TED@BCG Singapore
Stefan Larsson: What doctors can learn from each other
Stefan Larson (Stefan Larsson): Šta doktori mogu da nauče jedni od drugih
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887,249 views
Različite bolnice stvaraju različite rezultate različitih procedura. Samo što pacijenti ne znaju te podatke, što odabir hirurga čini veoma rizičnom igrom pogađanja. Stefan Larson posmatra šta se dešava kada doktori mere i dele svoje rezultate u operaciji zamene kuka, na primer, da bi videli koje se tehnike pokazuju kao najefektivnije. Može li zdravstveni sistem da se poboljša i pojeftini ukoliko bi doktori učili jedni od drugih u neprekidnom lancu razmene mišljenja? (Snimljeno na TED@BCG.)
Stefan Larsson - Value-based health care advocate
A doctor by training, Stefan Larsson of BCG researches how transparency of medical outcomes and costs could radically transform the healthcare industry. Full bio
A doctor by training, Stefan Larsson of BCG researches how transparency of medical outcomes and costs could radically transform the healthcare industry. Full bio
Double-click the English transcript below to play the video.
00:12
Five years ago, I was on a sabbatical,
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Pre 5 godina bio sam
na plaćenom odsustvu
na plaćenom odsustvu
00:15
and I returned to the medical university
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i vratio sam se
na Medicinski fakultet
na Medicinski fakultet
00:17
where I studied.
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gde sam studirao.
00:19
I saw real patients and I wore the white coat
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Video sam prave pacijente
i nosio sam beli mantil
i nosio sam beli mantil
00:24
for the first time in 17 years,
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po prvi put u 17 godina,
00:26
in fact since I became a management consultant.
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zapravo od kada sam
postao konsultant upravljanja.
postao konsultant upravljanja.
00:30
There were two things that surprised me
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Postojale su 2 stvari
koje su me iznenadile
koje su me iznenadile
00:32
during the month I spent.
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tokom mesec dana
mog boravka tamo.
mog boravka tamo.
00:34
The first one was that the common theme
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Prva stvar je bila je to
što su zajedničke teme
što su zajedničke teme
00:36
of the discussions we had were hospital budgets
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diskusija koje smo imali,
bili bolnički budžeti
bili bolnički budžeti
00:39
and cost-cutting,
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i smanjenje troškova,
00:41
and the second thing, which really bothered me,
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a druga stvar,
koja me je stvarno brinula,
koja me je stvarno brinula,
00:43
actually, was that several of the colleagues I met,
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zapravo bila je to što
nekoliko kolega koje sam sreo,
nekoliko kolega koje sam sreo,
00:46
former friends from medical school,
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kolege iz srednje medicinske škole,
00:48
who I knew to be some of the smartest,
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za koje sam znao da su
među najpametnijim,
među najpametnijim,
00:50
most motivated, engaged and passionate people
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najmotivisanijim, najangažovanijim
i najstrastvenijim ljudima
i najstrastvenijim ljudima
00:53
I'd ever met,
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koje sam ikada sreo,
00:55
many of them had turned cynical, disengaged,
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mnogi od njih
su postali cinični i odvojeni
su postali cinični i odvojeni
00:59
or had distanced themselves
from hospital management.
from hospital management.
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ili su se distancirali
od bolničkog upravljanja.
od bolničkog upravljanja.
01:02
So with this focus on cost-cutting,
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Sa fokusom na smanjenje troškova,
01:05
I asked myself, are we forgetting the patient?
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pitao sam se, da li
zaboravljamo na pacijenta?
zaboravljamo na pacijenta?
01:09
Many countries that you represent
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Mnoge zemlje koje predstavljate
01:11
and where I come from
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i odakle ja dolazim
01:13
struggle with the cost of healthcare.
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se bore sa troškovima
zdravstvenih usluga.
zdravstvenih usluga.
01:16
It's a big part of the national budgets.
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To je veliki deo nacionalnog budžeta.
01:19
And many different reforms aim
at holding back this growth.
at holding back this growth.
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Mnoge različite reforme pokušavaju
da uspore ovaj rast.
da uspore ovaj rast.
