Our health economies suffer from “organisational Alzheimer’s”, where an obsession with activity drives up costs and dehumanises the whole system of care.

Hamish Dibley delivers this sobering picture of modern healthcare during his presentation to the 2016 European Healthcare Design Congress at the Royal College of Physicians, urging the sector to adopt a fresh perspective aimed at really understanding patient issues and designing a system in which problem-solving can flourish.

The video link to the video is: http://www.dibleyconsulting.com/videos.html

In this talk, Hamish outlines his work looking into patient demand across both secondary and primary care in the Oxfordshire health system. He describes the real performance challenges facing all healthcare economies are actually counterintuitive to the conventional mindset. The common belief in raising demand is simply not borne out by the empirical facts.

In fact, there exists high levels of amplification or representing demand amongst relatively small numbers of the GP-registered population. Patient need for primary care in Oxfordshire is concentrated within ‘vital few’ numbers of the population who consume disproportionate levels of professional activity.

Moreover, there is a strong association with these ‘vital few’ patients, who frequently present to their GP practices as well as experience high amounts of secondary care activity. For instance, the highest consuming 6% also responsible for 40% of secondary care costs. These higher users have a considerably greater prevalence of specific chronic conditions compared to the rest of the population.

Unlike activity-levels, secondary care demand is not rising but stable and predictable (in-line with actual population growth). The top 5% of patients consume over 50% of resource. The cause for increases in activity (and costs) lay in the inability to successfully design responses based on genuine understanding of person needs.

This approach affords commissioners the means to achieve the holy-grail of healthcare: better services at less cost. By understanding the true nature of demand it is possible to redesign systems and services with greater confidence and knowledge. It offers a practical way in which to think and act differently.

This talk explores a new and refreshing approach to how we understand and improve healthcare systems. Hamish Dibley, outlines his alternative approach to realising better healthcare services at less cost. It begins with looking at healthcare not from a conventional activity perspective but from a person-centred one.

The NHS must change the way it operates to effectively meet future challenges. The starting point for improved services at less cost rests on more intelligent use of data to inform future performance improvement through system and service redesign.

Hamish Dibley will talk about his work in applying genuine patient-centred principles to healthcare analysis and service design. This alternative approach – The Humanising Healthcare Methodology – to realising better healthcare services and less cost begins with looking at healthcare not from an activity perspective but from a person-centred one. Unlike existing practice, the work establishes time-series data to interpret the true nature of person demand for acute services, to better understand the root cause(s) of service challenges facing commissioners and providers alike.

Understanding patient demand is the first step in arriving at intelligent system and service redesign solutions around patient cohorts. This informs a more integrated and preventive system that will successfully alter the nature and consumption curve for care and reduce costs across the system.

This radical and elegant approach provides for innovative thinking as to how to propose future improvement schemes, not only to reduce patient demand but also to better respond to, and therefore manage, such demand. This latter aim requires proof of concepts to test new approaches and processes with a small cohort of patients.

This work serves to inform and constructively challenge current cost and quality improvement programme plans, as well as provide the basis for healthcare integration. Moreover, this way of working provides a better approach to overcoming the principal performance challenges facing all healthcare economies - A&E breaches, delayed transfers of care, and waiting time lists for planned care.