Designing the system for each segment of the population
Since 1948 the NHS has been organised using two different organisational types. One of these is the bureaucracy and the creation of the NHS in 1948 was the creation of a huge and effective bureaucracy which transformed healthcare, particularly for the benefit of those who could not afford to participate in the chaotic world of private practice. The second organisational type, which was introduced in 1990 was the market, but there is now general agreement, in business as well as in healthcare, that relying on either bureaucracy or the market or a combination of only those two organisational forms will not deliver the appropriate response to a complex challenge like the health problems of populations . It can be argued that providing health services is the most complex business on earth and that requires a different type of organisational form.
The 20th century was the century of bureaucracy; the 21st century is the century of the system with a system being a set of activities with a common set of objectives focused on outcomes that matter. In the White Paper Integration and Innovation the term system is cited 251 times in comparison with the term hospital which is mentioned only 21 times. This is not to deny the importance of hospitals and health centres but for complex problems systems are needed and this module describes what a system is, how a population based system can be designed and developed and how systems can deliver higher value health and social care
The White Paper sets out clearly the following four purposes for systems:
- Improving population health and healthcare;
- Tackling unequal outcomes and access;
- Enhancing productivity and value for money; and
- Helping the NHS to support broader social and economic development.
This module will be followed by a module on developing the networks to deliver the system’s objectives and then by modules of ensuring personal value and on creating the culture of stewardship
Module 4 Micromodules and Topics
- Micromodule 4.1 – Understanding the need for a value framework – systems
- Micromodule 4.2 – Developing and applying a value framework