8 de gen. 2017

winter is coming and there's no bed in hospital that can resist it

The Nuffield Trust is looking closely at some of the big issues behind pressure on the NHS in winter months. Prof John Appleby Director of Research and Chief Economist presents some solutions:
  • For some hospitals, the answer is simple: providing more beds and more staff will help them weather the storm through winter.
  • For most others, recording bed occupancy in real time rather than taking a snapshot each day will help them to better coordinate the flow of patients.
  • And for virtually all, reducing delays once patients are medically fit to leave hospital is essential.
Recent articles to look forward by Nuffield Trust and The Health Foundation in relation to winter pressures:

1) Winter bed pressures (2016)
2) How to help health care flow to winter pressures (different materials) 

and the Report of the Health Committee appointed by the House of Commons to examine the policy, administration and expenditure of the Department of Health and its associated bodies

3) 3rd Report - Winter pressure in accident and emergency department (2016)

Photo: Aaron Harris / Reuters (2014)

19 de nov. 2016

cowboys doctors or... comforters doctors

David Cutler from Harvard University, et. al in 2015 published a working paper to test whether patient demand-side factors or physician supply-side factors explained regional variations in health care spending. They founded that:
  1. Patient demand was relatively unimportant in explaining variation in spending after accounting for physician beliefs.
  2. Physician organizational factors matter,
  3. The single most important factor is physician beliefs about treatment: 35 percent of end-of-life spending, and 12 percent of U.S. health care spending, are associated with physician beliefs unsupported by clinical evidence.

The authors differentiated two types of doctors.
  • "cowboys": Physicians treating a critically ill patient may decide either to provide intensive care beyond the indications of clinical guidelines (such as implanting a defibrillator to counter severe heart failure),
  • "comforters": Physicians treating a critically ill attempt to make the patient more comfortable by administering palliative care.
The cowboy doctors push the frontier of medicine by going above and beyond clinical evidence showed little or no marginal benefit derived from the extra procedures, resulting in wasteful spending.

The authors say that the healthcare system’s current incentives often do not prompt doctors to ask the right questions, such as whether a proposed treatment truly benefits the patient. “If doctors restrict themselves to performing what is evidence-based, “we can save hundreds of billions of dollars a year.” Doctors tend to follow their own beliefs about the right treatment to use, leaving patients little say in the process. How to treat a patient is often a multiple-choice question without a straightforward, single “correct” answer. Doctors should pay more attention to the patient’s preferences, instead of relying on their own experience.

The research suggests that it’s time for the cowboys to rein themselves in, and learn to listen.

Access to the article (pdf) Physician Beliefs and Patient Preferences (wp 2015)

photo: Leonard McCombe LIFE Magazine

9 d’oct. 2016

some controversies about competition in health care


Vicente Ortún Professor and former Dean of the School of Economic and Business Sciences, University Pompeu Fabra of Barcelona and founder and member of the Center for Research in Economics and Health (CRES), published on 16 of September and article titled "public and private in Health". 

One of the ideas of the article, that he is suggesting since long time ago, is the introduction of "yardstick competition (competence by comparison)" among health care organizations.

For those politicians, journalists, trade unions, associations, experts in talk shows, and people who want to read, learn and study before to make statements without any idea here you have some literature to read.

Competition in UK health care sector by Nuffield Trust (2013).
Competition in hospital sector by OECD (2012)

photo: (*) Photosolde

24 de jul. 2016

When organizations are growing

Larry Grainer wrote this article in 1972. In 1998 it was republished in Harvard Business Review as a Classic. The author removed some outdated material from the opening sections. He also wrote a commentary “Revolution is still inevitable,” to update his observations.

