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Advanced Search The leading cause of morbidity and mortality in the United States is chronic, or noncommunicable, diseases. The impact of chronic diseases on health and wellness can be significantly altered by individual health and behavior choices or modifications.
Furthermore, the burden of chronic disease goes beyond health and the health care system and may influence an individual's wellness. The purposes of this article are: Noncommunicable diseases NCDsalso called lifestyle or chronic diseases, are the major cause of morbidity and mortality in the United States and in most countries around the world. As a result, the World Health Organization WHO and the Centers for Disease Control and Prevention CDC have labeled lifestyle diseases both epidemic and pandemic and have identified the need for the development of new solutions to address this growing problem.
Health The WHO developed what has become the most commonly referenced definition of health: Improving quality and tackling complexity Public service reform has often focused on improving the efficiency of the supply of services while driving up performance in delivering outputs through the imposition of targets. There has been less thought given to ways of managing the demand for services. As the Wales Public Services Programme and other analysts have argued, we now need a more radical approach, which takes account of the whole system of public service delivery and emphasises the importance of understanding the relationship between public services and those who need them most.
This kind of systemic change and engagement with service users and the wider public requires us to think about issues that are of different orders of magnitude in terms of complexity. At one end of the scale, there is unnecessary demand created by poorly-drafted letters and leaflets causing a high volume of calls to a call centre.
This has been documented by a wide range of services, for example Colchester Borough Council realised that this was the case for their benefits and tax team.
Addressing them effectively will require public services to collaborate and work with both the people of Wales and specific target populations, so they can play a much more active role in helping to define the problem, design solutions and take greater responsibility for their own wellbeing and use of services.
Improving quality and tackling complexity in a time of sustained resource pressures will demand fundamental changes in the ways in which services are designed and delivered. Existing mind sets, tools and structures are not going to be sufficient.
And, in light of this, new ideas have emerged, for example using behavioural insight, and some older, as yet unrealised, aspirations such as joining-up services, are being revisited.
What is demand management? Demand management is an emerging field covering a range of approaches and practices.
It contrasts demand for services with need, as a means of making the distinction between inefficient use of public services from appropriate provision. There is a long tradition of public service leaders, managers and professionals working on various aspects of demand management.
However, it is only recently that the discussion has focused on what it means for the way public service organisations and public service systems as a whole work. This includes how they relate to the public and service users as well as links to wider public service reform. Demand and need We can identify four types of unnecessary, potentially wasteful demand: Examples include over-prescribing, provision of an unneeded care aid or lab test, even an unnecessary length of stay in an acute bed.
On the user side it might include calls which are not emergencies Failure demand: This can include unnecessary referrals or hand-offs by front-line staff, multiple assessments, or the failure to respond first time to a simple request Avoidable or preventable demand: It is worth noting that these categories are not mutually exclusive; indeed there will be services that experience all of these to some degree.
Health needs assessment: Needs assessment: from theory to practice
There is evidence that in many services some proportion of use is either unnecessary or ineffective. Common examples of unnecessary or ineffective use include instances where: Whatever the case, the key is to understand the behaviours and circumstances that drive demand, as opposed to need, for a service.
This concept of demand is broader than the idea of imprudent healthcare. It acknowledges the health system faces demand which arises from factors outside its remit or control, whether that be other services or wider societal factors. This suggests there could be value in a broader discussion of the challenge facing the Welsh NHS — one which considers the way in which the health system interacts with wider society.
Demand management strategies A variety of techniques for understanding and managing demand are now emerging across a range of public services.
We have not attempted to compile a definitive list but the literature points to a range of strategies including: The diagram below outlines types of demand how different strategies can be used modify the relationship between services and those who use them, in order to meet demand effectively.
Needs assessment: from theory to practice
Demand management in local government Local government has shown an increasing interest in demand management strategies and there are a growing number of case studies and examples. The quality of the evidence varies and independent evaluation of interventions using these strategies is not common, though some agencies have attempted to quantify benefits. There is reasonably strong evidence to suggest that demand management strategies can help to achieve better outcomes, but the extent to which this is accompanied by an overall reduction in cost is less clear.
Examples of demand management based initiatives include: The application of lean systems thinking in social care and other services Early intervention to improve the life chances of vulnerable people Co-production with older people The use of peer groups rather than reliance on professionals Service integration. There are fewer examples of bringing all these strategies together to achieve organisation-wide change — Oldham and Monmouthshire are often quoted as being examples of councils trying to achieve this.
There are others who are rethinking the whole way they work and their relationship with communities but this remains very much work in progress especially as there is more to be done to firm up the business case. There is also a compelling need to make a sometimes bemusing array of different and variable sources of evidence more accessible to busy policy-makers, managers and professionals so they can adopt demand management approaches they know will work.
Demand management and the health service The issue of rising demand and limited resources has been driving reform in healthcare for some time. Demographic pressures, alongside the increasing costs of new technologies and drugs and a wage bill that only gives limited scope for efficiencies has meant many approaches to demand management have been trialled in healthcare.
There is an extensive literature on these type of initiatives and there are a number of approaches that are fairly closely aligned with the broader understanding of demand management presented in this chapter.
Meeting the challenge of increased demand on healthcare services | Making prudent healthcare happen
Redesigning healthcare systems and practice — There have been many studies into systems and practice, from using lean techniques to Choosing Wisely. The Kings Fund has reviewed approaches to demand management. Investing in prevention and early intervention — In the last few decades the focus on prevention has increasingly shifted towards population health, and the social determinants of health — the conditions of daily life that contribute to health and ill health.
The evidence about what works in changing health behaviours varies both in terms of quality and quantity. There is good evidence about the behaviours that need to be addressed, but the evidence base for the effectiveness of interventions is still developing. How to tackle smoking and substance misuse are better understood than, for example, how to increase physical activity.
Similarly, while there are interventions that have been shown to be successful, for example education programmes using reminders, providing targeted support and raising awareness , the long-term effects and relative cost effectiveness of preventative interventions is still not well understood. Changing the relationship between citizen and state — The Health Foundation, among many others, argues the case for self-management.
This approach is supported by their review of pieces of high-quality research, which evidence the effectiveness of self-management.
Managing the task Several challenges are commonly encountered in understanding needs assessment. Firstly, the mosaic of information required for needs assessment reflects its key components: The evidence based medicine movement has meant that information on effectiveness can more easily be obtained, 1617 but this is not true for information on epidemiology or services provided.
Good quality local data on the structure and utilisation of health services can be surprisingly difficult to obtain. The absence of common disease definitions, common classification systems, and compatible software—and the partial recording of activity—limits the value of many databases.
Useful information can be either local or national, either numerical or textual, and collected either routinely or ad hoc.Is Salt Bad for ME??? (You Won’t Believe the Research)
The figure sets out key items for the needs assessors. National sources of epidemiological and effectiveness data offer assessors of healthcare needs a firm starting point for their work. A second challenge is the involvement of health professionals in healthcare needs assessment.
The traditionally individualistic approach of doctors in particular may be difficult to reconcile with the utilitarian approach of planners with a population focus.
Thirdly, needs assessment is futile if it does not result in improved services to patients. A key to successful needs assessment is the proper understanding of how it is related to the rest of the planning process.
If the information and recommendations produced are not timely, they will not be useful.