01:22
In some countries, we have long waiting times
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U nekim zemljama
pacijenti dugo čekaju
pacijenti dugo čekaju
01:24
for patients for surgery.
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na operaciju.
01:27
In other countries, new drugs
are not being reimbursed,
are not being reimbursed,
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U drugim zemljama,
novi lekovi se ne refundiraiju
novi lekovi se ne refundiraiju
01:29
and therefore don't reach patients.
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i stoga ne dolaze do pacijenata.
01:32
In several countries, doctors and nurses
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U nekoliko zemalja, doktori
i medicinske sestre
i medicinske sestre
01:34
are the targets, to some extent, for the governments.
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su u neku ruku mete za vlade.
01:38
After all, the costly decisions in health care
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Uostalom, skupocene odluke
u zdravstvenoj nezi
u zdravstvenoj nezi
01:42
are taken by doctors and nurses.
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donose doktori i medicinske sestre.
01:44
You choose an expensive lab test,
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Izaberete skupocen laboratorijski test,
01:47
you choose to operate on an old and frail patient.
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izaberete da operišete
starog i bolešljivog pacijenta.
starog i bolešljivog pacijenta.
01:51
So, by limiting the degrees of freedom of physicians,
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Ograničavajući stepen slobode lekara,
01:55
this is a way to hold costs down.
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ovo je način da se troškovi smanje.
01:58
And ultimately, some physicians will say today
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Na kraju, neki doktori
će danas reći
će danas reći
02:01
that they don't have the full liberty
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da nemaju potpunu slobodu
02:03
to make the choices they think
are right for their patients.
are right for their patients.
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da naprave izbore za koje misle da su
pravi za njihove pacijente.
pravi za njihove pacijente.
02:07
So no wonder that some of my old colleagues
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Nije ni čudo onda da su
neki od mojih starih kolega
neki od mojih starih kolega
02:09
are frustrated.
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isfrustrirani.
02:12
At BCG, we looked at this,
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Na Bostonskoj grupi za konsultacije,
pogledali smo ovo
pogledali smo ovo
02:14
and we asked ourselves,
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i zapitali smo se,
02:16
this can't be the right way of managing healthcare.
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ovo ne može da bude pravi način
vođenja zdravstva.
vođenja zdravstva.
02:19
And so we took a step back and we said,
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Stoga smo se vratili
korak unazad i rekli:
korak unazad i rekli:
02:23
"What is it that we are trying to achieve?"
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"Šta je to što želimo da postignemo?"
02:25
Ultimately, in the healthcare system,
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U suštini, u sistemu zdravstvene nege,
02:27
we're aiming at improving health for the patients,
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težimo da poboljšamo
zdravlje naših pacijenata,
zdravlje naših pacijenata,
02:31
and we need to do so at a limited,
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i treba to da uradimo sa ograničenim
02:34
or affordable, cost.
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ili pristupačnim troškovima.
02:36
We call this value-based healthcare.
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Mi ovo nazivamo zdravstvenom negom
zasnovanom na vrednosti.
zasnovanom na vrednosti.
02:38
On the screen behind me, you see what we mean
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Na ekranu vidite šta podrazumevamo
02:40
by value:
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pod vrednošću:
02:42
outcomes that matter to patients
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ishodi koji se odnose na pacijente
02:44
relative to the money we spend.
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u odnosu na novac koji trošimo.
02:47
This was described beautifully in a book in 2006
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Ovo je prelepo opisano
u knjizi iz 2006.
u knjizi iz 2006.
02:50
by Michael Porter and Elizabeth Teisberg.
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Majkla Portera i Elizabet Tajzberg.
02:54
On this picture, you have my father-in-law
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Na ovoj slici se nalazi moj tast
02:57
surrounded by his three beautiful daughters.
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okružen sa svoje tri prelepe ćerke.
03:01
When we started doing our research at BCG,
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Kada smo počeli
da radimo istraživanja na BGK
da radimo istraživanja na BGK
03:04
we decided not to look so much at the costs,
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odlučili smo da
ne gledamo toliko na troškove,
ne gledamo toliko na troškove,
03:06
but to look at the quality instead,
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nego na kvalitet,
03:09
and in the research, one of the things
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i u istraživanju, jedna od stvari
03:11
that fascinated us was the variation we saw.
