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Upon reflection, the inter-relationship between these phenomena is obvious. The systemic impact is not. Let us explain the interactions, locally and globally.  Presently, most developed countries, including the United State and Europe, are not training enough healthcare professionals at home to provide essential services to their older, sicker populations. To alleviate this workforce gap, developed countries actively seek out skilled workers from developing countries. Tragically, such a grab for talent only compounds the already severe manpower crisis that developing countries face. (More on this dilemma when we discuss the conditions of developing countries and the work the Callaway Group is doing to contribute to solutions.)

One country’s journey toward better healthcare. Today, the United Kingdom (UK) is actively involved in the transformation of its healthcare delivery system, with the stated goal of providing better quality care, more efficiently and effectively. In the UK, healthcare is considered a basic ‘right’ of citizenship; has been provided almost exclusively by the country’s National Health Service (NHS) for more than sixty years; and has always been paid for by the government. In spite of the government’s commitment to offer comprehensive ‘cradle to grave’ healthcare for everyone, the NHS has struggled with serious service access and cost issues for at least three decades.

Just one indicator, wait times for already-approved essential clinical procedures demonstrates the magnitude of the problem. In parts of the UK, wait times for often life-saving procedures such as cancer surgery or cardiac procedures routinely stretch into months, not weeks. These wait-times begin after a diagnosis is made and the appropriate intervention recommended. One consequence of these ‘inconveniences’ is the growth of medical tourism, the phenomenon where average citizens travel to other countries for sophisticated medical treatments that are either unavailable or too costly in their own country. The cover story of the May 12, 2008 issue of US News and World Report: Medical Tourism presents an excellent interview of this growing trend. (www.usnews.com) (The jury is still out about whether medical tourism is a long-term viable solution to issues of access and affordability, but that is a topic for another day.) 

A transformational strategy. Like the US, healthcare costs in the UK continue to escalate at a rate faster than the country’s economic growth, even in good years. In 2000, responding to these issues and growing public dissatisfaction with the ‘status quo’, Prime Minister Tony Blair and the UK’s Secretary of State for Health introduced a sweeping reform plan that is altering both the payment for and delivery of all healthcare services. In fact, it leaves no aspect of the healthcare delivery or relationships among providers untouched. For those who are interested, the NHS Plan can be found at http://www.nhshistory.net/nhsplan.pdf.

It is not easy for any organization, large or small to transform itself. As the 2nd largest employer in the European Union, the NHS is massive. Remaking a cumbersome delivery system into one that formally integrates the perspective of patients through community boards, patient advocates, and patient-centered care while also streamlining service delivery is a massive undertaking that will take time. To get a candid, objective view of the reform’s implementation progress, go to http://www.reform.co.uk/health.php.  Almost a decade into the reform process, unexpected setbacks and large doses of inevitable resistance to change have slowed anticipated gains.

Implementation Milestones. Nonetheless, in some NHS quarters, one can observe discernable progress. Policies set general guidelines for change. Transformation takes place from the ground up, with leaders at the strategic and operational level courageously moving their own organizations toward well-defined outcomes. At the level of primary care, some Primary Care Trusts (PCTs), a formal grouping of general practitioners (GPs) within a geographic area, have learned how to contract effectively for local and specialty inpatient hospital services. They are also learning how to make physician office practices more patient-friendly while working to move healthcare into more appropriate, lower-cost settings. 

At the hospital level, further legislation enacted in 2004 established a rigorous process that existing NHS hospitals must complete to qualify for the newly created Foundation Trust status. (All hospital providers must convert to NHS Foundation Trusts (FTs) by 2012) Chief Executives and their teams who are in charge of these new organizations face much tougher performance standards. The transition to FTs has introduced more effective management systems and robust financial accountability. Human resource capacity building efforts are now a priority. For the first time, all executive team members must complete formal 360° Performance Appraisals, ones that seek formal input from subordinates and peers. As a result of these broad-based strategic and operating changes, if a traditional NHS hospital system becomes an NHS Foundation Trust, its operating, financial and service performance improve in ways that can be measured.

The introduction of empowered community boards (similar to local boards of non-profit hospitals in the USA) has also introduced a level of public accountability that has not existed before. The challenge will be to sustain such gains long-term. 

Speeding transformation. Is it possible to accelerate progress? Yes, if one adopts the behavior of living systems. An observable characteristic of all healthy living systems -- as small as a cell or as large as a human body -- is that essential information, including ongoing feedback, is automatically shared among all functions. Through such information sharing, adaptation to changing internal and external conditions occurs naturally. Thus, as one or more healthcare organizations within the NHS come into better alignment with its transformational strategy, and are willing to share their insights through collaboration with others, the speed of overall systemic transformation is increased.

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US News and World Report Cover Story: "Medical Tourism" (www.usnews.com)

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CG Insights Volume 1