Radio Value

Professor Sir Muir Gray talks through the latest glossary term www.3vh.org

Professor Sir Muir Gray talks through one of 3V's glossary terms - culture.

Professor Sir Muir Gray talks about the definition of the glossary terms Equity and Equality

Podcast from Professor Sir Muir Gray on the glossary terms: overuse and underuse

Glossary podcast on 'variation' from Professor Sir Muir Gray

Professor Sir Muir Gray explains the importance of defining words by words

Podcast from Professor Sir Muir Gray on language. 3V Glossary term - waste

Glossary podcast on language - this episode from Professor Sir Muir Gray focusses on Value & Values

When working on value in health and care, we have found there is nothing so important as language. These short podcasts are a discussion about our definition of a word or phrase. We encourage you to share and discuss the meanings with colleagues.

Teaser: Have you ever been kept awake worrying about how value relates to efficiency or to cost effectiveness? Relax, these are just concepts each created by an academic who down played, or ignored and did not even reference, the other two concepts in the competitive world of academia. Weick makes it clear that you just have to relax and make sense of the perspectives of these different experts and authorities

Peter Senge describes how in most organisations people save their creative, open style of learning for the weekends, and at work just get on with the job. But it doesn't have to be like that..

Everett Rogers had it all worked out decades before the internet came along. The digital medium has changed some of the rules but the game is the same, and this book described the rules of the game in 1995.

Wenger describes how most organisations usually work in ignorance of how other organisations, with the same mission, are getting on. If they compare performance with others it is usually to compete and win, or at least avoid losing. In a community of practice they share to learn.

Teaser: “I don’t know” are the most important three words in medicine. The truth is, the more one knows, the less certain one is. And this is certainly true in medicine where combining an individual’s personal goals and specific attributes to the research evidence means that the Uncertain Physician is one of the most experienced. In this great book, Kurt Link explores the ideas around managing and dealing with uncertainty in healthcare.

Teaser: Images of Organization is a classic based on a very simple premise—that all theories of organization and management are based on implicit images or metaphors that stretch our imagination in a way that can create powerful insights. Morgan provides resources for exploring the complexity of modern organizations.

Teaser: This is a 700-page report released for the Government of the United Kingdom on 30 October 2006 and is considered as one of the most important documents to combine climate change science and economics. It has important implications for health - the impact on health itself, the economic effects of changes in health and the impact on health from economic changes. Leaders of health systems cannot ignore climate change and their role in recognising that healthcare services have a major environmental impact on the planet, making this landmark report critically important.

Teaser: How do we avoid a culture of contentment so that we don’t make the changes we need. In this great book, world-leading health economist Cam Donaldson defends NHS-type systems on the same basis as their detractors: economic efficiency. However, protecting government funding of health care is not enough: scarcity has to be managed. Donaldson goes on to show how we can get more out of our systems by addressing issues of value for money. In particular, he demonstrates what has been achieved through health care reform but questions how much more this can deliver relative to getting serious about priority setting.

Culture forms a complex framework of national, organizational, and professional attitudes and values within which groups and individuals function. In this book the authors explore the influences of culture in two professions, aviation and medicine. Their focus is on commercial airline pilots and operating room teams. Within these two environments they show the effect of professional, national and organizational cultures of individual attitudes and values and team interaction.

Teaser: Have you ever wanted to better understand the role of professions like doctors and nurses? In this book, Elliot Krause considers the autonomy and leverage of modern professional groups---medicine, law, university teaching, and engineering. Krause considers the implications for professionals and those they serve.

Teaser: How we make decisions in healthcare is heavily influenced by our emotions, whether we like it or not. This important book outlines the impact that emotions have on decision making, so at least we can have a hope of making better emotions. It describes prospect theory, which suggests two stages to decision making and how it can be influenced.

Teaser: Anybody who wants to display graphical information should read this book. Anybody who wants to understand how beautiful data can look should read this book. Read this book and do not put up with unintelligible and ugly graphics ever again.

Teaser: This book is one of the great blockbusters of management. It is a synthesis of the empirical literature currently available on organisational structuring. Importantly, Mintzberg discusses organisations that are staffed by highly trained professionals, like clinicians. So, if you want to understand the evidence of leading and managing the health service, this is one of the best.

