The approach to Reducing Harm and Waste in Realistic Medicine is to focus on value. When resources are limited, interventions are offered to those who will benefit most and who are more willing to accept risk and in these conditions it is more likely that high value healthcare is delivered. However as resources increase, interventions are offered to those less likely to benefit while the likelihood and magnitude of harm stays the same and in these conditions it is more likely that low or negative value healthcare is delivered. A personalised approach to care can help communicate these concepts for patients and help understand what benefit and risk mean for a patient’s personal situation. Personalised care can also reduce the impact of adverse events. Being Open is a best practice framework used in Scotland which creates an environment where patients and families feel supported and healthcare professionals and managers have the confidence to act appropriately. “Psychological harm to families is reduced when they experience compassionate care, their perspective is valued and when they are central to the review of care.” Being Open has also been used to prevent future harm when staff participate with the learning and improvement generated from the adverse event review reports. [The Scottish Government. Personalising Realistic Medicine: Chief Medical Officer for Scotland’s Annual Report 2017-18. Published 2019. https://www.gov.scot/publications/personalising-realistic-medicine-chief-medical-officer-scotland-annual-report-2017-2018/pages/7/]
During the pandemic some healthcare services were scaled back in order to minimise harm. Also, people were reluctant to access services and it is of concern that they have chosen to stay away. Routine care has been delayed and is now becoming more urgent. The organisation and delivery of care will need to be reviewed as demand increases. Shared decision making and personalising care will help people make an informed choice about their care and allow effective and efficient use of services, reducing harm and waste. Modernising Patient Pathways Program (MPPP) is transforming outpatient services across Scotland by ensuring the optimal pathway is chosen at first point of contact. Active Clinical Referral Triage (ACRT) has the potential to reduce waiting times by eliminating unnecessary face to face appointments. Discharge Patient-Initiated Review (PIR) encourages patient independence and helps to avoid unwarranted use of our clinical resources, as well as our patients' valuable time, by avoiding routine "check-ups”. [The Scottish Government. The Chief Medical Officer for Scotland’s Annual Report 2020-21: Recover, Restore, Renew. Published 2021. https://www.gov.scot/publications/cmo-annual-report-2020-21/ ]
Value can be assessed in many different ways and can include cost-effectiveness analysis, economic analysis, disinvestment, and reducing overuse and overprescribing. Below is a selection of journal articles and reports which are about waste in healthcare. If you are looking to answer a specific question please submit a literature search request at the link above. If you would like to be alerted when new content is available here then please sign in and select Follow. You are welcome to leave comments and suggestions below in the comments section.
Academy of Medicine Royal Colleges. Protecting resources, promoting value: a doctor’s guide to cutting waste in clinical care. AMRC, Nov 2014
“The Academy’s report into how the NHS can achieve better value in care and cost through ensuring that resources in clinical care are used appropriately and unnecessary interventions which do not add value for patients are avoided.”
- Doctors should embrace the values of resource stewardship in their clinical practice and use the waste reduction toolkit provided in this report to maximise the value of every intervention.
- Medical Royal Colleges and specialist societies should establish mechanisms to identify the areas of waste within their specialty and provide leadership in tackling them using tools such as: a. The NICE ‘do not do’ recommendation database b. A ‘Choosing Wisely’ list of low-value interventions for their specialty
- Local Education and Training Boards, deaneries and medical schools should support the development of clinical and leadership skills for high value care, see Box on page 17.
- NHS organisations across the UK should provide doctors with the appropriate time and support to review their clinical practice to find areas where they can reduce wasted resource.
- Health Commissioners should encourage the reduction of waste in clinical processes.
- Public health authorities across the UK should create and support initiatives that reduce wasted resource in clinical settings.
- All those working in health should take steps to increase their understanding of the carbon costs of health care activities.” (page 8)
Royal College of Physicians. Less waste, more health: a health professional's guide to reducing waste. RCP, April 2018.
From the website:
The Less waste, more health report explains how health professionals can positively influence societal health and wellbeing by making simple changes to the procurement and disposal of medical supplies.
In England, there are 165 hospital trusts with a combined expenditure of over £4.6 billion per annum on medical supplies and other consumables. What we use and how we dispose of it has an impact not only on the finances of the NHS but the environment and population health. Less waste, more health features a range of case studies and 12 recommendations setting out how everyone from individual to trust level can:
- positively influence the health of patients
- aid financial savings
- shape the impact of the NHS on the environment.
SMITH, G.L., et al, 2022. Model to reduce waste in healthcare and add value. BMJ Open Quality, 11(1), pp. 03.