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koja nas je fascinirala bile su
varijacije koje smo videli.
varijacije koje smo videli.
03:14
You compare hospitals in a country,
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Uporedite bolnice u zemlji,
03:17
you'll find some that are extremely good,
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naći ćete neke koje su izuzetno dobre,
03:19
but you'll find a large number
that are vastly much worse.
that are vastly much worse.
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ali ćete takođe naći veliki broj
onih koje rade dosta lošije.
onih koje rade dosta lošije.
03:22
The differences were dramatic.
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Razlike su bile dramatične.
03:25
Erik, my father-in-law,
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Erik, moj tast,
03:27
he suffers from prostate cancer,
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pati od raka prostate,
03:29
and he probably needs surgery.
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i verovatno mu treba operacija.
03:32
Now living in Europe, he can
choose to go to Germany
choose to go to Germany
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Živeći u Evropi, može da bira
da ide u Nemačku
da ide u Nemačku
03:34
that has a well-reputed healthcare system.
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koja ima sistem zdravstvene zaštite
sa dobrom reputacijom.
sa dobrom reputacijom.
03:38
If he goes there and goes to the average hospital,
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Ukoliko ode tamo
i poseti prosečnu bolnicu,
i poseti prosečnu bolnicu,
03:42
he will have the risk of becoming incontinent
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imaće rizik od dobijanja inkontinencije
03:46
by about 50 percent,
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za oko 50 procenata,
03:48
so he would have to start wearing diapers again.
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pa bi morao ponovo da počne
da nosi pelene.
da nosi pelene.
03:51
You flip a coin. Fifty percent risk. That's quite a lot.
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Bacate novčić. 50% rizika.
To je prilično mnogo.
To je prilično mnogo.
03:55
If he instead would go to Hamburg,
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Da je umesto toga
otišao u Hamburg,
otišao u Hamburg,
03:57
and to a clinic called the Martini-Klinik,
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u kliniku po imenu Martini-Klinik,
04:00
the risk would be only one in 20.
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rizik bi bio jedan u 20.
04:03
Either you a flip a coin,
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Ili bacate novčić
04:04
or you have a one in 20 risk.
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ili imate rizik jedan u 20.
04:06
That's a huge difference, a seven-fold difference.
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To je velika, sedmostruka razlika.
04:10
When we look at many hospitals
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Kada pogledamo mnoge bolnice
04:12
for many different diseases,
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za mnoge različite bolesti,
04:13
we see these huge differences.
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vidimo te ogromne razlike.
04:16
But you and I don't know. We don't have the data.
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Ali vi i ja ne znamo.
Nemamo podatke.
Nemamo podatke.
04:19
And often, the data actually doesn't exist.
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A podaci često zapravo ne postoje.
04:21
Nobody knows.
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Niko ne zna.
04:23
So going the hospital is a lottery.
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Odlazak u bolnicu je lutrija.
04:27
Now, it doesn't have to be that way. There is hope.
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To ne mora da bude tako.
Postoji nada.
Postoji nada.
04:32
In the late '70s, there were a group
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Kasnih '70-ih, postojala je grupa
04:34
of Swedish orthopedic surgeons
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švedskih ortopedskih hirurga
04:37
who met at their annual meeting,
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koji su se sreli
na svom godišnjem sastanku,
na svom godišnjem sastanku,
04:38
and they were discussing the different procedures
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i počeli su da diskutuju
o različitim procedurama
o različitim procedurama
04:40
they used to operate hip surgery.
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koje su koristili za operaciju kuka.
04:44
To the left of this slide, you see a variety
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Na levoj strani
ovog slajda, vidite razne
ovog slajda, vidite razne
04:45
of metal pieces, artificial hips that you would use
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metalne delove, veštačke kukove
koje biste koristili
koje biste koristili
04:48
for somebody who needs a new hip.
