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toshiba-medical.eu/lets-talk Aplio provides a comprehensive set of tools enabling you to perform an increasing number of procedures under ultrasound guidance. From automated needle enhancement to precise modality fusion, these applications allow you to navigate complex anatomy with pinpoint accuracy, improving both your clinical confidence and your productivity. Let’s talk. Is there a simpler way to guide my interventional cases ? www.toshiba-medical.eu www.healthcare-in-europe.com 3NEWS & MANAGEMENT A challenging shift from cure to care Yann Bourgueil, Director of the Institute for Research and Information in Health Economics (IRDES), Paris, France John Brosky meets Yann-Bourgueil Healthcare systems need to move beyond reform and transform services for chronically ill patients to be delivered beyond hospitals After 20 years of reform and reor- ganisation efforts, many countries in Europe continue to deliver anti- quated and inadequate care for chronically ill patients, according to Yann Bourgueil, the Director of the Institute for Research and Information in Health Economics (IRDES) in Paris, France. Many of these initiatives have been implemented slowly or have met with outright resistance. In some cases they have been simply aban- doned and, considering the expecta- tions for change, success has been limited. Bourgueil suggests the difficul- ty comes from hospitals and large organisations trying to extend their model for curative activities rather than looking to alternative approach- es that allow more innovative models for patient care. At the 18th European Health Forum Gastein (30th September - 2nd October 2015), Bourgueil offered insights into the French experience during a workshop on ‘Improving the Skill-Mix for Chronic-Care.’ When it comes to caring for the chronically ill patient, he said, health- care institutions tend to concentrate on tools and technologies to exter- nalise services. For example, great expectations are placed on electronic medical records (EMRs) and informa- tion technologies (IT). ‘You are not going to suddenly cre- ate coordinated care for patients by introducing IT like some magic wand that will solve all the problems,’ he said. ‘IT can only come in support of a coordinated care that has already been established through changes to the culture among care givers.’ Today we have sophisticated tele- phones, yet care professionals do not even use these to cooperate where they have not learned how to coop- erate, he said. ‘The challenge we all face is to change the culture so there is a willingness to work together, where there are common objectives, where we have provided the right training, and have made sure the incentives support this organisation of care and team work. Healthcare is a human activity, and if we want to change a process of care, then we need to change how people work to deliver that care.’ The fundamental challenge is that care today is still centred on the hospital, and with chronic care, the centre of gravity shifts away from the hospital to the community. Yet financial incentives continue to be built around the separation of specialties in a hospital. In France, Bourgueil pointed out, patient ambulatory care continues to be guided by principles that were defined back in 1927. Doctors, nurs- es, physical therapists, pharmacists and even social care workers are all paid a fee for a specific activ- ity or medical act, and these actors required for coordinated care do not have an incentive to spend time with a patient beyond that activity, for example for education or counsel- ling, to explain to the patient how to deal with their condition or the prescribed treatment. Unfortunately, the coordination of these different services most often depends upon the patient, or the patient’s family when there is such support. As a result, chronically ill patients tend to be heavy users of the emergency medical network, which often puts them back in the hospital. Training in new skills and align- ing incentives to reward coordinated care become critical to transforming chronic care delivery. ‘We have a great opportunity to effect change in France at this moment because there is a change underway in the workforce with young doctors and allied health workers who have different expec- tations than the older generation,’ Bourgueil said. ‘This new generation is more open to the idea of working in teams, to sharing the workload with other pro- fessionals, and they are open to new methods of payment.’ There are also new opportunities to facilitate change with the tools and techniques available through IT when applied to an appropriately transformed approach, he added. Additionally there is a great oppor- tunity to accelerate change through the emergence of patient groups that bring a new kind of organisation into the mix, one that is specific to the needs of their members and which is an active player in this landscape, he observed. ‘These are good levers for bringing about change, and though it is a slow process, it will take some years, but we will see a lot of change.’

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