having the autonomy to manage ourselves is fundamental. Being able to manage our own agendas, timetables and cover for each other, among other things, has allowed us to adapt the task of caring to the reality of the territory and also to the realities of each professional by trying to reconcile our work and family life. What is more, it allows for on-going training.
The other key point is the relationship with a top-level centre like the Hospital Sant Joan de Déu which ensures we get on-going training and it solves problems of professional isolation that we might experience in zones a long way from the metropolis.
In a way, we feel we have a ‘big brother’ that helps us when there are difficulties and who accompanies along our journey.
Do you think this innovative model of self-management could be applied to other medical specialities and extrapolated to other regions?
I am absolutely convinced that it is a model which can be reproduced in almost all areas of care and in all regions. The important thing is to find professionals who are willing to accept the challenge and that the administration believes in it and is willing to back it.
Information and communication technologies (ICT) have played a key role from the beginning. Of all the innovative actions you have fostered, which one has worked the best?
The web page and virtual consulting room without a shadow of a doubt.
The web page, with its internal part, gives us access to all professionals and it is where all protocols are hung and this means we all work in the same way, including family doctors that are on call in different doctor’s rooms in the Alt Urgell and who have access to it.
The virtual doctor’s consulting room, likewise, means parents’ doubts can be clarified in a relaxed way and without interrupting visits (as always happens with untimely phone calls). On-site visits that require time investment by parents and, above all, discomfort are thus avoided.
You opened a virtual doctor’s consulting room on your web page five years ago, addressed to parents and tutors. Do you receive a lot of consultations via this channel?
As a matter of fact, no. We get 12 consultations a day on average, shared between the four paediatricians on duty in the region (paediatrician and paediatric nurse).
It must be stressed that we have very good accessibility to on-site visits and we attend a total of 3400 children meaning that numbers are logically not very high. The family’s and professional’s satisfaction, respectively, is very high.
Innovation has been the motor of your initiative. Do you have plans for implementing a new project this year?
In December last year, we incorporated the obstetricians from La Seu d’Urgell into the cooperative society. In practical terms, they were already working in close collaboration since 2012 and now form part of the cooperative; this fact consolidates the project a lot.
We would like to have the midwives from the Alt Urgell in the cooperative because with a few small changes, this would allow us to improve care, especially in community health which is lacking at the moment in our region.
This year, CatSalut has asked us to implement the model in other areas of the Pyrenees where there are problems of cover and it is now one of the issues we are looking into.
Interview prepared by Neus Solé Peñalver (@neussolep).
From 10 to 12 May, Barcelona becomes the European capital of digital health innovation, thanks to the Health 2.0 Europe congress. The seventh edition of this event for experts from the healthcare sector gathers more than 120 speakers and around 600 professionals from around the world.
The Agency for Health Quality and Assessment of Catalonia (AQuAS) and the Observatory of Innovation in Healthcare Management (OIGS) will be present in the free panel Digital health tools transforming the nurses’ daily mission, where we can see live demonstrations of technological solutions, developed by and for nurses.
The coordinator of the convention and consultant in digital health Aline Noizet (@anoizet) gives more details in this interview and explains how the European healthcare system is being redefined through these digital tools.
Aline Noizet, consultant in digital health and organiser of Health 2.0 Europe 2016
What do we understand by digital health of health 2.0?
The group of all new technologies focused on the patient that can be interconnected and that provide data that facilitate decision-making is known as digital health or health 2.0. They are tools developed for start-ups that encompass items from applications for mobile phones and wearable devides to virtual platforms. They always appear in response to a very specific need and contribute to improving the work of medical professionals and the experience of users.
If experts claim these new technological solutions are redefining the healthcare ecosystem, in what does this transformation consist?
The current ecosystem is vaster and encompasses more agents, directly or indirectly involved in the healthcare management, such as the small technological companies, pharmaceutical industry and insurance companies. The main novelty, however, lies in the fact that it puts the patient in the centre of the healthcare system.
In this system, where everything turns around the patient, how can digital tools improve his experience?
The new solutions facilitate communication between patients and healthcare professionals. Currently, there are platforms and virtual spaces where you can find quality information and clear doubts, almost in real-time. Thanks to the new technologies, the patient can be more involved when it comes to making decisions and can use telematics to explain how he feels and how his treatment progresses. The digital tools grant him more autonomy and convert him into the CEO of his own health.
And the healthcare professionals, how do they benefit from the use of this technology?
There are many benefits to the use of digital tools. They help the medical team to make faster and more accurate diagnoses, and offer a wider view on the users’ health state. Furthermore, they allow cost reduction through patient monitoring at home and they could improve the quality of care with the use of augmented reality glasses. Moreover, new technologies facilitate communication between health professionals from anywhere in the world, who can share information or get a second opinion immediately.
In the panel, with the participation of the Observatory of Innovation and moderated by the Portuguese nurse Tiago Vieira, member of the Advisory Council of the European Forum for Primary Care (EFPC), demos of the most innovating digital health tools will be presented. Whom is this session addressed to?
