Population medicine (Healthcare Transformation Book 2)

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Transformational change is essential to enable the healthcare sector to meet increasing demand and increasing costs within a limited budget. Isolated service or process improvements are not enough: healthcare organisations must learn how to design and implement system integration and whole-of-system change that fundamentally transform the way care is delivered.

This series provides a toolkit for creating transformational change in the complex healthcare environment.

In Volume 2, we examine population medicine.

What is population medicine? Imagine you are a rheumatologist in Auckland, Melbourne or Singapore. Last year you saw 346 patients with rheumatoid arthritis and worked hard to improve the effectiveness and safety of the service offered, struggling to reduce costs while ensuring each of the 346 patients had a good experience. This is evidence-based, patient-centred, and high quality medicine, all of which is necessary and meritorious, but, when applying the principles of population medicine, you estimate that about 1000 people in the population of 647,000 have rheumatoid arthritis. Not all of them have been diagnosed, and some may have been wrongly diagnosed. A small survey allows you to estimate that 200 of those not referred would derive great value from your service. Rather than seeking extra resources, you build a network of general practitioners, pharmacists, physiotherapists, and patients, and define clear pathways using the Internet to run the network and offer patients unbiased information. You and your team feel responsible for all the resources, human, financial and carbon, used by the population-based service. You write an annual report to be accountable to the population served, which also enables you to compare your service with other similar services.

Population Medicine explains these new responsibilities for the 21st century clinician. It focuses on the clinician's responsibilities for productivity, efficiency, better value, sustainability, equity, and the whole population in need. In addition, it sets out the wide range of skills needed to create systems, build networks, map pathways, engage both patients and the public, manage knowledge, build and use a budget, and create the right culture. This is the future, and it is needed now. Population healthcare, not institution-based healthcare, is the new paradigm, and clinicians have a key role to play in its creation.