The Management of Chronic Diseases: Organizational Innovation and Efficiency

164 Pages·2018·1.964 MB·English

by  Pierre Huard

The Management of Chronic Diseases
FOCUS SERIES
Series Editor
Bruno Salgues
The Management of
Chronic Diseases

Organizational Innovation and Efficiency

Pierre Huard
First published 2018 in Great Britain and the United States by ISTE Ltd and John Wiley & Sons, Inc.
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as
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© ISTE Ltd 2018
The rights of Pierre Huard to be identified as the author of this work have been asserted by him in
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Library of Congress Control Number: 2017957895

British Library Cataloguing-in-Publication Data
A CIP record for this book is available from the British Library
ISSN 2051-2481 (Print)
ISSN 2051-249X (Online)
ISBN 978-1-78630-171-0
Contents
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Chapter 1. The Challenge of Chronic Diseases . . . . . . . . . . 1
1.1. Chronic diseases . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1.1. The burden of chronic diseases . . . . . . . . . . . . . . 1
1.1.2. Characteristics of chronic diseases . . . . . . . . . . . 3
1.1.3. The case of type 2 diabetes . . . . . . . . . . . . . . . . . 6
1.2. Management of chronic diseases . . . . . . . . . . . . . . . 8
1.2.1. Complex care . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.2.2. Characteristics of effective care . . . . . . . . . . . . . 8
1.3. Organization of the health system and coordination . . 11
1.3.1. Organizational imbalance of the health sector . . . . 11
1.3.2. Low coordination capacities . . . . . . . . . . . . . . . . 12
1.3.3. Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Chapter 2. Some Alternative Schemes for the
Management of Chronic Diseases . . . . . . . . . . . . . . . . . . . 17
2.1. Cooperation systems at the initiative of professionals . 17
2.1.1. Care and health network . . . . . . . . . . . . . . . . . . 17
2.1.2. A cooperative network . . . . . . . . . . . . . . . . . . . . 18
2.1.3. Multiprofessional health home . . . . . . . . . . . . . . 20
2.1.4. Care teams . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.2. Cooperation systems at the initiative of insurers . . . . 23
2.3. Chronic care model . . . . . . . . . . . . . . . . . . . . . . . . 25
vi The Management of Chronic Diseases
Chapter 3. Difficulties in Implementing
Effective Management . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.1. Technical difficulties . . . . . . . . . . . . . . . . . . . . . . . 29
3.1.1. The nature of the information . . . . . . . . . . . . . . 29
3.1.2. Communication processes . . . . . . . . . . . . . . . . . 31
3.2. Social difficulties . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.2.1. Influence as a promotion means in the interest
of actors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.2.2. Collaboration as a threat to actors’ autonomy . . . . 33
3.2.3. Collaboration as an opportunity . . . . . . . . . . . . . 35
3.3. Cultural difficulties . . . . . . . . . . . . . . . . . . . . . . . 36
Chatper 4. Redefining Conditions for the Effective
Management of Chronic Diseases . . . . . . . . . . . . . . . . . . 41
4.1. Quality of the activities involved in the patients’
management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
4.1.1. Quality as an attribute of actors . . . . . . . . . . . . . 41
4.1.2. Quality as balance between care abilities and
requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
4.2. Diversity and relevance of the range of care, services
and skills that can be mobilized . . . . . . . . . . . . . . . . . . 44
4.3. Cooperation of actors and coordination of their
interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
4.3.1. Cooperation between actors . . . . . . . . . . . . . . . . 47
4.3.2. Intervention coordination for chronic disease
management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Chapter 5. Activities Specific to an Effective
Management of Chronic Diseases . . . . . . . . . . . . . . . . . . 53
5.1. Nature of specific activities . . . . . . . . . . . . . . . . . . 53
5.1.1. Specific activities linked to the quality of
procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
5.1.2. Specific activities linked to the range of care
and services that can be mobilized . . . . . . . . . . . . . . . 55
5.1.3. Specific activities linked to cooperation and
coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
5.2. Implementation and funding of specific activities . . . . 57
5.2.1. Implementation problems of specific activities . . . 57
5.2.2. Funding of specific activities . . . . . . . . . . . . . . . 57
Contents vii
Chapter 6. Dynamic Processes for the Provision
of Efficient Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
6.1. Deadlock and efficiency . . . . . . . . . . . . . . . . . . . . . 59
6.2. Care quality and costs . . . . . . . . . . . . . . . . . . . . . . 62
6.3. System size and costs . . . . . . . . . . . . . . . . . . . . . . . 64
6.4. Funding of a collective system and fee-for-service . . . . 67
Chapter 7. Lump Sum Funding, Efficiency and
Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
7.1. Different lump sum funding methods . . . . . . . . . . . . 71
7.1.1. Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
7.1.2. Capitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