Teaser: Repeated research studies demonstrate that doctors and patients alike overestimate the likelihood of benefits and underestimate the likelihood of harms. That is because we do not understand risk. Gerd Gigerenzer, is the director of the Max Planck Institute for Human Development in Berlin, Germany, and lectures around the world on the importance of proper risk education for everyone from school-age children to prominent doctors, bankers, and politicians. In this book he outlines way in which we can make better decisions in healthcare.

Teaser: This book, the first in Castells′ ground–breaking trilogy, is an account of the economic and social dynamics of the new age of information. Based on research in the USA, Asia, Latin America, and Europe, it aims to formulate a systematic theory of the information society which takes account of the fundamental effects of information technology on the contemporary world.

Teaser: The great management expert Peter Drucker said “Culture eats strategy for breakfast”. Repeated studies have shown the importance of culture on healthcare importance. Yet, almost all healthcare reform focuses on structural and transactional change, forgetting culture. The guru on culture is Edgar Schein. Organizational Culture and Leadership is the classic reference for leaders seeking a deeper understanding of the inter-relationship of organizational culture dynamics and performance.

Teaser: We all work in organisations. But do we understand why and how organisations work? This book is a classic text in sociology. It provides a succinct overview of the principal schools of thought of organizational theories, placing each into critical, historical, and cultural context. Vividly written, with many specific, student-oriented examples, Complex Organizations offers a critical perspective on organizations, analyzing their impact on individuals, groups, and society as a whole.

Teaser: The 21st Century is the age of networks; this is the only way we can deliver the complexity of population health and care. Bureaucracies are critical for linear tasks, but networks are needed for complexity. In this book two leading Japanese business experts, Ikujiro Nonaka and Hiro Takeuchi, outline how networks can create new knowledge and use it to produce successful products and technologies. They describe the hypertext organisation, that floats alongside the bureaucracy.

Teaser: In this book, Wilkinson and Pickett remind us that it is not poverty but inequality that causes most damage to society. They also outline how more equal societies enjoy greater health and well-being and that this benefits everyone in society- the most and least deprived. In healthcare, we must therefore, address inequity of access, or the Inverse Care Law, as this is a form of inequality that is entirely within our control.

Teaser: When we study healthcare at a population, as opposed to institutional, level, a whole new perspective emerges- unwarranted variation. This is variation that is not driven by a failure to standardise, but variation that shows we do not have systems for population healthcare. Understanding the symptom that is unwarranted variation helps inform how we can fix the causes of lower value population healthcare.

Teaser: How much should we spend on people with frailty versus people with mental health problems? Unless we can answer questions like this, we cannot have high value universal healthcare. Alain Enthoven, is mistakenly blamed for suggesting to Margaret Thatcher that the NHS should introduce the purchaser provider split- actually his Nuffield Trust paper advocated the development of accountable care organisations. However, this book is about the work he and colleagues did on creating programme budgets in the Department of Defense (sic) in the US. Originally published in 1971 this is a book of enduring value and lasting relevance. Enthoven details the application, history, and controversies surrounding the Planning, Programming, and Budgeting System.

Teaser: Making decisions, especially where there are competing priorities, is complex and sometimes impossible. Arrow describes two ways in which decisions can be made in democratic capitalist countries, markets and politics. Understanding these options are critical to anyone in a position to influence resource use in healthcare...

Teaser: This book really is obligatory reading for anyone who influences the use of resources in healthcare and is interested in quality. Avedis Donabedian's name is synonymous with quality of health care. He unravelled the mystery behind the concept by defining it in clear operational terms and provided detailed blueprints for both its measurement (known as quality assessment) and its improvement (known as quality assurance). Many before him claimed that quality couldn't be defined in concrete objective terms. He demonstrated that quality is an attribute of a system which he called structure, a set of organised activities which he called process, and an outcome which results from both.

Teaser: The people we serve would expect resources to be used fairly and reasonably. In this book, Daniels and Sabin outline that we lack consensus on principles for allocating medical resources, and in the absence of such a consensus we must develop and rely on a fair decision-making process for setting limits on health care so we can use resources more fairly.

Teaser: Anybody leading a public service organisation, a hospital, a clinic, a healthcare payer, should understand their role in providing public value. This great book by Mark Moore summarises what value means within the public sector, and the different perspectives that need to be taken.

Teaser: The current fashion is for targeting interventions towards those at higher risk. But this is often at the expense of interventions that are targeted at a whole population. Which is best? The population strategy of prevention refers to prevention activities that target a whole population regardless of variation in individuals' risk status, whereas a high-risk strategy targets individuals identified as having elevated risk for some adverse health outcome (e.g. thorough screening). In this classic book by Geoffrey Rose, the pros and cons of each approach are discussed.

