Rebuilding Place in the Urban Space

"A community’s physical form, rather than its land uses, is its most intrinsic and enduring characteristic." [Katz, EPA] This blog focuses on place and placemaking and all that makes it work--historic preservation, urban design, transportation, asset-based community development, arts & cultural development, commercial district revitalization, tourism & destination development, and quality of life advocacy--along with doses of civic engagement and good governance watchdogging.

Wednesday, June 08, 2011

Healthcare innovation: process redesign and innovation in DC and Prince George's County (Post #2)

While I think the Health Innovation conference is cool, it's focused on data and applications, and while data and applications are cool, they are enabling technologies, and they can't fix poorly designed "systems" of practice.

That's where systems analysis and process and organizational redesign comes in.

I have written a fair amount about health care planning and health and wellness planning over the years, much of it in the context of DC and the region, but also in terms of active transportation (a goodly amount of the reason that I bicycle--besides "acting out" against my Michigan upbringing--is because my father and his brother both died at the age of 54, and I figure that active transportation for me is a practical way for daily exercise and positive health behaviors) and the health benefits it provides.

Some past entries include:

-- How to Solve the Hospital Crisis
-- Speaking of Hospitals and Regional Equity
-- Disruptive Innovation/Once Again
-- Bods/Cuerpos
-- Rethinking health care service delivery in significant ways is not likely to happen in health care "reform"

This is also a good resource, How to Create and Implement Healthy General Plans (from the Planning Healthy Places initiative of the Public Health Law and Policy Project)

For example, I find it fascinating that many people do not consider the problems of hospitals in Prince George's County (Dimensions Health Care System) and DC (Greater Southwest Hospital now United Medical Center, the closure of DC General Hospital, occasional financial and other problems with Howard University Hospital) connected.

We need to consider health care provision on a regional scale.

And I found the whole health care debate fascinating but frustrating because of the evidence that compared to other "developed" countries, the US spends more money on health care but more people are uninsured and overall health outcomes in the US are not better than peer countries such as Canada or Britain.

While I would argue that like a lot of areas involving government in the city, we don't have a comprehensive health care plan or a health and wellness plan, the fact is that some of the DC Department of Health initiatives, while not absolute best practice, are reasonably impressive.

One such initiative is the Medical Homes DC Capital Projects Program managed by the DC Primary Care Association and funded by DOH. This program supports the development and improvement of primary care facilities in the District’s poorest communities.

DC has amongst the fewest "uninsured" of any large city, fewer than 4% of the population, despite the fact that 20% of DC residents are severely impoverished. This is because DC's primary care program, by providing Medicaid benefits to people in need through expanded eligibility requirements compared to national minimum standards, provides care to people who would not normally be eligible.

Process redesign opportunity for DC's health care system

1. DC has taken the first step by expanding their primary care programs through Medicaid and the development of community health care clinics throughout the city.

2. But care in these facilities isn't coordinated in the same way it would be in a best practice system like Kaiser-Permanente.

3. And there isn't coordinated development and delivery of health and wellness program and chronic disease management assistance programs within the primary care system in DC.

4. Get K-P to work with the DC primary health care system and move it towards the creation of an integrated system, including the use of the same type of medical record system.

5. Then, expand the same concept and system of care to the Prince George's County's health care system, where Dimensions Health Care System is under constant financial pressure (partly because of the closure of DC General Hospital many years ago)

That would be a life's work...

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