strategy – AQuAS Blog

PIPPI project: community of practice in procurement based on value

13 Dec

Innovation has been present in the AQuAS blog with projects such as Antisuperbugs and Ritmocore but there are many more on the go right now. Today we put the focus on the purchase of innovation and on how this innovative methodology can have an impact on clinical practice.

We interview Ramon Maspons, engineer specialised in the management of innovation and technology, coordinator of innovation at AQuAS.

What tools does the health system at present have within its reach to add value to healthcare?

The public procurement of innovation is one of the facilitating instruments when adopting innovation and developing policies for technology and innovation. Due to the characteristics of the health sector this becomes a strategic element. There are other sectors where this does not happen because the public purchaser does not have market power.

In what way does innovation provide added value?

At a first level, we could say that if there is no application no value is generated. At a second level, I would say that the changes in the process are what add value. And at a third level, we could talk directly about the user.

A very brief article was published not long ago on this subject in the journal Annals de Medicina. Recently, in another context, the King’s Fund published a report on models of innovation.

Could you highlight an innovative project within the field of innovation?

Yes, the PIPPI project, coordinated by the Karolinska University Hospital in which AQuAS is involved, together with six other institutions in the hospital and university environment in Sweden, Holland, Italy, Austria, Spain, Finland and the United Kingdom. It is a platform made up of hospitals from the European Hospital Alliance, which is the network of the most relevant European hospitals, and then AQuAS. The focus of this work group is the new models of procurement based on value using digital technologies as an element to transform health services.

Have you considered changing the name of the project?

No, but in fact yes, because the name has curious meanings and connotations in different languages. This was one of the subjects that arose in the Kickoff meeting of the project.

Jokes aside, what is the involvement of AQuAS in the PIPPI project?

The expertise of AQuAS in assessment, innovation and the procurement of innovation is key. This project proposes an environment where the different stakeholders involved in change can come to an agreement and work together, both when revealing the needs of a health system, of hospitals, as well as when involving companies, technological centres, universities, patients and caregivers.

It is a very ambitious aim. What would you say is special about this project?

Its strategic focus of putting the different stakeholders involved in improving healthcare in the same project but having the support of the leadership of hospitals and an assessment agency. Identifying needs and solutions using this vast network of diverse expertise is one of the strengths of this project.

How will the PIPPI project work?

The project needs to develop a community of practice where challenges can be posed and solutions considered within an international framework.

Could you be a little more specific about which environments digital technologies will have an impact on in the health services?

By all means. We can include very different subjects such as co-creation with clinicians, telemedicine, data analytics, artificial intelligence, and so on. Some aspects are nearer on the horizon and others more distant. There exists a powerful reflection on digital technologies: it is said that everything that is digitalised is dematerialised and demonetised (it may be a subject too complex to go into here) and there are also those who say that, in the end, what is digitalised is democratised, but now that really would be going into other subjects.

Earlier you mentioned involving patients – who and what are we talking about exactly?

The patient is a key element in procurement based on value because the patient generates value and this is something difficult for other sectors to understand. When we talk of digital transformation, the involvement of patients is often as necessary as it is a sensitive issue and a certain methodology is therefore required, or specific game rules. We are talking about complex systems which require complex ways of working where, among other things, very diverse sensitivities, organisational models, governances, health systems or types of providers are involved. In short, what we are talking about is getting patients to become a part of identifying needs and taking decisions; we are talking about expert patient concepts, the participation of citizens and about health literacy.

And how are you going to achieve all this?

As members of this consortium, we have the experience, knowledge, methodologies and leadership to forge ahead with a project of this nature. I recommend looking at the presentation of Romualdo Ramos and Tanja Stamm of the Medical University of Vienna to know more about this project.

What is the aim of the PIPPI project in a few words?

Impossible in just a few words, but can I do it in nine? Facilitating the joint design of the best healthcare possible.

Towards research in nursing with a (greater) impact

15 Mar

What is it that makes a particular research have an impact on society beyond the strictly academic and which is truly transformative? Can a whole series of actions be planned in the way that one follows a cooking recipe which leads directly to the desired social impact? Unfortunately, the answer is no. The impact is multifactorial and depends on so many different elements and actors that it is difficult to establish a formula to guarantee it.