7.1.3. Overall capitation . . . . . . . . . . . . . . . . . . . . . . 75
7.2. Overall capitation and development . . . . . . . . . . . . . 76
7.3. Endogenous development limits . . . . . . . . . . . . . . . . 78
Chapter 8. An Illustration . . . . . . . . . . . . . . . . . . . . . . . . . 83
8.1. Presentation of the care network . . . . . . . . . . . . . . . 83
8.2. Analysis of RSD operation and development . . . . . . . 87
8.2.1. Cost reduction . . . . . . . . . . . . . . . . . . . . . . . . . 88
8.2.2. Size increase . . . . . . . . . . . . . . . . . . . . . . . . . . 90
8.3. Illustration scope and limits . . . . . . . . . . . . . . . . . . 90
8.3.1. Point of the illustration . . . . . . . . . . . . . . . . . . . 91
8.3.2. Illustration limits . . . . . . . . . . . . . . . . . . . . . . . 93
Chapter 9. From Processes to Organizational
Structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
9.1. An organized system . . . . . . . . . . . . . . . . . . . . . . . 97
9.1.1. Differentiation . . . . . . . . . . . . . . . . . . . . . . . . . 97
9.1.2. Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . 99
9.2. Coordination practices . . . . . . . . . . . . . . . . . . . . . . 101
9.3. Steering function . . . . . . . . . . . . . . . . . . . . . . . . . 104
Chapter 10. Contractual Relationship Configurations . . . . . 107
10.1. Structuring relationships . . . . . . . . . . . . . . . . . . . 107
10.1.1. Orderly coordination relationships . . . . . . . . . . 107
10.1.2. Complex coordination relationships . . . . . . . . . . 109
10.1.3. Contractual relationships. . . . . . . . . . . . . . . . . 111
10.2. Organizational configuration . . . . . . . . . . . . . . . . . 113
viii The Management of Chronic Diseases
10.2.1. A structured field of action . . . . . . . . . . . . . . . 113
10.2.2. Areas and authorities . . . . . . . . . . . . . . . . . . . 114
10.2.3. Organizational dynamics. . . . . . . . . . . . . . . . . 115
Chapter 11. Implementation Strategy . . . . . . . . . . . . . . . . 119
11.1. Two change concepts . . . . . . . . . . . . . . . . . . . . . . 119
11.1.1. Synoptic change . . . . . . . . . . . . . . . . . . . . . . . 119
11.1.2. Strategic change . . . . . . . . . . . . . . . . . . . . . . 120
11.2. The success of a doomed reform . . . . . . . . . . . . . . . 121
11.2.1. The 1991 British reform . . . . . . . . . . . . . . . . . 121
11.2.2. A double dynamic . . . . . . . . . . . . . . . . . . . . . 123
11.2.3. Determinants of the change dynamic . . . . . . . . 124
11.3. Strategy elements . . . . . . . . . . . . . . . . . . . . . . . . 125
11.3.1. Principles and action logic . . . . . . . . . . . . . . . . 126
11.3.2. Strategic management . . . . . . . . . . . . . . . . . . 129
11.3.3. Management authority . . . . . . . . . . . . . . . . . . 131
Chapter 12. IS in Health System Restructuring . . . . . . . . . . 135
12.1. The unbalanced organization of the health
care system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
12.1.1. An unsuitable organization . . . . . . . . . . . . . . . 135
12.1.2. A dissociation movement . . . . . . . . . . . . . . . . . 137
12.2. IS in the system organization development . . . . . . . 138
12.2.1. Intermediary structures . . . . . . . . . . . . . . . . . 138
12.2.2. Health operator model . . . . . . . . . . . . . . . . . . 139
12.3. Promoting IS . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
12.3.1. More or less effective measures . . . . . . . . . . . . 142
12.3.2. Structural obstacles to IS creation . . . . . . . . . . 144
12.3.3. Some principles for a reform . . . . . . . . . . . . . . 147
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Acknowledgements
I wish to make reference to the following French journals:
“Pratiques et Organisation des Soins” and “Santé Publique”,
for allowing me to use passages of text and figures used
within articles [HUA 11a, HUA 11b, HUA 14].
I wish to thank my friend (and co-author of the articles
above), Dr. Philippe Schaller, creator and manager of
“Réseau de Soins Delta” and the health center “Cité
Générations” in Geneva, Switzerland, for a long
collaboration and without whom this book wouldn’t have
come to fruition.
Introduction
This book details a general reflection on the management
of chronic diseases1, and more specifically, the organizational
forms that are likely to promote its effectiveness and
efficiency. This reflection is based on the premise that
chronic diseases are increasing in the morbidity pattern as
well as the difficulties that the health system is
encountering while dealing with this problem and thus seeks
to define new care models.
An extensive literature addresses these issues; in most
cases, it adopts an approach that is both descriptive and
prescriptive. More specifically, it describes the
characteristics of alternative forms (Health Maintenance
Organization, Care Networks, Multiprofessional Health
Homes, etc.) and gives recommendations on the conditions to
be met in order to improve the quality of chronic disease
management.
However, these descriptions and recommendations list
conditions (required or sufficient?), but do not provide much

1 The expressions “management”, “care”, “treatment”, etc., “of chronic
diseases” mean an overall activity (medical, paramedical, public health,
medico-social, etc., practices) in support of patients suffering from one or
more chronic or psychosocial diseases.