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za nekoga kome je
potreban novi kuk.
potreban novi kuk.
04:51
They all realized they had
their individual way of operating.
their individual way of operating.
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Svi oni su shvatili da imaju
sopstveni način operisanja.
sopstveni način operisanja.
04:55
They all argued that, "My technique is the best,"
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Svi su tvrdili:
"Moja tehnika je najbolja,"
"Moja tehnika je najbolja,"
04:57
but none of them actually knew,
and they admitted that.
and they admitted that.
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ali nijedan od njih zapravo
nije to znao i to su i priznali.
nije to znao i to su i priznali.
05:00
So they said, "We probably need to measure quality
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Stoga su rekli: "Verovatno treba
da merimo kvalitet
da merimo kvalitet
05:04
so we know and can learn from what's best."
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da bismo znali i mogli
da naučimo od najboljeg."
da naučimo od najboljeg."
05:08
So they in fact spent two years debating,
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Oni su zapravo proveli
dve godine u raspravi:
dve godine u raspravi:
05:11
"So what is quality in hip surgery?"
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"Kakav je kvalitet operacije kuka?"
05:13
"Oh, we should measure this."
"No, we should measure that."
"No, we should measure that."
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"Trebalo bi da merimo ovo."
"Ne, trebalo bi da merimo ono."
"Ne, trebalo bi da merimo ono."
05:16
And they finally agreed.
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I konačno su se dogovorili.
05:18
And once they had agreed, they started measuring,
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Kada su se jednom dogovorili,
počeli su da mere
počeli su da mere
05:20
and started sharing the data.
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i da razmenjuju podatke.
05:23
Very quickly, they found that if you put cement
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Veoma brzo, otkrili su
da ukoliko stavite cement
da ukoliko stavite cement
05:25
in the bone of the patient
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u kost pacijenta
05:27
before you put the metal shaft in,
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pre nego što unutra
stavite metalnu cev,
stavite metalnu cev,
05:29
it actually lasted a lot longer,
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to je trajalo mnogo duže,
05:31
and most patients would never have to be
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i većini pacijenata
više nije bila potrebna
više nije bila potrebna
05:33
re-operated on in their lifetime.
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ponovna operacija za života.
05:35
They published the data,
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Objavili su podatke
05:37
and it actually transformed
clinical practice in the country.
clinical practice in the country.
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i to je zapravo preobrazilo
kliničku praksu u zemlji.
kliničku praksu u zemlji.
05:40
Everybody saw this makes a lot of sense.
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Svako je primetio da
ovo ima dosta smisla.
ovo ima dosta smisla.
05:43
Since then, they publish every year.
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Od tada, objavljuju radove
svake godine.
svake godine.
05:46
Once a year, they publish the league table:
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Jednom godišnje,
objavljuju tabelu saveza:
objavljuju tabelu saveza:
05:47
who's best, who's at the bottom?
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ko je najbolji, ko je na dnu?
05:50
And they visit each other to try to learn,
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Sreću se međusobno
kako bi pokušali da uče
kako bi pokušali da uče
05:53
so a continuous cycle of improvement.
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i nastave stalni krug poboljšanja.
05:56
For many years, Swedish hip surgeons
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Godinama, švedski hirurzi za kuk
05:59
had the best results in the world,
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su imali najbolje
rezultate na svetu,
rezultate na svetu,
06:02
at least for those who actually were measuring,
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barem za one koji su zapravo merili,
06:04
and many were not.
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a mnogi nisu.
06:07
Now I found this principle really exciting.
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Smatram ovaj princip
izuzetno uzbudljivim.
izuzetno uzbudljivim.
06:09
So the physicians get together,
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Doktori se okupe,
06:11
they agree on what quality is,
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dogovore se šta je kvalitetno,
06:13
they start measuring, they share the data,
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počnu da mere, razmenjuju podatke,
06:17
they find who's best, and they learn from it.
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otkriju ko je najbolji i uče iz toga.
06:21
Continuous improvement.
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Stalno poboljšanje.
06:23
Now, that's not the only exciting part.
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Međutim, to nije jedino zanimljivo.
06:26
That's exciting in itself.