However, having said that, the fact that there is research which has a particular social impact does not mean that it is a totally random phenomenon and that there is no way of predicting, facilitating or promoting it. Years ago, from the Research Assessment group at the Agency for Health Quality and Assessment of Catalonia (AQuAS), and with the help and complicity of the International School on Research Impact Assessment, ISRIA, we identified a series of facilitators with regards the impact of research.

A fundamental facilitator is people, and the values, culture and capacity of leadership they have. Two identical results of research can have different impacts if the capacity of leadership, drive and will to get beyond academic impact is different. But this is still not enough. The strategy, organisation, collaborations and openness that institutions have will be a great facilitator or barrier for the researchers that have carried out the research.

Finally, both people and institutions will need two indispensable elements in order to aspire to having an impact: on the one hand, a close and effective communication with the different social actors that can play a role in transferring the results of research, and on the other, an approach focused on the participation of all these key players.

To paraphrase Confucius when he said “explain it to me and I will forget, show me and maybe I will remember, involve me and I will understand”, it is all about involving all the necessary actors to bring about a real change and make research transformative.

It is in this context that SARIS (Catalan acronym) came into being, the Assessment System of Research and Innovation in Health. It is a strategic tool which emerged from the PERIS (Strategic Plan for Research and Innovation in Health 2016-2020) with the aim of assessing the research carried out in health in Catalonia from the perspective of always wanting to facilitate and influence so that it has an impact beyond academia. To do this, the motivation and involvement of actors has been defined as a key factor for its development.

Last November, we started a series of participative sessions with nurses who were selected from the PERIS 2017 call in which a line of intensification of nursing professionals was financed.

It is important to emphasise that launching this line with nursing research makes full sense for three reasons: on the one hand, one of the thematic priorities of the PERIS is clearly that of “the development of clinical and translational research which facilitates the growth of scientific and technological knowledge, putting special emphasis on primary care agents and research in nursing”. In addition, the PERIS 2017 nursing fund has been the first to come to an end and it was appropriate to address ourselves to them first and foremost.

Last but not least, the conditions in which nursing research is carried out, with patients and their recovery as its central goal, makes it especially appropriate to ensure that this research has a direct impact on health. Hence, it is important that the research done in nursing be capable of demonstrating the impact that this group of professionals has because it can give it a comparative advantage with regards other biomedical disciplines. Indeed, nursing research is intrinsically translational.

Therefore, the first session centred on identifying the influential actors and in empowering the nurse to carry out an effective communication which amplifies the productive interactions needed to transform the results obtained into benefits for a better and improved health for patients.

We would like to express our deepest gratitude to the nurses for their participation (readiness and motivation) who attended of their own free will and in their time off work ensuring thus that the session was a success. This demonstrates that from the AQuAS we have leverage to give support to those researchers who are motivated to driving the impact of their research.

At present, we are preparing other sessions that will enable mutual learning between researchers and the assessment agents at the AQuAS.

Post written by Núria Radó Trilla (@nuriarado).

Jornada SARIS: Participación en recerca Barcelona, April 4th 2018.

Low value clinical practices from the citizenry’s perspective

13 Oct

During the fifth edition of the international Preventing Overdiagnosis Congress, strategies for implementing solutions to avoid overdiagnosis and overuse were addressed based on the available scientific evidence.

In this year’s edition, which was held in Barcelona last year, apart from the involvement of professionals and organisations, patients had the opportunity to actively participate.

Experiences in different healthcare areas were shown in the use of best practices to communicate and to empower patients to achieve a better understanding of shared decisions.

Different world initiatives addressed the best practices to empower citizens in subjects related to low value practices, overdiagnosis and overtreatment. Experiences were shared and a debate was initiated on fundamental subjects such as the communication and participation of patients.

In recent years, the Essencial Project has studied the perspective of health professionals on low value practices, their causes and possible solutions so as to avoid them.

Essencial Project team: Cari Almazán, Johanna Caro, Liliana Arroyo and Hortènsia Aguado

For example, in a previous post, we explained the results of a survey we carried out with professionals in the field of primary care. The results of this survey highlighted the need to involve and empower the population more. Patients are also important decision makers in relation to their needs and in the demand for certain health services. Hence, the project must be accompanied by a communications strategy aimed not only at patients but also at citizens in general.

That is why we, from the Essencial Project, have been interested in finding out the opinion of patients in addition to the perspective of professionals. In the international Preventing Overdiagnosis 2017 Congress we participated explaining how an exploratory first approach was made to identify the beliefs, attitudes and perceptions of patients regarding the most important elements in consultations, low value practices and the essential components of an effective dialogue between professionals and patients. The end purpose of this was to understand the position of people before initiating possible interventions in the citizenry and to determine the most effective communicative tools and channels.

