President Obama with his daughters and First Dog Bo

As President Obama is seeking support in Congress for a plan to tackle the failed US health care system, he got welcome news from a poll which showed the overwhelming majority of Americans support substantial changes to the country's health care system, including a government-run health insurance option. The survey by the New York Times and CBS News found that 85 percent of respondents said the healthcare system needed to be fundamentally changed or completely rebuilt. The publication of the poll coincided with a new report by the Economist Intelligence Unit, which offers 5 clear steps for innovation in health services. The research highlights that, although advances in medical science and technology have progressed swiftly, these have not been matched by innovation in healthcare management and processes—a failure that costs both taxpayers and patients. The report, entitled Doctor innovation: Shaking up the health system, which was commissioned by Philips, focuses on the organisational and structural impediments hindering innovation in healthcare outcomes.

The report, the second in a series of four to be published in 2009, seeks to identify and draw lessons from some of the most promising examples of organisational innovation from around the world. It is based on a number of interviews with leading experts, extensive desk research and the results of a survey of 775 healthcare professionals.

“The incredible advances seen in medical technology have not been matched by innovation in healthcare management and processes. This is a failure that costs taxpayers and patients dearly,”says Robin Bew, Editorial Director of the Economist Intelligence Unit.

"One of the findings of this study shows that care delivery needs to be organised around the needs of the patient instead of around the clinical specialty of the doctor,"says Dr Eric Silfen, Chief Medical Officer for Philips Healthcare."Combining human insight with a solid clinical understanding helps care providers deliver better patient outcomes at overall lower costs."

The five ideas outlined in the report are:

• Share information, especially on the outcome of treatments, to improve quality:Knowing what actually works best in given situations is central to outcomes-based medicine. But only recently, driven by cost at least as much as by purely clinical considerations, has such data begun to be collected. In places where this has been carried out, the results are often striking. For example, Minnesota Community Measurement, a non-profit organisation, has seen local rates of childhood immunisation leap from 52% to 78% since it started publishing comparable outcomes data in 2006.
• Bring outside entrepreneurship to healthcare:In healthcare, innovation is more likely to come from incremental change by existing bodies than through revolutionary change from outsiders. But it does not always have to go this way. For example, when the UK’s National Health Service (NHS) would not begin screening for abdominal aortic aneurysms, which kill one in 50 British men, a group of doctors in 2002 formed a private service. They have since examined 15,000 people, with about one in 200 requiring urgent attention.
• Deliver integrated care based on medical conditions rather than provider expertise:“Patient-centric” healthcare has been a buzzword in the industry for some time, although with little evidence of progress. But where processes have been redesigned around the needs of the patient, progress has been promising. The West German Headache Centre, for example, provides consultations with various types of specialists, all of whom work within the same facility and collaborate. The proportion of patients missing more than six days of work in six months fell by around 80% after going through its programme, all at a lower cost to the healthcare system.
• Treat patients as a source of innovation:Data from the Pew Research Center shows that of those Americans with Internet access, 83% use it to look for health information. These “e-patients” increasingly use social networking platforms to teach each other about conditions and treatments. Rather than resisting such changes, healthcare professionals need to embrace this change, as it will continue to enrich the doctor-patient relationship. In time, it could even create the basis for a more market-driven system where customers are able to make informed choices about varying providers.
• Use these ideas together:The ideas and approaches reviewed in this study are not mutually exclusive. Together, they become even more powerful. India’s Aravind Eye Care System provides a compelling story of innovation in medicine, employing all of the advice listed above. It is entrepreneurial in its outlook; it measures and reports outcomes data; and it is highly integrated. It also learns from its customers, with some of its innovations coming after market surveys of patient needs and service uptake.

Health Care Showdown-  - Paul Krugman, New York Times