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To je zanimljivo samo po sebi.
06:28
But if you bring back the cost side of the equation,
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Ali ako se vratimo
na deo jednačine s troškovima
na deo jednačine s troškovima
06:31
and look at that,
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i pogledate to,
06:32
it turns out, those who have focused on quality,
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ispostavlja se da su oni koji su se
fokusirali na kvalitet
fokusirali na kvalitet
06:35
they actually also have the lowest costs,
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zapravo imali i najniže troškove,
06:37
although that's not been the purpose
in the first place.
in the first place.
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iako to nije bila prvobitna svrha.
06:40
So if you look at the hip surgery story again,
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Ako ponovo pogledate
priču o operaciji kuka,
priču o operaciji kuka,
06:43
there was a study done a couple years ago
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urađeno je istraživanje
pre nekoliko godina
pre nekoliko godina
06:45
where they compared the U.S. and Sweden.
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gde su poređene SAD i Švedska.
06:49
They looked at how many patients have needed
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Videli su kom broju pacijenata
je bila potrebna
je bila potrebna
06:51
to be re-operated on seven years after the first surgery.
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ponovna operacija
nakon 7 godina od prve.
nakon 7 godina od prve.
06:55
In the United States, the number was three times
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U SAD broj je bio tri puta
06:58
higher than in Sweden.
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veći nego u Švedskoj.
07:01
So many unnecessary surgeries,
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To je mnogo nepotrebnih operacija
07:04
and so much unnecessary suffering
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i mnogo nepotrebne patnje
07:07
for all the patients who were operated on
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za sve pacijente
koji su bili operisani
koji su bili operisani
07:08
in that seven year period.
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u periodu od sedam godina.
07:11
Now, you can imagine how much savings
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Možete zamisliti
kolika bi to ušteda
kolika bi to ušteda
07:12
there would be for society.
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bila za društvo.
07:15
We did a study where we looked at OECD data.
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Napravili smo istraživanje sa podacima
organizacije za ekonomsku saradnju i razvoj.
organizacije za ekonomsku saradnju i razvoj.
07:18
OECD does, every so often,
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Ova organizacija veoma često
07:21
look at quality of care
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posmatra kvalitet nege
07:23
where they can find the data
across the member countries.
across the member countries.
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gde mogu naći podatke
o zemljama članicama.
o zemljama članicama.
07:28
The United States has, for many diseases,
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Za mnoge bolesti
SAD zapravo imaju
SAD zapravo imaju
07:30
actually a quality which is below the average
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kvalitet koji je ispod prosečnog
07:32
in OECD.
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u OEES.
07:34
Now, if the American healthcare system
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2154
Ukoliko bi se američki
sistem zdravstvene nege
sistem zdravstvene nege
07:36
would focus a lot more on measuring quality,
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fokusirao više na merenje kvaliteta,
07:38
and raise quality just to the level of average OECD,
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i podigao kvalitet
na nivo prosečnog u OEES,
na nivo prosečnog u OEES,
07:43
it would save the American people
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to bi američkom narodu uštedelo
07:45
500 billion U.S. dollars a year.
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500 milijardi dolara godišnje.
07:49
That's 20 percent of the budget,
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To je 20% budžeta,
07:52
of the healthcare budget of the country.
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budžeta za zdravstvenu negu zemlje.
07:55
Now you may say that these numbers
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Možda ćete reći da su ovi brojevi
07:57
are fantastic, and it's all logical,
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fantastični i to je sve logično
08:00
but is it possible?
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ali da li je moguće?
08:02
This would be a paradigm shift in healthcare,
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Ovo bi bila promena paradigme
u zdravstvenoj nezi,
u zdravstvenoj nezi,
08:05
and I would argue that not only can it be done,
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i ustanovio bih da to ne samo da
može da se uradi,
može da se uradi,
08:08
but it has to be done.
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već i mora da se uradi.
08:10
The agents of change are the doctors and nurses
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Agenti promene su
doktori i medicinske sestre
doktori i medicinske sestre
08:14
in the healthcare system.
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u sistemu zdravstvene nege.