In Catalonia, AQuAS carried out the first exploratory qualitative study at the end of 2016 using a focus group of parents and children assigned to a primary care team. Low value practices in paediatrics are frequently associated with an over-diagnosis regarding antibiotics, bronchodilatadors, antipyretics or imaging tests, among others. These scenarios have been transferred to the debate with patients themselves. In total, seven women, mothers and grandmother of 14 children participated.

The first point of discussion was the most important elements in a consultation with health professionals and it was found that the treatment (29%) and information received (28%) are the most important elements received by professionals (representing approximately 60% of those mentioned). The relationship with the professional comes next (15%, often related to the degree of trust), followed by the feeling that their wishes or needs are met (12%), information requested (9%) and the diagnosis (5%).

The participants did not know the concept of low value practice but did recognise situations of an excessive prescription of medication or the request of unnecessary tests, especially in emergency services and private consultations.

Regarding communication, the participants said they appreciated that professionals communicate in a simple and direct manner, explaining the reasons for decisions. Similarly, that they felt it was important to receive printed information from professionals which they could peruse later at home. They also said they would like more informative sessions or community groups where these types of subjects could be explained to them and so gain more knowledge about these types of practices.

In our context, this is the first exploratory study done to identify low value practices and the communicative strategies of the citizenry, being the start of a series of studies on the population. Nonetheless, one of the limitations with which we find ourselves was that the participation was lower than expected. Although the term ‘low value practices’ is not known, participants identify situations in which they have experienced them.

Similarly, it is important to underline how patients value the treatment and information received as well as the professional-patient relationship. In the same way, patients recognise the need for a professional’s communication skills and the need for tools to support an effective communicative exchange.

Post written by Johanna Caro Mendivelso (@jmcaro103).

The value of collaboration and participation in the Essencial Conference 2017

4 May

In the world of health, the involvement of professionals is necessary for a project to be successful and for it to reach health centres. On 21 April this year, the Conference for the implementation of the Essencial Project was held with the slogan “More is not always better: let’s avoid low value practices”.

When talking about the Essencial project, an initiative that identifies clinical practices of low value and promotes recommendations to avoid them, the collaboration between professionals becomes fundamental and even more so with reference to primary care, which is the gateway for patients to the health system.

For a conference devoted to this project, we wanted to have the active participation of health professionals and this did not seem easy in a conference where 750 attendees were expected.

How do we get them all to express themselves? How do we listen to their opinions? How do we use new technologies to meet these challenges?

Glyn Elwin, a doctor, researcher, Professor at the Dartmouth Institute for Health Policy and Clinical Practice in the United States and a real authority on the subject of shared decisions attended the conference.

At a later stage, a round table was held with speakers that spoke about the implementation of the Essencial project from the perspective of the project, of organisation, of primary care teams and of patients. Provision had been made for members of the audience to make their first contributions here in a round of questions open to the floor. Thus far, no difference to what happens in other scientific conferences.

But what was special about the approach of the 2017 Essencial conference?

We wanted to innovate and do things somewhat differently. A monologue was presented showing what the day to day of a primary care outpatient consultancy might be like. With the aim of reflecting on the communication between health professionals and patients, we highlighted the importance of communicative skills when explaining to patients why it might NOT be necessary to carry out a test or receive medication.

Using Kahoot (a tool for online voting) the attendees, in real time, were able to decide on the most important recommendations to include in the Essencial project. In this way, it was possible to vote and then make known the chosen recommendations during the conference in a process in which the professionals were the protagonists.

To end it all, the Prize for the most innovative idea to avoid low value practices in primary care was awarded as part of the conference’s programme. The prize consisted of a trip to this year’s Preventing Overdiagnosis Conference to be held in Canada in August. The winner was Mariam de la Poza of the primary care centre CAP Doctor Carles Ribas in Barcelona with a contribution on the recommendation “More antibiotics is not always the best: let’s avoid side effects, unnecessary costs and antimicrobial resistance”. Excitement right to the very end!

It goes without saying that organising a conference is complex and that there are many professionals taking part who do not always appear in the programmes. An expert team in communication and events organisation is crucial for the success of a conference of this type.

Post written by the Communication’s Unit at the AQuAS.