Abstract

There are some odd design ‘rules’ in healthcare. They include: the obsession with organising around medical disciplines rather than patient problems; the disconnection between primary and home care; the common occurrence of the sickest patients being seen by the most junior doctor; and the system of outpatient care, which could be viewed as nothing more than patient storage.

But, according to Nigel Edwards, a set of new design principles for service delivery is beginning to take shape and challenge the old concepts. Some, such as standardising where appropriate, and centralising where necessary and decentralising where possible, already apply in many health systems.

Others are still gaining influence and include: understanding the population’s health needs and creating systems that allow for services to be matched to patient characteristics based on need and risk; developing the capability to deal with the complexity of patient needs and matching these to services; focusing on flow and aligning the different parts of the health system and the pace at which they work; and managing a system rather than individual institutions.

Other new design principles for the delivery of modern health services include: sharing information for coordination, continuity, improved access, etc; focusing purposefully on the design and improvement of the health system; considering the measurement of outcomes and key processes; and working closer with the wider community.