He described in the article how organizations develop and he designed 6 phases of growth that includes in each phase a period of relatively stable growth (evolution) followed by a stage of crisis (revolution) when major organizational change is needed if the company is to carry on growing. This crisis period it's not a bad thing it's a "change period or turning point".
  1. Phase 1: Creativity. Crisis: Leadership
  2. Phase 2: Direction. Crisis: Autonomy
  3. Phase 3: Delegation. Crisis: Control
  4. Phase 4: Coordination. Crisis: Red Tape
  5. Phase 5: Collaboration. Crisis: Internal growth crisis
  6. Phase 6: Alliances
This is still a useful model, however not all businesses will go through these phases and crisis in this order. We could use this as a starting point for thinking about our business growth, and adapt it to our circumstances.

Access to the article (.pdf): Larry Greiner (1998) HBR Classic

photo: (*) Photosolde

10 de juny 2016

Health economics in Spain: two recent interesting articles

Health Economics (2016)

Editorial written by David Cantanero Associate professor at the Department of Economics, University of Cantabria and Juan Oliva Associate professor at the Department of Economics University of Castilla la Mancha

The editorial puts the focus around the eight categories described by Alan Williams in the 1987-plumbing diagram (determinants of health; measurement and valuation of health; economic evaluation of treatment; demand for insurance and healthcare; supply of healthcare; market equilibrium and rationing; system evaluation; planning, budgeting and monitoring).

They put some Spanish papers as an example of how health economics is a powerful tool to evaluate public programs and policies.

Health Care System in Spain (2016)

Written by Guillem López-Casasnovas Professor at the Department of Economics of the Pompeu Fabra University of Barcelona and Beatriz González López-Valcarcel Professor at the Department of Economics of the University of Las Palmas de Gran Canaria

The article overviews the Spanish healthcare system and its idiosyncratic interconnected sources of problems including, a deficit of good governance, inadequate incentives for agents to take proper responsibility, and a lack of a consensus model for articulating the public and private sectors. In this paper the authors propose some antidotes in order to improve the future prospects of the system: to combine governance with autonomy, to change copayments and to modify the institutional architecture in making coverage decisions, by creating an independent agency, along the line of NICE in England. This latter country as well as the Netherlands provides reform lessons from which the Spanish system may learn.

photo: bansky

8 de juny 2016

Three Dialogues in: Ethics applied to companies and organizations

The Fundació Factor Huma in collaboration with the Obra Social "la Caixa", organized three workshops related to Ethics applied to companies and organizations.

The purpose was to create a common ethical reflection shared between the academic and business worlds. The 3 workshops where about:
  • Ethics and Governance
  • Ethics and Management
  • Ethics and People
The workshop was conducted by the expert Begoña Roman, who in every session focused the topic to be deliberate.
  • Begoña Román Maestre holds a PhD in philosophy from the University of Barcelona. Between 1996 and 2007 she headed the Department of Ethics at University Ramon Llull (Barcelona) and she is currently professor in the Faculty of Philosophy of the University of Barcelona. In addition, she is Chairperson of the Ethics Committee of Catalonian Social Services and member of Bioethics Committee of Catalonia. Her area of specialization is Bioethics and Ethics applied to professional and organizational environments.

Access to sessions: Diàlegs

You will find the videos of each session with the Begoña Roman speeches and access to document with an abstract of the key note speech and the conclusion of the workshop.

photo: (*) Photosolde

11 de maig 2016

Social media and the worldwide leadership crisis

Article: Beyond Viral (2016)

"The proliferation of social media usage has not resulted in significant social change". Information spreading is key to the formation of collective beliefs, opinions, and attitudes. But incentives play an equally important role. Convincing someone of an idea is one thing. Recruiting them to incur substantial time, effort, and risk toward supporting a cause requires much more.

  • Manuel Cebrian is Research Group Leader with the Data61 Unit at the Commonwealth Scientific and Industrial Research Organisation (CSIRO), Australia.
  • Iyad Rahwan is an associate professor of Media Arts and Sciences at the Media Lab, Massachusetts Institute of Technology.
  • Alex “Sandy” Pentland directs the MIT Connection Science and Human Dynamics labs and previously helped create and direct the MIT Media Lab and the Media Lab Asia in India.
Video support:
photo: (*) Photosolde