User:Muirgray/Clinical Systems

A healthcare system is a set of activities with a common set of objectives. For each objective it is necessary to choose one, or more, criteria that can be used to measure progress or the lack of it. The dataset of criteria provides another of the essential elements of a system – the feedback loop.

The setting of objectives and the choice of criteria relating to the healthcare provided for a condition such as Parkinson Disease or Renal Failure has a number of benefits, notably

•	if recorded using a table like the BetterValueHealthcare System Control Chart the data allow those who manage the system to take action

•	It allows a patient to compare the performance of that aspect of healthcare that is of most importance to them •	It allows those who allocate resources to judge the value that would be added if additional resources were to be invested in that system, at the expense of systems focussed on other health problems.

It is necessary to have closed systems like hospitals and primary care services to employ staff and ensure money is administered with probity but they are all parts of an open system of healthcare and changes imposed in any one closed system will have unintended consequences elsewhere through a feedback mechanism that may, or may not, be predictable. Traditional approaches have sought to manage health problems by tighter control of organisations which cover a wide range of health problems, hospitals and community care for example with patients being referred to the former and discharged to the latter. This two-box approach has many weaknesses, implying, for example, that a hospital is not a community service. Another approach is to present different levels of care in the form of a Venn Diagram For serious, acute problems, a fractured femur for example the spectrum of the relative contributions of the different sectors of care, are consistent from between countries and within a country. Self-care is minimal, primary care by an ambulance service brief, and most care is provided in secondary care, with tertiary care being needed for the person who has multiple injuries in addition to the fractured femur and needs the services of a trauma centre. For chronic conditions, however the distribution of care is often sub optimal because the indications for moving from one level of care to another are often unclear and may be influenced by emotional and, apparently, irrational factors. Even if the number of patients in each part of the spectrum is correct there will be some

•	Receiving care that is more intensive than they need •	Receiving care that is less intensive that they need

Both groups reduce the value derived from the resources invested.