08:16
In my practice as a consultant,
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U svojoj praksi kao konsultant,
08:19
I meet probably a hundred or more than a hundred
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srećem verovatno stotinu
ili više od stotine
ili više od stotine
08:21
doctors and nurses and other hospital
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doktora i medicinskih sestara
i ostalog bolničkog
i ostalog bolničkog
08:24
or healthcare staff every year.
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i zdravstvenog osoblja svake godine.
08:27
The one thing they have in common is
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Jedna stvar koja im je zajednička
08:29
they really care about what they achieve
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je da oni zaista paze
na to šta postižu
na to šta postižu
08:31
in terms of quality for their patients.
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u smislu kvaliteta za svoje pacijente.
08:34
Physicians are, like most of you in the audience,
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Doktori su, poput
mnogih vas u publici
mnogih vas u publici
08:36
very competitive.
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504991
2536
veoma takmičarski nastrojeni.
08:39
They were always best in class.
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1750
Uvek su bili najbolji u generaciji.
08:41
We were always best in class.
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Bili smo najbolji u grupi.
08:44
And if somebody can show them that the result
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Ako neko može
da im pokaže da rezultat
da im pokaže da rezultat
08:47
they perform for their patients
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1587
koji pokazuju za svoje pacijente
08:48
is no better than what others do,
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2854
nije bolji od onog
koji postižu drugi,
koji postižu drugi,
08:51
they will do whatever it takes to improve.
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519830
2707
uradiće bilo šta što je
potrebno za poboljšanje.
potrebno za poboljšanje.
08:54
But most of them don't know.
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2333
Ali većina njih ne zna.
08:56
But physicians have another characteristic.
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2415
Ali doktori imaju drugu karatkeristiku.
08:59
They actually thrive from peer recognition.
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Oni zapravo napreduju kroz
prepoznavanje uspeha od strane kolega.
prepoznavanje uspeha od strane kolega.
09:03
If a cardiologist calls another cardiologist
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531127
2234
Ako kardiolog zove drugog kardiologa
09:05
in a competing hospital
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u suparničkoj bolnici
09:07
and discusses why that other hospital
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2029
i razmatra zašto ta druga bolnica
09:09
has so much better results, they will share.
200
537238
2795
ima toliko bolje rezultate,
oni će to podeliti.
oni će to podeliti.
09:12
They will share the information on how to improve.
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3717
Deliće informacije o tome
kako se poboljšati.
kako se poboljšati.
09:15
So it is, by measuring and creating transparency,
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4120
Dakle, kroz merenje
i stvaranje transparentnosti
i stvaranje transparentnosti
09:19
you get a cycle of continuous improvement,
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2910
dobijate ciklus stalnog usavršavanja,
09:22
which is what this slide shows.
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što je ono što vam
ovaj slajd pokazuje.
ovaj slajd pokazuje.
09:25
Now, you may say this is a nice idea,
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Možete reći da je ovo dobra ideja,
09:28
but this isn't only an idea.
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1904
ali ovo nije samo ideja.
09:30
This is happening in reality.
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558499
2028
Ovo se dešava u stvarnosti.
09:32
We're creating a global community,
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3154
Stvaramo globalnu zajednicu,
09:35
and a large global community,
209
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1863
veliku globalnu zajednicu,
09:37
where we'll be able to measure and compare
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565544
2547
gde ćemo biti u mogućnosti
da merimo i poredimo
da merimo i poredimo
09:40
what we achieve.
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568091
1714
ono što smo postigli.
09:41
Together with two academic institutions,
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2627
Zajedno sa dve akademske institucije,
09:44
Michael Porter at Harvard Business School,
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572432
1994
Majkl Porter na
Harvardskoj poslovnoj školi,
Harvardskoj poslovnoj školi,
09:46
and the Karolinska Institute in Sweden,
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574426
1884
i institutu Karolinska iz Švedske
09:48
BCG has formed something we call ICHOM.
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3965
BGK je formirala nešto
što zovemo IKMZI.
što zovemo IKMZI.