Teaser: Friedman’s great addition to management thinking was that we need to stop focussing on doing a lot of activity productively and start to focus on outcomes. More importantly, hold ourselves accountable for doing so, Outcomes Based Accountability (OBA) can be used to improve the quality of life in communities, cities, counties, states and nations, including everything from the well-being of children to the creation of a sustainable environment. It is an approach that supports value-based population health.

Teaser: Why have costs risen in healthcare? How can we improve the value of care? In Designing Care, Harvard Business School professor and doctor Richard Bohmer explains that health-care professionals are tasked with providing two very different types of care - sequential and iterative.  To reduce costs and manage care effectively, sequential and iterative care situations require different management systems. Bohmer reveals how health-care providers can successfully manage both modes.

Fjeldstad, Ø. D., Johnson, J. K., Margolis, P. A., Seid, M., Höglund, P., & Batalden, P. B. (Accepted/In press). Networked health care: Rethinking value creation in learning health care systems. Learning Health Systems, [e10212]. https://doi.org/10.1002/lrh2.10212

How does participating in a deliberative citizens panel on healthcare priority setting influence the views of participants? Reckers-Droog V et al (2020) et al./Health Policy 124143–151 https://doi.org/10.1016/j.healthpol.2019.11.011

Health Care Hotspotting — A Randomized, Controlled Trial Finkelstein, A. et al (2020), N Engl J Med 2020;382:152-62. DOI: 10.1056/NEJMsa1906848 https://www.nejm.org/doi/full/10.1056/NEJMsa1906848

Full reference and title from the journal: Health Equity in England: The Marmot Review 10 Years On. February 2020 Professor Sir Michael Marmot, Jessica Allen, Tammy Boyce, Peter Goldblatt, Joana Morrison Link to paper https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on

Link to paper: https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2019.01266

Full reference and title from the journal: A Prescription for Longevity in the 21st Century Renewing Purpose, Building and Sustaining Social Engagement, and Embracing a Positive Lifestyle. JAMA. Published online January 9, 2020. doi:10.1001/jama.2019.21087

Reference to paper: Whitty C.J.M.et al 2020 BMJ 2020;368:l6964 doi: 10.1136/bmj.l6964 (Published 6 January 2020) Link to paper: https://www.bmj.com/content/bmj/368/bmj.l6964.full.pdf For more blogs see here: https://www.3vh.org/essential-insights/category/paper-of-the-week/

Are clinical networks the future way to organize healthcare? Managing the performance of general practitioners and specialists referral networks: A system for evaluating the heart failure pathway. SabinaNutiaFrancescaFerréaChiaraSeghieriaElisaForesiaTherese A.Stukelb, Health Policy, Volume 124, Issue 1, January 2020, Pages 44-51 https://www.sciencedirect.com/science/article/pii/S0168851019302581

This is a free pdf with the full articles and accompanying editorials https://cdn.nejm.org/pdf/Notable-Articles-of-2019.pdf For more Podcasts and Blogs visit: https://www.3vh.org/essential-insights/category/paper-of-the-week/

Full reference and title from the journal: Biases distorting priority setting BjørnHofmann Health Policy, Volume 124, Issue 1. January 2020. Pages 52-60. https://www.sciencedirect.com/science/article/pii/S0168851019302799#!

Papers of the decade in JAMA by Oxford Centre for Triple Value Healthcare

Funding orphan medicinal products beyond price: sustaining an ecosystem. Author- De Sola-Morales, Oriol, The European Journal of Health Economics (2019) 20:1283–1286. https://doi.org/10.1007/s10198-019-01047-0

Association Between a Temporary Reduction in Access to Health Care and Long-term Changes in Hypertension Control Among Veterans After a Natural Disaster Aaron Baum, PhD; Michael L. Barnett,MD, MS; Juan Wisnivesky,MD, DrPH; Mark D. Schwartz, MD. JAMA Network Open. 2019;2(11):e1915111. doi:10.1001/jamanetworkopen.2019.15111 (Reprinted) November 13, 2019 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2755309

Waste in the US Health Care System; Estimated Costs and Potential for Savings William H. Shrank, MD, MSHS1; Teresa L. Rogstad, MPH1; Natasha Parekh, MD, MS2 JAMA. 2019;322(15):1501-1509.