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Muir Gray

Muir Gray: Population based and personalised care—two sides of the same coin

4 Jul, 14 | by BMJ

muir_grayHealth services have become archipelagos. There are great islands like primary care and secondary care, acute and community, or public health and clinical practice, and each one is surrounded by deep water with the occasional ferryboat or swimmer going between them.

Any tension between public health and clinical practice is artificial; a population perspective and a clinical perspective are views of two sides of the same coin. The best way to understand this is to think about value. more…

Muir Gray: Population health—what’s in a name

4 Jun, 14 | by BMJ

muir_graySuddenly the word population is everywhere. The Oxford University Department of Public Health is now the Department of Population Health Sciences, the Institute for Healthcare Improvement has added population health to form its triple aim, the American Hospital Association talks about a second wave of hospitals with population health as their theme. Furthermore, Public Health England has launched Population Healthcare, which is defined below:

“The aim of population healthcare is to maximise value and equity by focusing not on institutions, specialties, or technologies, but on populations defined by a common symptom, condition, or characteristic, such as breathlessness, arthritis, or multiple morbidity.” more…

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…
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