09:52
You may think that's a sneeze,
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580275
2205
Možda ćete pomisliti
da je to kijavica,
da je to kijavica,
09:54
but it's not a sneeze, it's an acronym.
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582480
3127
ali nije, to je skraćenica.
09:57
It stands for the International Consortium
218
585607
2576
To je skraćenica
za Internacionalni konzorcijum
za Internacionalni konzorcijum
10:00
for Health Outcome Measurement.
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2960
za merenje zdravsvenih ishoda.
10:03
We're bringing together leading physicians
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Mi spajamo vodeće
doktore i pacijente
doktore i pacijente
10:05
and patients to discuss, disease by disease,
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3591
da zajedno diskutuju
jednu po jednu bolest
jednu po jednu bolest
10:09
what is really quality,
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2102
šta je zapravo kvalitetno,
10:11
what should we measure,
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599585
1987
šta bi trebalo da merimo
10:13
and to make those standards global.
224
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2488
i da ti standardi postanu globalni.
10:16
They've worked -- four working groups have worked
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2355
4 radne grupe je radilo
10:18
during the past year:
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606415
1968
tokom prošle godine:
10:20
cataracts, back pain,
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608383
2844
katarakte, bol u leđima,
10:23
coronary artery disease, which is,
for instance, heart attack,
for instance, heart attack,
228
611227
4226
bolest koronarnih arterija,
što je, na primer, srčani udar,
što je, na primer, srčani udar,
10:27
and prostate cancer.
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2181
i rak prostate.
10:29
The four groups will publish their data
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2404
Četiri grupe će objaviti svoje podatke
10:32
in November of this year.
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1842
u novembru ove godine.
10:33
That's the first time we'll be comparing
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2458
To je prvi put da ćemo porediti
10:36
apples to apples, not only within a country,
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2946
babe sa babama,
ne samo unutar zemlje,
ne samo unutar zemlje,
10:39
but between countries.
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3181
već između zemalja.
10:42
Next year, we're planning to do eight diseases,
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3978
Sledeće godine, planiramo da
uradimo 8 bolesti,
uradimo 8 bolesti,
10:46
the year after, 16.
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2554
a one tamo godine, 16.
10:48
In three years' time, we plan to have covered
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2456
U trogodišnjem periodu
planiramo da pokrijemo
planiramo da pokrijemo
10:51
40 percent of the disease burden.
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3113
40% opterećenja bolesti.
10:54
Compare apples to apples. Who's better?
239
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2650
Poređenje baba sa babama.
Ko je bolji?
Ko je bolji?
10:57
Why is that?
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3051
Zašto to?
11:00
Five months ago,
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648267
2865
Pre 5 meseci,
11:03
I led a workshop at the largest university hospital
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3034
vodio sam radionicu u najvećoj
univerzitetskoj bolnici
univerzitetskoj bolnici
11:06
in Northern Europe.
243
654166
1710
u severnoj Evropi.
11:07
They have a new CEO, and she has a vision:
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655876
3487
Imaju novog izvršnog direktora,
a ona ima viziju:
a ona ima viziju:
11:11
I want to manage my big institution much more
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659363
3606
želim da svoju veliku instituciju
više fokusiram
više fokusiram
11:14
on quality, outcomes that matter to patients.
246
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4105
na kvalitet, ishode
koji se tiču pacijenata.
koji se tiču pacijenata.
11:19
This particular day, we sat in a workshop
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3498
Tog posebnog dana,
sedeli smo na radionici,
sedeli smo na radionici,
11:22
together with physicians, nurses and other staff,
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2810
zajedno sa doktorima, medicinskim
sestrama i ostalim osobljem,
sestrama i ostalim osobljem,
11:25
discussing leukemia in children.
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4498
diskutujući o leukemiji kod dece.
11:29
The group discussed,
250
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1777
Grupa je diskutovala,
11:31
how do we measure quality today?
251
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2040
kako merimo kvalitet danas?
11:33
Can we measure it better than we do?
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2565
Možemo li da ga merimo bolje
nego što to sad radimo?
nego što to sad radimo?
11:36
We discussed, how do we treat these kids,
253
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2222
Razgovarali smo o tome kako
lečimo tu decu,
lečimo tu decu,
11:38
what are important improvements?
