TGIV and it is Friday – Stewardship

Thank G** It’s Value – Thank G** It’s Friday, the weekly blog from Muir Gray in Oxford to supplement our Healthcare Value Briefing.

The term “sustainability” is often used in a much broader context in healthcare to mean whether or not a service is living within its means or not.  Building a new block for elective surgery when it is clear that the amount of elective surgery is not going to increase would be an example of an unsustainable service and it is for example unsustainable to run a health service that relies on the recruitment of staff from impoverished countries; it is also unethical.

Linked to sustainability is the concept of stewardship – a term increasingly used in public services. Stewardship is to hold something in trust for another, for the generations to come in the case of the NHS In stewardship the person responsible for resources has to aim to leave a service in better condition than they found it and not simply use resources for immediate results without thinking of the longer term implication, or how else they could be used. The Academy of Medical Royal Colleges Report on Protecting resources, promoting value: a doctor’s guide to cutting waste in clinical care emphasized:

“…avoiding waste and promoting value are about the quality of care provided to patients – which is a doctor’s central concern.  One doctors’ waste is another patient’s delay.  Potentially, it could be that other patient’s lack of treatment.

[reducing waste] creates a higher value health care system where resources: cash, carbon and staff time, are released from some parts of the system to develop a new services or support struggling services.  Reducing waste in today’s climate of constrained resource is really about creating the health care system that we want to have.  It is not just about cutting corners or reducing spending.  As responsible stewards, doctors can provide a more effective use of constrained economic and environmental resources…A cultural shift is required which calls upon doctors and other clinicians to ask, not if a treatment or procedure is possible, but whether it provides real value to the patient and genuinely improves the quality of their life or their prospects for recovery.”  

“Doctors should embrace the values of resource stewardship in their clinical practice

The culture of stewardship is a concept rooted in the literature of sustainability but now widely adopted in business and government:

“The stewardship concept demands that we constantly ask the question:  Will the resource be in better shape after my stewardship?” (1)

 “Stewardship is to hold something in trust for another.” (2)

As one colleague said to me ‘I feel as though I have been signing cheques confident in the knowledge that Barclays Bank would be paying because Barclays Bank is written on the cheque’

Sources: Holmgren, D.   (2002)   Permaculture.  Principles and pathways beyond sustainability.   Holmgren Design Services, (p.5).

Block P. (1996)  Stewardship: choosing service over self-interest.  Berrett-Koehler Publishers, (p.xx).

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