The Economics of Patient Safety

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The Economics of Patient Safety

Luke Slawomirski, MSc( HlthEcon ), BSc(Physio)(Hons)

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What is safety and quality in health care? W hy is it important?

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Patient safety

Reducing the risk of unnecessary harm associated with health care to an acceptable minimum* * Acceptable minimum: the collective notions of current knowledge , resources available and the context in which care was delivered and weighed against the risk of non-treatment or alternative treatment.

OECD Health Working Papers No. The economics of patien safety: Strengthening a value-based approach to reducing patient harm a national level C)) OECD Luke Slawomirski, Ane Auraaen, Nicolaas S. Klazinga

Slawomirski, L., A. Auraaen and N. Klazinga (2017), "The economics of patient safety: Strengthening a value-based approach to reducing patient harm at national level",  OECD Health Working Papers , No. 96, OECD Publishing, Paris,  https://doi.org/10.1787/5a9858cd-en .

Slawomirski, L., A. Auraaen and N. Klazinga (2017), "The economics of patient safety: Strengthening a value-based approach to reducing patient harm at national level",  OECD Health Working Papers , No. 96, OECD Publishing, Paris,  https://doi.org/10.1787/5a9858cd-en .

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Donabedian’s 7 pillars definition of quality

Celebrating Avedis Donabedian's Seminal Article Published 50 Years Ago in The Milbank Quarterly | Milbank Memorial Fund

Efficacy : the ability of care, at its best, to improve health; Effectiveness : the degree to which attainable health improvements are realized; Efficiency : the ability to obtain the greatest health improvement at the lowest cost Optimality : the most advantageous balancing of costs and benefits Acceptability : conform to patient preferences, the patient-practitioner relation, the amenities, the effects of care, and the cost of care Legitimacy : conformity to social preferences concerning all of the above E quity : fairness in the distribution of care and its effects on health

Donabedian A. The seven pillars of quality. Arch Pathol Lab Med. 1990 Nov;114(11):1115-8. PMID: 2241519

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Institute of Medicine (IOM)

Q uality care is: safe effective p atient-centred timely efficient equitable

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Committee on the Quality of Health Care in America. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press; 2001.

About that quality chasm

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The World Health Organization

THE SIX BUILDING BLOCKS OF A HEALTH SYSTEM Good health services are those which deliver effective, safe, quality personal and rm-personal health interventions to those that need them, when and where needed, with minimum waste of resources. A well-performing health workforce is one that works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances (i.e. there are sufficient staff, fairly distributed; they are competent, responsive and productive). A well-functioning health information system is one that ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status. • • A well-functioning health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use. A good health financing system raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them. It provides incentives for providers and users to be efficient. Leadership and govemance involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition- building, regulation, attention to system-design and accountabilityc

https://www.who.int/healthsystems/strategy/everybodys_business.pdf

https://www.who.int/healthsystems/strategy/everybodys_business.pdf

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An introduction to healthcare quality: defining and explaining its role in health systems Reinhard Busse , Dimitra Panteli , and  Wilm Quentin https://www.ncbi.nlm.nih.gov/books/NBK549277/ Exploring the harmful effects of health care Charles M Kilo, Eric B Larson https://pubmed.ncbi.nlm.nih.gov/19567446/

An introduction to healthcare quality: defining and explaining its role in health systems Reinhard Busse , Dimitra Panteli , and  Wilm Quentin https://www.ncbi.nlm.nih.gov/books/NBK549277/ Exploring the harmful effects of health care Charles M Kilo, Eric B Larson https://pubmed.ncbi.nlm.nih.gov/19567446/

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Cover of Improving healthcare quality in Europe

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Why were the OECD reports on the Economics of Patient Safety commissioned? How has patient safety has evolved as a health policy priority?

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Describe key findings from the OECD reports. What can you say about the gap between evidence and policy making (ambition) in health systems?

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Unsafe care: 1. exerts a large disease burden

Developing countries 1 in 4 hospitalisations result in harm ~3 million deaths each year. >1 in 20 people die from unsafe hospital care

DALYs (millions) Road injuries HIV/AIDS Patient harm Diabetes Malaria Tuberculosis 67 67 64 57 56 40

High-income countries ‘1 in 10’ law continues More costly & preventable in specialised settings

Global Burden of Disease

Slawomirski, L. and N. Klazinga (2020), The economics of patient safety: From analysis to action“ OECD Publishing, Paris. http://www.oecd.org/health/health-systems/Economics-of-Patient-Safety-October-2020.pdf