254
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2051
koja su bitna poboljšanja?
11:40
And we discussed what are
the costs for these patients,
the costs for these patients,
255
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2781
Diskutovali smo o tome šta su
troškovi tih pacijenata,
troškovi tih pacijenata,
11:43
can we do treatment more efficiently?
256
691316
2348
možemo li obavljati
tretman efikasnije?
tretman efikasnije?
11:45
There was an enormous energy in the room.
257
693664
1944
Bila je ogromna količina
energije u sobi.
energije u sobi.
11:47
There were so many ideas, so much enthusiasm.
258
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3489
Bilo je toliko ideja,
toliko entuzijazma.
toliko entuzijazma.
11:51
At the end of the meeting,
259
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2294
Na kraju sastanka,
11:53
the chairman of the department, he stood up.
260
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3309
predsedavajući odeljenja je ustao.
11:56
He looked over the group and he said --
261
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4577
Pogledao je grupu i rekao -
12:01
first he raised his hand, I forgot that --
262
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1785
prvo je podigao ruku,
zaboravio sam to -
zaboravio sam to -
12:03
he raised his hand, clenched his fist,
263
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2469
podigao je ruku, stegnuo pesnicu,
12:05
and then he said to the group, "Thank you.
264
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2897
a zatim je rekao grupi:
"Hvala vam."
"Hvala vam."
12:08
Thank you. Today, we're finally discussing
265
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2923
Hvala vam. Danas,
mi konačno diskutujemo
mi konačno diskutujemo
12:11
what this hospital does the right way."
266
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3574
o tome šta ova bolnica
radi na pravi način."
radi na pravi način."
12:14
By measuring value in healthcare,
267
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2087
Mereći vrednost zdravstvene nege,
12:17
that is not only costs
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2025
ne samo troškova
12:19
but outcomes that matter to patients,
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2473
već ishoda koji se tiču pacijenata,
12:21
we will make staff in hospitals
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1798
od osoblja u bolnicama
12:23
and elsewhere in the healthcare system
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1859
i svuda u sistemu zdravstvene nege
12:25
not a problem but an important part of the solution.
272
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4094
napravićemo ne problem,
nego važan deo rešenja.
nego važan deo rešenja.
12:29
I believe measuring value in healthcare
273
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1936
Verujem da će merenje vrednosti
u zdravstvenom sistemu
u zdravstvenom sistemu
12:31
will bring about a revolution,
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2771
doneti revoluciju,
12:33
and I'm convinced that the founder
275
741968
2109
i uveren sam da bi se osnivač
12:36
of modern medicine, the Greek Hippocrates,
276
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3463
moderne medicine, Grk Hipokrat
12:39
who always put the patient at the center,
277
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koji je uvek stavljao
pacijenta u centar,
pacijenta u centar,
12:42
he would smile in his grave.
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verujem da bi se osmehivao u grobu.
12:44
Thank you.
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Hvala vam.
12:47
(Applause)
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(Aplauz)
ABOUT THE SPEAKER
Stefan Larsson - Value-based health care advocateA doctor by training, Stefan Larsson of BCG researches how transparency of medical outcomes and costs could radically transform the healthcare industry.
Why you should listen
In the developed world, health care represents 9 to 18 percent of the GDP -- and these costs are rising faster than economic growth. Stefan Larsson -- a senior partner and managing director in BCG’s Stockholm office, the global leader of BCG’s Health Care Payers and Providers sector, and a BCG Fellow since 2010 -- believes that the answer isn’t just managing costs, but improving patient outcomes.
The idea at the center of this approach: registries of health outcomes. By coming up with criteria for measuring quality of care, sharing data on how procedures and parts are working, and learning from each other constantly, doctors and nurses can become agents of change, providing better care and lower costs at the same time.
Larsson is co-founder of the International Consortium of Health Outcomes Measurement, a not-for-profit organization for global standardization of outcomes measurement, which has Michael Porter, HBS and Karolinska Institute as partners.
Stefan Larsson | Speaker | TED.com