The session will be most inspiring for nurses, since they are in direct contact with both doctors and patients, and they know from firsthand the needs of both groups. The new technologies are transforming their role and can offer them many advantages with respect to patient care. Entrepreneurs will show them the operation of their solutions and professionals from different European countries will explain the benefits of implementing digitalization in their Center. The session may also be of interest to doctors, patients, entrepreneurs, investors, pharmaceutical laboratories and insurance companies. Start-ups can find inspiration and ideas for new solutions for medical personnel, while investors will have the opportunity to learn about the most innovative projects in digital health. If you’re a healthcare professional, you will discover how these tools can improve your performance in your daily tasks, and if you’re a patient or normal citizen, you can participate by giving your opinion as a user or future user of these new applications.
In order to participate in this free session about health digital tools, you only need to register. We would be delighted if you could join us!
Interview prepared by Neus Solé Peñalver (@neussolep).
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?
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 ofDoctoralia, 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).
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:
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.
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.
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.
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.
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.
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.
Frederic Llordachs (referred to below as FL), doctor and founder of the online portal Doctoralia, in an interview with Montse Moharra (referred to below as MM), coordinator of the Catalonia’s Observatory of Innovation in Health Management (OIGS), defends the position that medical professionals should take advantage of the current boom in new technologies to improve service provision. Frederic is confident that in the next few years’, teleconsultation, distance care provision and above all virtual triage will become established practice.
MM: How would you rate the level of innovation in the Catalan healthcare system as it stands today?
FL: It’s an excellent public service and the public are still not fully aware of the social advantages this represents. However, I believe that the current healthcare model is not the most ideal and we should be evolving towards more sustainable models such as those implemented in Holland and Germany.
MM: And do you think the field of Healthcare 2.0. is progressing at the right pace?
FL: Great effort is being made in this area and the digitalization process of public resources on the scale of the HIMSS (Healthcare Information and Management Systems Society) is a good example of this. Progress has also been made by way of providing the public access to their data via the La Meva Salut (My health) channel. However, as yet there is no integration with the private healthcare sector, which represents almost 30% of services used by the public. But I’m sure this will be addressed.
MM: Are initiatives such as those undertaken by the Innovation in Healthcare Management in Catalonia (OIGS, as per the Catalan acronym) helping in this shift towards innovation?
FL: As Lord Kelvin said: “If you cannot define it, you cannot measure it; if you cannot measure it, you cannot improve it; that which is not improved will always become degraded”. In this sense, the Observatory helps define and measure potential improvements, and provides the sector with ideas to implement.
MM: Which of the Observatory’s experiences would you highlight as the most noteworthy on a practical level?
FL: Undoubtedly, the pre-operatory online assessment carried out by the Hospital de Viladecans, a multi-award winning practice internationally since 2012 which, inexplicably, has yet to be implemented in the rest of the public healthcare network.
MM: How should healthcare professionals approach the changes associated with innovation in their day-to-day?
FL: Three years ago, the multi-millionaire technologist Vinod Khosla announced that in ten years’ time, 80% of doctors’ work would be performed by machines and it is easy to see how this prediction could be expanded to include other healthcare professions. The best way to cross a river is to do so with, not against the current, so the best way to survive the innovation tsunami heading our way is to become part of it. We must concentrate on the areas where we can make improvements and lead innovation from the positions we hold: sometimes changes can seem insignificant, but the outcomes can make an enormous impact. As the fictional Catalan TV character Capità Enciam used to say: “Small changes are powerful!”.
MM: Where do you see the developments in the Catalan healthcare system in terms of e-health in five years’ time?
FL: I imagine a patient with access to their public and private information who is connected via a standard similar to the American system Blue Button, and that health professionals have access to this information. I imagine sensorization and telemedicine services capable of resolving issues online for chronic patients. I imagine the public not having to travel unnecessarily for routine services, such as postoperative wound check-ups, and also that patients will be able to receive physiotherapy from the comfort of their homes. Above all, I envisage online triage using algorithms designed to reduce the care workload and reinforce self-healing, but then maybe I’m letting my imagination run a little wild…
MM: And what do you think Doctor’s work will be like?
FL: Just as we make house calls now, doctors will be performing teleconsultation, because finally, the system will compensate them for this. And patients will be able to have a virtual appointment with a specialist together with their GP, just as health Insurance and mutual health Insurance companies are doing nationwide today, organizations such as Sanitas and Mutua Universal. But the one thing that’s sure to happen is that we’ll continue doing what doctor’s do.
Montse Moharra (@mmoharra), Dolors Benítez and Anna García-Altés (@annagaal)
Students at the Pompeu Fabra University can respond to the challenges arising from the OIGS (Centre for Innovation in Health Management in Catalonia) innovation community
Over 600 health professionals met in Barcelona on Monday September 21st during the Third Edition of the Centre for Innovation in Health Management in Catalonia (OIGS), which was attended by the Minister of Health, Boi Ruiz. During the ceremony, 21 innovative experiences received the quality certificate.
The Minister welcomed the involvement of health professionals in “responding to our major concern, which is to improve healthcare” and gave “thanks to the people who believed that the best way to change things is do it from within.” It also found that OIGS is a project of “an extraordinary dimension” and that its current numbers (189 experiences and more than 500 users) denote its consolidation. He also stressed that in times of budgetary constraints, they are undertaking pioneering improvements in the health system to help improve the health care for citizens.Continue reading →
