Networked health care: Rethinking value creation in learning health care systems
Networked health care: Rethinking value creation in learning health care systems
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DOI：
10.1002/lrh2.10212
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发表时间：
2019-12-05
影响因子：
3.1
通讯作者：
Batalden, Paul B.
中科院分区：
文献类型：
--
作者：
Fjeldstad, Oystein D.;Johnson, Julie K.;Batalden, Paul B.
在今天的医疗保健服务中创造更好的价值是非常具有挑战性的。这样做的社会压力对每个医疗保健系统及其领导层来说都是真实的。制造业部门的工作通过使用“价值链”思想取得了真实的效益，这种思想认为工作是制造产品所必需的一系列相互联系的工序。对于医疗保健系统中类似的活动，该模型可能非常有用。然而，在医疗保健系统中广泛“安装”价值链的尝试令人沮丧。因此，寻求更好价值的善意领导者采取了降低成本的计划，而不是重新设计服务。专业人士并不是很乐意或愿意参与。卫生保健服务的工作需要一种扩大的价值创造模式，一种更好地与工作相匹配的模式。本文提出了一个网络化的架构，可以调动和整合资源的卫生保健专业人员，感兴趣的病人，家庭，和其他社区成员的医疗保健系统的交付和改善。它还提出了这种创造价值的结构如何有助于研究和开发新知识。两个案例说明了拟议的体系结构及其对系统设计和实践，技术开发，以及参与医疗保健系统的所有参与者的角色和责任的影响。我们认为，这种模式更适合制定和改善医疗服务的需要。这种对如何创造价值的扩展理解引起了高级领导人的关注，那些试图促进改善现有系统的人，参与医疗保健服务合作生产日常工作的患者和临床医生，那些负责准备和培养未来专业人员的人，那些测量和进行医疗保健服务研究的人，以及那些领导政策，支付，和报销制度。
Creating better value in health care service today is very challenging. The social pressure to do so is real for every health care system and its leadership. Real benefit has been achieved in manufacturing sector work by the use of "value-chain" thinking, which assumes that the work is a series of linked processes necessary to make a product. For those activities in health care systems that are similar, this model may be very helpful. Attempts to "install" the value chain widely in health care systems have, however, been frustrating. As a result, well-meaning leaders seeking better value have resorted to programs of cost reduction, rather than service redesign. Professionals have not been very happy or willing participants. The work of health care service invites an expanded model of value creation, one that better matches the work. This paper proposes a networked architecture that can mobilize and integrate the resources of health care professionals, interested patients, family, and other community members in the delivery and improvement of health care systems. It also suggests how this value-creation architecture might contribute to research and the development of new knowledge. Two cases illustrate the proposed architecture and its implications for system design and practice, technology development, and roles and responsibilities of all actors involved in health care systems. We believe that this model better fits the need of making and improving health care services. This expanded understanding of how value is created invites attention by senior leaders, by those attempting to facilitate the improvement of current systems, by patients and clinicians involved in the daily work of health care service coproduction, by those charged with the preparation and formation of future professionals, by those who measure and conduct research in health care services, and by those leading policy, payment, and reimbursement systems.