Slawomirski, L. and N. Klazinga (2020), The economics of patient safety: From analysis to action“ OECD Publishing, Paris. http://www.oecd.org/health/health-systems/Economics-of-Patient-Safety-October-2020.pdf

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2. consumes a big slice of health spending

acute care harm primary care harm LTC harm all other spending 5.3999999999999999E-2 3.3000000000000002E-2 3.875E-2 0.87424999999999997

All harm 12.6% of health expenditure about USD 878 Billion (2018 PPP) across OECD 1.4% of combined GDP

Factoring in preventability 8.7% of total health expenditure USD 606 Billion

Slawomirski, L. and N. Klazinga (2020), The economics of patient safety: From analysis to action“ OECD Publishing, Paris. http://www.oecd.org/health/health-systems/Economics-of-Patient-Safety-October-2020.pdf

Slawomirski, L. and N. Klazinga (2020), The economics of patient safety: From analysis to action“ OECD Publishing, Paris. http://www.oecd.org/health/health-systems/Economics-of-Patient-Safety-October-2020.pdf

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3. slows economic growth & development

GWP: actual/projected 2015 2016 2017 2018 2019 2020^ 2021^ 2022* 2023* 2024* 74799 75824 80262 84930 86599 82355.64899999999 86802.854045999993 91405.490880253506 96300.344174909609 101564.79212041755 GWP: harm eliminated 2015 2016 2017 2018 2019 2020^ 2021^ 2022* 2023* 2024* 74799 76362.35040000001 81405.766407420015 86751.883361281245 89084.728532541398 85321.085829971445 90566.916278489924 96046.259734175168 101908.07711089998 108242.18430792187

Notes: Estimates based on Bommer (2017) ^based on IMF World Economic outlook (June 2020) *annual growth based on pre- covid IMF projections; Y-axis starts at USD 70 trillion; Source data: IMF https://www.imf.org/en/Publications/WEO

Notes: Estimates based on Bommer (2017) ^based on IMF World Economic outlook (June 2020) *annual growth based on pre- covid IMF projections; Y-axis starts at USD 70 trillion; Source data: IMF https://www.imf.org/en/Publications/WEO

Approx 0.75% p.a. ∆ 2024 = USD 6.7 trillion ∆ cumulative = USD 29.6 trillion (Based on NIDDM C-o-I study 2017 )

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Success relies on a systems-approach

- SYSTEM - Governance Information infrastructure Education & training Align incentives & risk - ORGANISATION - Digital technology Staffing and organisational culture Patient enagement , health literacy Transitions of care - CLINICAL - Infection prevention VTE prophylaxis Falls prevention Pressure ulcer prevention

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Current remuneration models may result in under-pricing risk

See p53. http://www.oecd.org/health/health-systems/Economics-of-Patient-Safety-October-2020.pdf

See p53. http://www.oecd.org/health/health-systems/Economics-of-Patient-Safety-October-2020.pdf

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What are some of the most challenging aspects to bringing new policies into health systems?

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Key Challenges

Resourcing innovation; strong business case Complexity Multiplying risks – embrace but don’t underestimate – build resilience Implementation change behaviour; win hearts and minds

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Change is hard

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“Nothing is more difficult to plan, more doubtful of success, nor more dangerous to manage than a new system. The initiator has the enmity of all who would profit by the preservation of the old institution and merely lukewarm defenders in those who gain by the new ones.” - Niccolo Machiavelli -

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Further reading …

Kotter’s model for organisational change www.kotterinc.com/8-steps-process-for-leading-change/ ‘Structure – Process – Outcome’ – Donabedian 1966 https://pubmed.ncbi.nlm.nih.gov/5338568/ False Dawns and New Horizons in Patient Safety Research and Practice - Mannion & Braithwaite 2018 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5726317/

Kotter’s model for organisational change www.kotterinc.com/8-steps-process-for-leading-change/ ‘Structure – Process – Outcome’ – Donabedian 1966 https://pubmed.ncbi.nlm.nih.gov/5338568/ False Dawns and New Horizons in Patient Safety Research and Practice - Mannion & Braithwaite 2018 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5726317/

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Leading Change: Kotter, John P.: 8601200421798: Amazon.com: Books

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In your experience, what are some ways in which we can continue to close the gap between what we know from evidence and what we do in policy making?

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Some thoughts

Need much more evidence on outcomes Better policy evaluation methods Much more collaboration between healthcare providers, policy and academia Also furnishing clinicians with an understanding of policy making and implementation And funding / rewarding efforts that bridge the gaps … money talks!

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Thank you and best wishes.

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