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Networked health care: Rethinking value creation in learning health care systems

机译：网络医疗保健：重新思考学习医疗保健系统中的价值创造

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摘要

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.
机译：在当今的医疗服务中创造更好的价值非常具有挑战性。这样做的社会压力对于每个医疗保健系统及其领导都是真实的。通过使用“价值链”思想在制造业部门的工作中获得了真正的好处，这种想法假定工作是制造产品所必需的一系列关联过程。对于卫生保健系统中类似的活动，此模型可能会很有帮助。但是，试图在医疗保健系统中广泛“安装”价值链的尝试令人沮丧。结果，善意的领导者寻求更高的价值，他们诉诸降低成本的计划，而不是重新设计服务。专业人士不是很高兴或不愿意参加。卫生保健服务的工作邀请了一种扩展的价值创造模型，该模型可以更好地与工作相匹配。本文提出了一种网络体系结构，该体系结构可以调动和整合医疗保健专业人员，感兴趣的患者，家庭和其他社区成员的资源，以提供和改善医疗保健系统。它还暗示了这种价值创造架构可能如何有助于研究和开发新知识。有两个案例说明了拟议的体系结构及其对系统设计和实践，技术开发以及医疗体系中所有参与者的角色和职责的影响。我们认为，该模型更适合于制定和改善医疗保健服务的需求。对如何创造价值的这种广泛理解引起了高级领导者，试图促进当前系统改进的人们，参与卫生保健服务联合生产的日常工作的患者和临床医生，负责未来的准备和形成的人们的关注。专业人士，衡量和开展医疗服务研究的人员以及领先的政策，付款和报销系统。

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