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Muir Gray

Muir Gray: Developing a system budget

16 Jan, 13 | by BMJ

Muir GrayRead the rest of this series of blogs about designing and planning population based systems of care here.

Step 8: Developing a system budget

One of the aims of developing systems is for clinicians and patient representatives to be involved in the stewardship of resources. They can fight for more resources, but they also need to accept responsibility for maximising value from the resources allocated. It is essential to prepare a budget for the system of care, starting with all the resources that contribute to the service. more…

Muir Gray: Defining the pathway for population systems of care

28 Nov, 12 | by BMJ

Muir GrayRead the rest of this series of blogs about designing and planning population based systems of care here.

Step 7: Defining the pathway

The pathway is the route the patient usually takes through the system. NICE produces pathways, but these need to be localised using the Map of Medicine or the Pathways for Health software. more…

Muir Gray: Creating a network for systems of care

21 Nov, 12 | by BMJ

Muir GrayRead the rest of this series of blogs about designing and planning population based systems of care here.

Step 6: Creating a network

The network is the set of individuals and organisations that delivers the system to the populations.

At the start of the project it is also important to agree who the partners are who will contribute to the service. In the first meeting of the systems development project it should be clear who the partners are, namely those organisations who have to make a commitment to develop and deliver the system. The governance of this network may take more time to develop. more…

Muir Gray: Setting standards for systems of care

15 Nov, 12 | by BMJ

Muir GrayRead the rest of this series of blogs about designing and planning population based systems of care here.

Step 5: Setting standards

Having formulated objectives and chosen criteria to measure those objectives, the next stage in the development of a system is to set standards. (Standards can be set for process criteria even in the absence of outcomes.)

Donabedian, in many ways the founder of the healthcare quality movement, said in a lecture that “the quality of a health service is the degree to which it conforms to pre-set standards of goodness.” more…

Muir Gray: Choosing criteria for systems of care

6 Nov, 12 | by BMJ

Muir GrayRead the rest of this series of blogs about designing and planning population based systems of care here.

Step 4: Choosing criteria

Choosing criteria is a more time consuming process and may need to be addressed separately. For example it is important to reach an agreed definition by what is meant by “diagnose quickly” and “diagnose accurately.”

Each objective needs to have one or more criteria associated with it in order to measure progress. Without criteria, objectives are meaningless.    more…

Muir Gray: Setting objectives for systems of care

1 Nov, 12 | by BMJ

Muir GrayRead the rest of this series of blogs about designing and planning population based systems of care here.

Step 3: Setting objectives

Having defined the scope of the system and agreed the population to be served, the next step is to set objectives. more…

Muir Gray: Defining the population for systems of care

23 Oct, 12 | by BMJ

Muir GrayRead the rest of this series of blogs about designing and planning population based systems of care here.

Step 2: Defining the Population

Having defined the scope of the system, what is to be included and what is to be left out, the second step is to define the population to be covered and served by the service.

It is essential to define the population to be served precisely, and even when the system is related to a particular bureaucratic entity like a CCG the population needs to be specified in terms of the practice and local authority populations that will be covered. For example, in the paper launching the design of a system for frail elderly people in Oxfordshire by the PCT/CCG this precondition was emphasised as follows—the limits of the population called “Oxfordshire” will need to be defined. In addition localities will need definition. more…

Muir Gray: Defining the scope of systems of care

15 Oct, 12 | by BMJ

Muir Gray

Read the first in this series of blogs about designing and planning population based systems of care here.

Step 1: Defining the scope

The focus of a system may be:

  • A symptom such as breathlessness.
  • A condition such as inflammatory arthritis or multiple sclerosis.
  • A sub group of the population such as frail elderly people, or children, or single homeless people. more…

Muir Gray: How to design and plan population based systems

8 Oct, 12 | by BMJ

Muir GrayI will present the approach we use in designing and planning population based systems of care in ten short blogs.

 

 

Here are the ten steps:

  • Define the scope of the system.
  • Define the population to be served.
  • Reach agreement on the aim and objectives of the service.
  • For each objective find one or more criteria.
  • For each of the criteria identify levels of performance that can be used as quality standards.
  • Identify all the resources used in the system, thus creating a system budget.
  • Define all the partners so that they need to be engaged in a clinical network.
  • Produce a system specification.
  • Prepare a plan to build the system.

Muir Gray is visiting professor of knowledge management, Nuffield Department of Surgery, University of Oxford.

Muir Gray: Meeting the Trish Greenhalgh challenge

26 Sep, 12 | by BMJ

Muir GrayIn the debate about the NHS reforms that occupied so much Twitter space before the Health and Social Care Bill was passed, Trish Greenhalgh quite properly challenged me to use the five whys approach that Taiichi Ohno used within Toyota and that I had been advocating be used for other issues, to drill down to the root of a problem, and to support my contention that reform was necessary. [1] more…

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