7.5 Managing in complex environments
It is vital to manage organisations, systems, models of care and service delivery to effectively identify and deal with circumstances of low-value care within the complexity of the health and aged care delivery continuum. Management areas include knowledge translation use and contribution to clinical care standards, protocols and models of care benchmarking; monitoring and evaluation; education and training; shared decision-making between clinicians and patients; health economic levers and environments that involve funding and payment models; and fostering cultures of accountability and continuous quality improvement.
Leadership
Leaders and managers in healthcare play a critical role in supporting and enabling specific and systematic responses to circumstances of potential delivery of low-value care in their organisations. Fundamental to those responsibilities is the ability to articulate a strong set of goals and objectives about quality, effectiveness and resource management responsibilities. Health system leaders need to foster a culture of transparency and accountability and promote a comprehensive and deep sense of quality assurance within and external to the organisation (Votova et al., 2019). To promote and incentivise high-value care requires a commitment to patient-centred care, continuous quality improvement and strong cost awareness in decision-making.
Culture, reform and change
To engage effectively around dealing with issues of low-value care, practitioners and teams need to create an environment of contemporary practice, reform practice and systems and pursue authentic change management. Encouraging healthcare providers and organisations to prioritise evidence-based practice and contemporary clinical pathway decision-making fosters a culture where the latest research and knowledge directly informs care delivery practice. Translation sciences offer a range of models and methods to help bring contemporary and new knowledge into practice and enable effective and efficient education and training programs to equip healthcare professionals with new knowledge and skills to identify and reduce low-value care through critical appraisal and shared decision-making.
Organisational improvement
Teams and health organisations can focus on improvement by enabling a culture of continuous learning and quality. This encourages shared decision-making between clinical practitioners and also in their relationships with patients and clients. Interdisciplinary professional collaboration enables a whole-of-practice approach to direct care and provides a strong environment to support individuals as they take on new and justified ways of providing direct care.
