Do we control outcomes?
A diagram similar to this forms one of the key organising principles for the much celebrated and studied South Central Foundation (Nuka) model of care in Alaska. A model of care that has transformed outcomes, including reducing deep seated inequalities. If you look closely enough, you can see similar organising principles in other renowned models of care such as the Buurtzorg model and the Brazilian Family Health System.
The diagram points to the fact that we (the health system) don’t control outcomes for the majority of our work*. So what might this mean for the way we organise? What would it mean to our model of care?
It certainly challenges us to think about our current approach of organising around diseases rather than people.
We would have far more urgency for integrated approaches to care such as multi-morbidity care.
It would lead to greater use of person-centred approaches such as health coaching.
You would see full scale collaboration with communities with a view to co-owning the responsibility for health – seeing communities as assets. Note this is not just a primary care thing – this applies to secondary care.
The family unit, and family health would become a core principle and unit of organisation.
Proactively addressing deep seated health inequalities would become as much of a priority as reacting to illness.
It would challenge the traditional notion of the professional > patient relationship and the power dynamics within.
We would re-orientate the systems of performance management that turn our attention away from outcomes and health (for example the relentless focus on access).
Longer appointments would become the norm.
We would prioritise the reduction of the inequalities caused by channels of access that are not equal to all.
We would work to a wider view of ‘health’ that goes beyond the ‘bio-medical’.
The system would prioritise greater continuity (removing the systemic barriers to it) and seek to form, not avoid, relationships with citizens.
It would mean MUCH greater investment in primary care and integration with social care and the voluntary sector.
We would seek to understand and support context earlier, and to a much greater extent, even for secondary care interventions.
Now of course, some of this is happening in pockets around the country. But imagine if the NHS institutionally adopted this as an organising principle?
What else might we see as a result?
*This is supported by numerous studies on the social determinants of health.
· The WHO on the social determinants of health: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
· NHS England on the social determinants of health: https://www.gov.uk/government/publications/health-profile-for-england/chapter-6-social-determinants-of-health
· The Kinds Fund on health inequalities: https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/health-inequalities-nutshell
· The Marmot review on health inequalities: https://www.instituteofhealthequity.org
Other useful links:
· My blog on the reality of social context in general practice: https://www.cressbrookltd.co.uk/the-reality-of-social-context-gp/
· Asset Based Health Enquiry from London South Bank University: https://www.lsbu.ac.uk/__data/assets/pdf_file/0018/251190/lsbu_asset-based_health_inquiry.pdf
What we do to help you
We can WORK WITH YOU directly on any of the things above, either hand-on to provide energy and support you and your organisation towards rapid change or just in a LIGHT TOUCH advisory role > contact@pcnacademy.org.uk
We also run INT Development programmes - see the dedicated page here