Why look to other countries to learn about health?

The following article was written by Deputy Chief Executive of The Health Foundation Vin McGloughlin for Health Management and appeared in the May/June edition.

Healthcare is large, complex and dynamic. There are constant pressures for managers in health services for reform and higher levels of performance. This environment usually generates a sense of urgency which works against sorting the urgent from the important. Yet seeing the bigger picture is critical to delivering high quality health services. Looking across countries immediately highlights how many similar challenges are being dealt with in different ways. So it is possible to assess their relative effectiveness?

As part of our work at The Health Foundation, we look at the problems with healthcare internationally and specifically how the UK’s health system performs in terms of access, safety, effectiveness, the responsiveness and equity of care. For example, the international evidence indicates that in most developed countries 1 in 10 admissions to hospitals are associated with a patient safety incident about half of which could have been prevented. Looking more specifically at the UK’s performance in cancer and coronary care showed that it had improved significantly over time but international comparisons showed that other countries had improved even more. Could these levels of improvement be achieved here, if not why?

One of the ways we look to answer questions like this is through our Quest for Quality and Improvement (QQUIP) website which highlights aspects of this comparative performance and reviews the international evidence about what works to improve the quality of healthcare. It has been developed by working with world-leading experts and recognised research bodies such as the RAND Corporation and the Centre for Quality of Care Research in the Netherlands.

There are also many other valuable resources available. The Organisation for Economic Cooperation and Development (OECD) is probably the best known source of information about how different countries compare, alongside the World Health Organisation (WHO) and the World Bank. Data from the OECD show how much different countries spend on healthcare, how the care is organised and funded. It works with around 30 different countries including the USA, Canada, Australia, New Zealand, Japan and many countries in Europe. The OECD has extended its collection recently to include healthcare quality indicators. The WHO provides data on public health indicators across the world.

Of course there are significant challenges to interpreting the information from different countries, not just literally in translation but also in understanding how the differences in financing and institutional arrangements determine how care is delivered. Population size and distribution, approaches to the public sector, relative levels and trends in spending are important, as they determine the infrastructure and workforce capabilities among other things. 

A good illustration of why these factors matter is to consider the current issues around spending on the NHS. While the government has significantly increased spending over the last few years, for the previous 40 years spending on the NHS had been well below the average of OECD countries. This translated into fewer doctors and dentists per head of population, older buildings and equipment and low technology uptake - a situation which cannot be remedied overnight.

Some further cautions are warranted. The USA is a powerful influence for the UK. Because of its size the USA generates much of the world’s academic literature and American based global healthcare companies spread management fashions quickly. The USA spends 16% of its gross domestic product on healthcare. This is almost twice the OECD average. Its performance does not show a commensurate gain in health outcomes for the population. While we can learn a lot from the USA, these lessons need to be tested and adapted to the local context to ensure they work well.

As an example, we commissioned the US-based Institute for Healthcare Improvement (IHI) to bring their track record of performance improvement on patient safety to the UK. Their programme had to be adapted to hospitals with less data and resources, and some differences in the formal assessment of evidence.

Once data shows where to learn from, the next step is to visit the country. The Health Foundation’s Quality Improvement Fellowship offers up to three leading senior UK clinicians the chance to spend a year at the IHI. The European Hospital and Healthcare Federation, HOPE, also offers many potential avenues for mush shorter exchanges. The delegate lists from conferences can provide a starting point of who to contact. Healthcare is too complex to expect that any single country has got it all right but it is certainly useful to learn with others.