Conversations about “productivity improvement” are often met with ambivalence in clinical circles. There are probably two reasons for this. First, “productivity” (increasing outputs with given resources) is often confused with ”efficiency” (reducing the costs for desired outputs). We should not fall into this trap again. The second reason is cultural. In many clinical circles, there is a misplaced belief that service improvement and strategic debates should go no further than about clinical quality. Some schools of thought are even encouraging beliefs that we only need to focus on quality; once this is dealt with, all other aspects of care, including productivity and costs, will somehow fit in place.
Yet, the increase in productivity was the driver of economic growth in the 20th century and is going to be required in this one. However, productivity in the healthcare sector was lagging behind the long-term productivity growth of other sectors of the economy, even for the healthcare systems with the laudable productivity record. Adding to this that the healthcare spending continuously outstripped gross domestic product growth and that the wages of health care workers are below the level of economic growth and price inflation with the potential for additional talent drain, there seems to be no alternative to taking the bull by the horn and start talking about productivity improvements seriously.
In doing so, we should not rely on methods that have worked in industrial settings of the last century. The usual arsenal of process improvement tools, favoured by healthcare managers will not suffice, they will not bring necessary clinical skills in the right place, at the right time, or in the right quantity. Equally, our abilities to deliver within the constraints of the business model that was already cracking under the burden of demography and non-communicable chronic conditions are questionable, especially now when additionally challenged by the major disruptor.
Therefore, the debate about productivity needs to be put in the right place; it should be not in the domain of “why” or “if”, but “how”. And, “how” has always been the combination of infrastructure, education, technology, and business/service model. Innovation is its engine and leadership its driver. It is about working smarter not working harder.
Pathology and laboratory medicine can be the catalyst for this change. Due to their multiple interactions at every stage of patients' journey and with practically every stakeholder along patient pathways, as well as the vast amount of low-latency and longitudinal data acquired and shared, they can help the healthcare system to manage access, productivity, risks, and costs. We’ll discuss this in the forthcoming articles.
Histopathology, especially in the UK, is in the right place to enter this debate. The ongoing integration of pathology services into 29 Networks and the emerging Genomic Medicine Services provide the right platform for a mature discussion about the current fragmentation of services. The improved affordability and system support for the adoption of digital pathology are enabling solutions at a completely different level. Also, the RCPath Guidelines for Workload and Staffing provide the baseline and framework for discussions about productivity.
We will need to understand, discuss, and crowdsource ideas and solutions for all aspects of the patient journey along histopathology pathways. Starting with the patients and clinical users of our service. What is the end-to-end digital platform and what it needs to look like and do to enable productivity gains? What is the optimal composition of the advanced diagnostic power teams and how should they work more productively? How to work in a distributed manner over the larger geographic footprint? What are the optimal processes, interfaces, and tools? We will look at them one by one and your input will be much appreciated.
This week, on Tuesday 21 July, 13:00-14:00 BST, we will have the opportunity to explore how the advanced service model may look like. The ultimate “lean clinical model”: right clinical skills, at the right time in the right quantity. Decoupled and consolidated processing, decentralised, and distributed specialist reporting. Global.
oin us to hear from Jenny McKay how the truly global diagnostic pathology looks like. The pathology service that follows the Sun. But, as Jenny says "We would not be able to provide service like this without digital."
Before we go:
Recordings of our previous webinars are now available; please follow the links and let us know if there are problems with access.
Once again, thank you very much for supporting #dPath20.